The Case of a Person Bit by a Mad Dog: Communicated to the President by Mr. Ranby, F. R. S. Serjeant-Surgeon to His Majesty: From Charles Peters, M. D. F. Coll. Med. Lond.

Hence great Advantages will arise from this Way of Distillation: For, 1. We can keep a greater Fire, if Occasion be, without Fear of breaking our Glasses. 2. The Matter distill'd may be removed as often as we please; whereby we may always prevent the Drawing off any Spirit, &c. too low. And, 3. Any pure, fine, volatile Salt, which shall arise into the second Recipient, will not be so liable to be melted down, either by the Heat, or too watery a Fluid. IV. The Case of a Person bit by a Mad Dog: Communicated to the President by Mr. Ranby, F. R. S. Serjeant-Surgeon to His Majesty: From Charles Peters, M. D. F. Coll. Med. Lond. Read Jan. 24. JOHN Neale, of a robust Constitution, aged Forty-five, had, for some Years, followed the Occupation of curing Dogs: And, on Thursday preceding Michaelmas Day 1741, being employed in that Calling, he, endeavouring to drench one supposed to be mad, was bit in the Thumb. The Day following the Dog was observed to droop, refuse his Food, and at Night he died. The Patient, having been frequently conversant with the like Accidents, was sufficiently alarmed at the Danger; and, having been, the Year before, received a Patient into St. George's Hospital, repaired thither for Relief. Doctor Hoadly attending, in the Room of Doctor Bailey, the Physician of the Week, directed him to have the Wound scarified, be blooded, use the Pulvis antilyssus, and Cold Bath. About a Fortnight after the Accident, being the Full of the Moon, his Symptoms became so violent, that I was desired to meet my Brethren in Consultation. I found him sitting on a Bed, with one of his Legs tied to the Post; and, upon inquiring how he came placed in that Posture, he told me, He himself fastened the Cord, apprehending he might grow mischievous: And, upon our proposing to him to put on the strapp'd Waistcoat, he readily consented to it; expressing great Dread of becoming hurtful. He told us, He had felt a Numbness in the wounded Thumb, which shot up his Arm to the Shoulder; and that he was not sensible of having taken a Moment's Rest since the Accident had happened; and that, upon endeavouring to compose himself, he fell into Startings, and dreadful Apprehensions of Mischief from Dogs. His Eyes look'd wild, and he complained of an excruciating Pain in the Head. For some Days past he had been troubled with a Difficulty in Swallowing: I proposed to him to get down a small Piece of Bread; but he seemed to refuse it with great Abhorrence: However, being encouraged to make use of his Resolution (which he possessed to an extraordinary Degree), he forced it into his Mouth; where holding it for some Minutes, he endeavoured to swallow, but was seized with violent Spasms, beginning at the Bottom of the Abdomen; which, by a convulsive Progression, heav'd itself into the Thorax; from whence the Spasms were extended to the Pomum Adami; Adami; when the Patient fell into Strangulation, and afterwards Privation of Sense. Upon recovering from the Fit, as we perceived, that, notwithstanding these Obstacles, he had swallowed the Bread, allowing him Time to rest, we proposed to him to endeavour to swallow a Spoonful of Liquid, which he seemed most shock'd at: He answered with Fierceness, That he could not away with Drink: However, upon Recollection, he said, He would endeavour it: And, taking a Spoonful of Ale-house Drink into his Mouth, he was instantly seized with Convulsions, beginning from the Bottom of the Abdomen, and ascending with great Violence to the Head, till he fell into a Fit of longer Duration than the former: However, he swallowed the Liquor; and, upon his recovering his Senses, he pointed with great Vehemence to his Arm, signifying, that he desired to be blooded; from which, he afterwards told us, he had before found Relief. As his Pulse was extremely hard, we directed the Surgeon to take away 16 Ounces, which proved ad Deliquium: However, that soon passing off, his Pulse still continued hard, his Flesh hot, with grievous Complaints of the Pain in his Head. Upon considering his Case, as he had received no Relief from the ordinary Treatment of this Distemper, and that his Symptoms were now become highly inflammatory (Blood sity, and flammecous Urine); we resolved to lay aside all Thought of Infection, and to betake ourselves to the Method of Cure in inflammatory Fevers; with this Difference only, That, as he had pass'd some Days without Stools, he was directed to take an Enema, immediately: and then the following Bolus; Nitri purif. 3 fl, Confect. Mithridat. 