A CASE OF HYDROPHOBIA.
BY CHARLES D. HOMANS, M. D. 
 
A   CASE   OF   HYDROPHOBIA.
BY  CHAELES D. HOM.ANS,  M. D.        : v",
Bead before the Boston Society for Medical Observation, March 6, 1864.
    J. W. H., of Charlestown, a lad 15 years of age, rather small in stature,
 with light hair, eyes and complexion, of good general health, but of a some-
 what nervous temperament, was bitten, Jan. 27th, by a dog supposed to be
 mad, which was lying on the floor at the foot of the stairs  of the  house in
 which the lad resided.   As he stooped to caress the animal, he was bitten
 by him in the calf of the left leg and about the right ear; he was bitten first
 in the ear, and afterwards, raising his foot to kick the animal, received  the
 wound in the leg.   Immediately after this happened, the  lad hung down
 his head sullenly and slowly followed the dog, regardless of his mother's
 entreaties to return ;  this was totally unlike his  usual  habit.   Two other
 persons were bitten at the same time; one a lad of 9 years, the other an
 Irishman who afterwards killed the dog.   The wound of the man was
 slight and immediately cauterized, and neither of these persons have yet
 shown any signs of disease.   On being  spoken  to on Thursday  last, re-
 specting the death of the boy with  hydrophobia, the  Irishman appeared
 morose and sullen, but said  nothing.
   The  wounds of J. W. H.  were  bathed in laudanum and water, and
 healed  up kindly, or  at least scabbed over in forty-eight  hours,  without
 suppuration or  much pain.   Nothing was noticed in this  lad out of the
 common way, save that he always appeared more " elated " than was
 natural  to him, till Saturday evening,  Feb. 25, when, on conversing with
 a lady, he fell suddenly asleep, and  on awaking said  he could not help
 it.  On going to church  Sunday, Feb. 26, he  was noticed to shiver fre-
quently, and complained of feeling cold ; said  there  was a " catch in
his breath "  every few minutes.   This continued, mcreasing in severity,
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,   attended with loss of appetite, inability to swallow liquids without suffer-
   ing considerably, great restlessness and wakefulness.   His mother made
   him swallow about 3ij. of infusion of senna  on Sunday evening, which
   he  immediately vomited, together with the food he  had taken  in  the
   morning.   He passed a sleepless  night, and his sufferings  having in no
   way abated on Monday, his mother came to the city and requested me
   to visit him.
      Monday, Feb. 27, 1, P.M.—On entering room found patient lying in
   bed, with a rather hot, dry skin, tongue dry, slightly furred, papillae being
   very distinct; eyes widely open, with a fixed vacant expression ; coun-
   tenance  anxious, frightened;  pulse   80—100,  irregular,  intermitting;
   respiration very peculiar;  patient would  breathe quietly for three or four
   minutes, then would follow a  long, sighing, jerking inspiration, after
   which all  became natural again.   Touching his hand rather suddenly
   for the purpose of feeling his  pulse, caused  a shuddering of the whole
   body with spasmodic action  of the muscles  of the  neck, during which
   the sterno-mastoidei  appeared  very  prominent.  The same  effect was
   produced by speaking to him suddenly, by the  approach of any  one to
   the bed-side, or on his attempting  to  reply to any question.  Had swal-
   lowed nothing since Sunday evening, every  attempt to do so causing
   spasms.   A tumbler containing water was given to  him, with  the re-
   quest that  he would  drink from it; he took  it in his hand and endea-
   vored  to  bring it to  his mouth, but did not succeed.  Instead of  carry-
   ing the tumbler towards his mouth, his hand was  forced in  the  opposite
   direction, and his head jerked  backwards  notwithstanding  all his exer-
   tions,  which  were so great as to cause the perspiration to start from
   every part of his body, but especially from his head and  neck.   There
   were two cicatrices on  the  outside of left calf, about midway between
   knee and  ankle, marking the spots where the dog's teeth had entered ;
   each of these would, perhaps, cover the area  of a three-cent piece, were
   rather bluish in color, and covered with a furfuraceous scab.   On  pinch-
   ing these spots, patient made no complaint;   linear  cicatrices alone re-
   mained as the result of the wounds  about right  ear.  It being desirable
   that the lad  should  be ignorant  that any connection was supposed to
   exist between the bites made by the dog and  his present illness, none
   but indirect questions on this subject could be put to him.
