Grove House, Little Chelsea,
Nov. 29, 1828.
On Thursday morning, the 25th ult. I was called up about seven
o'clock to see a man who I understood was exceedingly ill, and
waiting in the surgery very impatiently for my arrival. I found
my patient (Mr. Barham), a fine looking old man, about 60,
labouring at intervals of about five minutes under strong spasmodic
paroxysms, affecting the muscles concerned in breathing and
deglutition. There was a wildness and an impatience depicted in his
countenance, totally different from any thing I had ever observed
in other spasmodic affections. His bowels were open, tongue clean,
skin moist, pulse full and a little accelerated. I took away
twenty ounces of blood, and prescribed a mixture containing ʒss.
of laudanum for a dose every hour until I should see him again.
He walked home half a mile from my house (Gloucester Road, Old
Brompton), and left me ruminating on the possible cause of so much
mischief occurring suddenly in a fine healthy subject. At ten a
message was sent, saying that he was much worse, and requesting
me to call as soon as possible. He received me tranquilly, and
said he was very glad that I had come to see him, for he was very
ill. His symptoms were now more distressing than when I first saw
him: he looked wildly and suspiciously at every one entering his
apartment, and his breathing was accompanied by a short convulsive
sobbing. On looking at his medicine I perceived he had taken none,
and expressing my surprise, he assured me it was impossible for
him to swallow a single drop, as the attempt had been followed
by violent spasms, and produced so much distress, that he had
desisted. At this period no one had the slightest idea of the
origin of his malady. I poured out some medicine into a tea-cup,
the very act of which produced much excitement and alarm. My first
impression as to the true nature of his disease arose at this
period, from the circumstance of his requiring a tea-spoon, with
which he endeavoured to take some of the medicine. The attempt
produced much excitement and alarm, and after two or three painful
efforts at deglutition, with one desperate effort he swallowed a
tea-spoonful, threw away the spoon, and begged, unless I wished
to destroy him, that he might have nothing more to swallow. I
now left his room, and inquired of a bystander whether any thing
particular had occurred to him within the last few weeks. On
recollection she said, "About a month since, late at night, a
strange dog came into the premises and fought with his own dog; he
got out of bed to separate them, and the strange dog bit him in
two places, on the left arm and hand; and bit a puppy, which died
about a fortnight after in a strange way, which was thought to be
some kind of a fit." To ascertain if this occurrence had produced
any effect on his mind, while again bleeding him I said, "You have
been in the wars, Sir, and had your hand and arm torn; how did
it occur?"--"Oh!" said he, carelessly, "that was done by a dog a
long time ago, but it healed." The circumstance was never again
mentioned to him, and he died in total ignorance of the cause of
his malady. The wounds were perfectly cicatrised, and there was not
the least action going on indicative of recent absorption. He bore
the bleeding pretty quietly: 40℥. were removed, which on cooling
presented strong marks of inflammation.
Ordered ℳiv. Acid. Hydrocyan. omni horâ, in a little water.
Twelve o'clock.--With much difficulty he has taken two doses of the
acid; pulse full and hard, 110. 30℥. more blood were removed.
Three o'clock.--Has taken two more doses; complains of a dreadful
sense of suffocation, and implores that nothing more may be given
him. Pulse full, and beating at 120 to 130. Continue the acid.
Eight o'clock.--Pulse full and hard. Has taken in all 24ℳ. of the
acid, but so painfully distressing has the deglutition now become,
that all attempts at repeating his medicine are discontinued.