3 i, sexta quaque Hora, addendo Dosi vesperin. Extr. Thebaic. gr j. & repetatur tertia quaque Hora (nisi interveniant Symptomata), donec concilietur Somnus: Epispastica applicentur Brach. & Crurib. intern. Upon visiting him in the Morning, the Nurse informed me, That, after having taken two Bolus's, he had slept about half an Hour, to his infinite Refreshment. His Blisters discharged plentifully; his Mind more composed; and his Horrors were so far mitigated, to swallow half a Pint of Ale at one Draught, tho' not without Repugnance. He still complained of living in a Flame; his Eyes ready to start out of his Head, where his Pain still remained acute; not without Numbness in the diseased Arm; Inquietude; Difficulty in Swallowing and Respiration. Mittatur Sang. e Br. ad 3 xii. & pergam in Usu Praescriptorum. The Night following he took two Bolus's, and slept near three Hours. The Symptoms appeared less violent the next Day, but still threatened Mischief. Applicentur Cucurbit. Occipit. ad extract. Sang. 3 viii. Epispastic. Laterib. Colli, &c. His Body was kept soluble with Manna, and other cooling Laxatives. This Method, with little Variation (such as Leeches, Pulv. sternutatorius, &c.), was continued for the Space of about fourteen Days, the Blisters being kept open during the whole Time; during which the Symptoms gradually abated. He fell into Languors, which were easily removed by the Use of Assa fetida, Valerian, &c. As he was now free from any Disorders in his Head, and his Pulse beat with a natural Softness, I advised him to return to the Use of the Cold Bath, Pulv. Antilyssus; with a Caution to bleed, and discontinue the Use of them, whenever he found himself heated. He is now restored to a tolerable State of Health (except at the New and Full Moon): For, tho' he feels some Alteration in the Quarters, they are not so considerable; at which time his Symptoms return in some Degree; but so slightly, as not to prevent him from following his Calling, which he has changed to Sciling of Greens; not being entirely freed from the Dread of Dogs. I had forgot to mention, That, during his Illness, he voided so great a Quantity of Saliva, that his Teeth, tho' naturally firm, became loose, and continued so, till the Abatement of the Complaint. As copious Bleeding is generally prescribed for the Cure of this Distemper, I shall make no other Remark upon that Advice, than by observing, That frequent Recourse was had to it, to the apparent Relief of the Patient; who thought himself likewise much benefited by the Nitre and Mithridate. As the Difficulty of Swallowing, in the present Disorder, was evidently spasmodic, and infinitely abated by Rest, tho' for half an Hour only, I submit to your better Judgment, how far Opiates may be conducive to the Cure in this Distemper; not only by giving them internally, but likewise by externally rubbing in such a Quantity, as may seem reasonably calculated for the Removal of spasmodic Tensions. During During this Illness, he complained of Coldness in the Extremities, with sour Eructations; so that, as soon as it was judged safe, he was directed to make use of a Vomit; which was repeated many times with Success. I observed, when any Liquid was offered him, he pour'd it into his Mouth with uncommon Hastiness: And, upon inquiring his Reason for doing so, he told me, He had experienced, that, by throwing in a large Quantity of Liquid into his Mouth at once, his Faculty of Swallowing became more easy: And that, whenever any Hindrance happened in the Performance, it was not without Difficulty that he recovered himself. I desire I may no way be thought to depreciate the Efficacy of the Pulv. Antilyffus* and Cold-Bath; for I believe them more generally successful than any other Means: Yet I think it clear in the above Case, that they were so far from alleviating the Complaints, that they tended evidently to promote them; the Patient never making use of the Cold Bath, but his Head-ach increased †, and his feverish Complaints grew more violent. As the contra Rabiem Powder now stands in our Pharmacopœia, it is compounded of two Drugs only. I have endeavoured to discover what Effect might be procured by the Liverwort; but, upon trying it, for Experiment's sake, in several different Cases, even in large Doses, I could never perceive the least Alteration either in the Pulse, or Secretions. --- * Of Dampier, as alter'd by Dr. Mead. † Therefore, in my Thef. Inaug. Lugd. B. 1724. I proposed the Use of warm Baths; for by them Heat and Thirst will be abated, and the Blood diluted, not render'd still more thick by Sweating, as is the Effect of Cold Baths. [See these Trans. No. 443, p. 319, and p. 360.]