       Patient was not  inclined to converse,  answering  questions  as much
    as  possible by  motions of the  head ; no appetite ;  great  thirst; com-
    plained of a continual sensation of chilliness  ;  no dejection  since Satur-
    day.  Ordered § ss. of castor oil in coffee, to  be taken in teaspoonful
    doses; mustard poultices to feet, 
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   5.}, P.M.—Visited patient with Dr. John  Homans ; Dr. W. B. Morris,
of Charlestown, was  also present, having  been called in during my ab-
sence, and from  this  time he followed the  case with me to its termina-
tion.  Pulse as  before.  Has had a  good  dejection from  the  oil,  after
having taken two teaspoonsful.   Skin moist, covered with an acid, offen-
sive perspiration.    Spasms occurred, without any particular exciting
cause, about once in ten minutes ; they  were of a shivering nature, and
lasted about one minute.   They were excited by  the  slightest  touch,
the sudden approach of a  person to  the bed-side, the  sight of a lamp,
or  by a current  of air, but not by the noise of liquid poured from one
vessel into another.   The approach of liquids  to his lips was especially
disagreeable to the  lad, causing a jerking backwards of the head  and  a
suffocative  feeling in  the throat.  No  increase of saliva.  During the
intervals of paroxysms,  respiration was tolerably easy, though always
hurried ; expression of countenance anxious, frightened ;  manner nervous,
agitated ; answered  questions correctly, and  was rather more inclined
to talk.   Ordered brandy, one part to two parts of water, a tablespoon-
ful to be given every half hour, and oftener  if possible.
   12, P.M.—Spasms were more frequent and distressing.  Patient was
able to take warm liquids 3J. at a time, but  with great suffering.   In
giving him anything to drink, it was  necessary to carry  the spoon slowly
towards his mouth, which always caused a  spasm as above stated.   Af-
ter a moment he was able to open his mouth  slightly, when the spoon
was quickly thrust  in by the attendant, and its contents  swallowed  with
a sudden  snapping  motion of the jaws ; this  was followed  by jerking
of the head backwards  and difficulty of respiration  for a minute  or so.
If the spoon was presented to  him suddenly, he said,  " Don't!  you
frighten me ! Oil dear ! 1  wish I wasn't so fidgety," he.  Brandy and
water had been  given  to him at short intervals, but the odor being disa-
greeable  to him,  whiskey  was  substituted.   The  paroxysms became
more frequent and violent, but the mental  faculties were almost preter-
naturally clear,  the lad frequently asking the nature of his complaint, the
cause of  the profuse  perspiration, &c, and  expressing  great willingness
to take anything which would " make him any better."
   Tuesday, Feb.  28.—At 12A, A.M., the inhalation of ether was  at-
tempted,  but the approach of the saturated  sponge causing frightful con-
vulsions,  it  was abandoned for  chloroform, which,  however,  we  were
obliged to lay aside  for the same reason.   He  violently  resisted  these
two remedies, would not suffer the sponge or  handkerchief to come near
his face,  and exacted a promise that the attempt should not be  made
a^ain.   Spitting of thin mucus commenced at  this time. 
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    At  1, A.M., thirty-five drops of  laudanum were  administered, and
  this was repeated  about once an hour till 7. A.M., the dose  being  in-
  creased to  sixty drops.   Cold  milk  was substituted for whiskey, at pa-
  tient's earnest request.  He slept about twenty minutes twice during the
• ni<dit, but waked both times with a  sensation of suffocation.   About 2,
  A.M., expressed a  belief that  he should die.   An hour later, after a short
  interval of quiet, his pulse became more feeble and rapid, varying from
  100—120; countenance collapsed  and very anxious.   He suddenly de-
  sired that all his family should be roused from their beds in order that
  he  might take leave of them.   His request having been complied  with,
  he  kissed them all, and bade  them  an affectionate farewell.   After  a
  short time, however, his pulse became stronger again, and the spasms re-
  turned with increased  violence.
    Several  times during the night he  became excited  and angry, but af-
  terwards apologized for any hasty expressions he might have used.   He
  complained constantly of heat and thirst;  once stripped himself entirely
  naked in consequence of this  feeling  of heat, and  remained so  for some
  time.  Was much  annoyed by perspiration constantly flowing  down his
  face and neck.   Made many  heroic efforts to wipe it off, every applica-
  tion of the napkin  causing terrible spasmodic action.   Restlessness and
  agitation continued, especially  when  attempts  were made to swallow
  liquids.   At 4.\, A.M., after  his second doze,  he complained still more
  of " agony," and expressed regret he had not  died  after taking leave
  of his family ;  said  he was perfectly  ready and anxious to die.   Once,
  only, during the, night did ho  show any incoherency in his language, and
  that only in one remark.   Once, also, about the same time, he  loudly
  and rather angrily ordered all persons to keep away from the  bed-side,
  as he feared he should have hydrophobia ;  a  moment afterwards he de-
  sired the attendants to return.    His sense  of hearing was so acute as to
  be annoyed by  a very slight singing noise made by the flame of a small
  spirit-lamp, of which only one wick was lighted, and standing at a distance
  from the bed on the mantel.  This noise he  referred  to his own throat,
  and  would not  believe it to be elsewhere till  the lamp was  removed
  from the  chamber.  Spitting of  thin  mucus continued, causing much
  distress to the patient.   1 left  him at 5J, A.M., more tranquil, and return-
  ing thanks  tome for remaining with  him  during  the  night;  indeed, he
  was very grateful for every attempt made to alleviate his sufferings.
   At 9,  A.M.. Dr. George Hay ward, Sen., visited the patient  with me.
  We found  him quite free from  spasm, save of a slight nature, and  con-
  versing freely with  his friends as to what he would do when he "Ot about 
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again.   He could take warm liquids  from a spoon with a little effort, the
spasms being much less severe than in night.   Every attempt to swallow
cold water, however, continued to be very distressing to the lad, though
not to  so great a degree  as yesterday.   He  was  able to take a tumbler
in his  hands, and after a few spasmodic  efforts  he could bring it  to his
lips  and  swallow a small  quantity of its contents. # Pulse 120;  skin
moist and warm ; tongue moist, without any coat.  Dr. Hayward  asked
him  what was  the matter with him : he replied,  " he thought it  was a
queer sort of disease, a ' nervous  fever,' he believed they called it."
   I did not see the patient again for two hours, but was told by Dr. Morris,
on my return at  11£ A. M.,  that a great  change for the worse had taken
place about half  an hour after Dr. Hayward's visit.  From  that time the
lad never had an interval  of rest till death released him.   His countenance
became more anxious; feeling of suffocation  increased; pulse more fre-
quent  and feeble.  Most of the time  he was sitting upon  the edge  of the
bed, with his chest exposed opposite an open window, anxious for air; was
agitated  by and  impatient  of any one crossing the  room between himself
and the window.  Spitting  of frothy viscid mucus constant.   Patient would
frequently order the window shut, half opened and re-opened widely, impa-
tiently requesting the person doing it to pass before him as rapidly as possi-
ble.   Intellect still remarkably clear.   Complained incessantly of his throat
and a  terrible feeling of distress about his chest,  which he was continually
beating with  his hands.   Talked much, rapidly and  loudly.  Said there
was something "rolled up like a cigar" sticking endwise  in his  throat,
which prevented  his breathing, and which he was continually endeavoring
to vomit  or spit  up.  Many times, after  spitting  almost incessantly for a
few minutes, he said "There! 1 have got it  up;" then  in a minute again,
 " No ! I have n't!"  Was furiously enraged at times by the sight of a crowd
of curious spectators m front of his window, in the street;  screamed loudly
at them  to be gone,  threatening to throw a bottle at their heads and  to
 wreak vengeance on the boys as soon as he should be well enough to  go
 out.   Would get up at times, move rapidly around  the room, and return to
bed, after a minute or two,  of his  own accord*   Peppermint tea was given
 in 3j. doses to allay thirst.   Vinegar was proposed  as an empirical remedy
 by some  of his friends, and was given once in the dose  of 5ij., distressing
 him exceedingly.   Mucus  expectorated  increased  continually in  quantity
 ami viscidity, the carpet near the bed being pretty well covered with it.
 Convulsive movements almost constant, and  restlessness much increased.
 Expressed  great agony at  the obstruction  in his throat; wished to vomit,
 and  to be beaten on the back while coughing to help dislodge it;  desired
 his  mother and other relatives to be kept out of the room in order that their
• There were no involuntary evacuations either of urne or faces. 
6
 feelings might be spared, and requested that they might be told that he was
 "only a little sick."
   At about a quarter before 2, P. M., patient being nearly pulseless, and
 his extremities  and countenance being quite livid,  Dr. John Homans and
 Dr.  Storer of Boston and Dr. Mason of Chariestown being present, together
 with Dr. Morris and  myself,  it was decided to use force and cause him to
 inhale chloroform fo» the purpose of relieving  his  agony, which had now
 become  excessive.   He was  accordingly enveloped in a blanket, after a se-
 vere struggle, and at 2£, P. M., he breathed his  last, while  under the influ-
 ence of this anaesthetic agent.

 .  The autopsy was  made on Wednesday, March 1st, at 10 o'clock, A. M.,
 20 hours after death.  Present—Drs.  Hodges,  C.Ellis,  Morris,  Mason,
 Braun and myself.
   External appearances.—Greenish discoloration and peculiar livid appear-
 ance of the  whole  surface of chest and  abdomen.    Lividity about lips
 strongly marked.  Posterior surface of body discolored by settling of bloodi
 Rigidity of limbs excessive.  Very offensive odor of commencing decompo-
 sition.  Cicatrices of bites on leg still  of a bluish color, with an induration
 around  them  like a  nodule in  the skin, and covered with a slight furfura-
 ceous scab.   Cicatrices about ear nearly disappeared.
   Cerebrum.—Membranes perfectly normal and  not congested.   Subarach-
 noid fluid, clear and  normal in quantity.   Pacchionian glands  not particu-
 larly marked.   Substance of brain natural in color and free from congestion,
 but  very soft throughout.   Distinction  between gray and white matter
 strongly marked.  Nothing remarkable about base of brain, medulla ob-
 longata, or origin of  cerebro-spinal nerves, save their general softness.
   Cerebellum generally quite soft, otherwise normal.
   Spinal Cord.—Fat deposited  on exterior  of dura mater of cord, more
 over some portions than over others.  5"j.—iv. of clear serous  fluid in the
 spinal  subarachnoid  space.   Consistence  firm and natural. Vessels  well
 filled in lower part of cord, empty above.
   Thorax.—Old pleuritic adhesions of lower  lobe of left lung.   Posterior
 portions of both lungs much congested.   Heart well contracted—left ven-
tricle empty; both auricles filled with soft  black coagula ; elsewhere, blood
 generally fluid.
   CEsophagus, larynx  and epiglottis  normal; no congestion.  Papilla? at
root  of  tongue well developed.  Salivary glands (submaxillary) of both
sides, normal,  ducts  pervious.  Stomach well contracted ;  internal surface
mamelonated in pyloric portion; mucous membrane firm and thick, covered
with a considerable amount of viscid mucus.
   Intestines—small,  empty; large, empty and contracted.   Liver firm and
healthy.   Pancreas  nothing abnormal.  Bladder contracted. Solar plexus
and thoracic ganglia  of sympathetic system presented nothing abnormal. 
7
  Remarks.—It  may be asked  why stimulants  were not given in greater
quantity, or why no other medicines than those mentioned above were ad-
ministered ?  The only answer  to such an interrogatory is, that everything
which was given to the unfortunate patient  caused such intense suffering
that it seemed absolutely cruel to persist in forcing him to swallow a quan-
tity of articles, in  favor of which  no argument could be brought forward
other than an empirical one.  A similar remark would apply to the admi-
nistration of chloroform or ether; the only time they were tried, they caus-
ed such terrible spasms that it was very easy to promise the lad they should
not be forced on him again.
  As usual in this disease, nothing was found at the autopsy to account for
the symptoms.   The only remarkable  appearances were  the rapidity with
which decomposition had commenced, and the general softness of the cere*
bral substance.
  It should have been stated before, that at  first the boy  had some fears of
hydrophobia; but after his wounds had healed, he had apparently thought
nothing more about it.
   I Chauncy Place,