140 



NATURE 



{Dec. 20, 1877 



of their real nature must be entertained. Here again 

 there are fallacies to be encountered of no insignificant 

 nature. The continued and terrible anxiety lest a bite 

 which has been inflicted should be followed by its terrible 

 consequences has led, in the case of persons of a 

 susceptible and unstable nervous system — as all other 

 long- continued worries and anxieties are liable to do— to 

 the development of hysteria and insanity and, in the 

 attacks of acute mania which have occurred in such indi- 

 viduals, many of the phenomena of hydrophobia have been 

 imitated. An admirably-narrated case of this " hydro- 

 phobic non rabique " of French writers was lately placed 

 on record by Mr. Hugh Norris, of South Petherton 

 (" Hydrophobia or its Eikon— which ?" — Lancet, Septem- 

 ber 22, 1877) : — "A gentleman underwent terrible anxiety 

 on account of his young son having been bitten by a dog 

 which suddenly had become ill and strange in its 

 behaviour. The danger which threatened the boy caused 

 the father to become intensely emotional, and prolonged 

 sleeplessness ensued. Other worries superadded them- 

 selves to this one great gnawing anxiety, and the poor 

 man fell ill ; at first there appeared symptoms which 

 simulated very closely the hydrophobic phenomena, but 

 these were succeeded by a genuine attack of acute mania, 

 which necessitated the^patient's removal to an asylum, 

 where he died on the seventh day of his illness." In 

 this case there was no evidence that the patient was 

 actually bitten by a dog, his statement that he had been 

 so injured having been made, in a peculiarly suspicious 

 manner, only after his illness had commenced, and being 

 apparently but one of the delusions' which afterwards 

 haunted him. Had this man been certainly bitten, and 

 had his illness been followed, as it might have been, by 

 recovery, his case would in all probability have been 

 quoted as one of the few instances of recovery from hydro- 

 phobia, though the impartial critic would have pointed 

 out some anomalies which rendered the conclusion 

 doubtful. The knowledge of the undoubted occurrence 

 of such cases necessarily imposes great caution in the 

 examination of alleged instances of recovery from hydro- 

 phobia. 



The drug to which attention has of late been directed 

 for the treatment of hydrophobia is curare or woorara, a 

 substance used by the natives of South America as an 

 arrow poison. This poison has been known since the end 

 of the sixteenth century, when Sir Walter Raleigh made 

 the conquest of Guinea ; but attention was drawn to it in 

 a special manner by the celebrated traveller, Waterton, 

 who first made experiments on animals with it, which 

 were continued by Sir Benjamin Brodie and Dr. Sibson, 

 and were succeeded by the now celebrated researches of 

 Claude Bernard, Kolliker, and other eminent physiologists. 

 Curare, the active principle of which is derived from 

 a strychniaceous plant, when directly introduced into the 

 blood or injected under the skin, produces paralysis of 

 all voluntary movements ; this paralysis depends upon 'ts 

 exerting a special action upon the terminations of motor 

 nerves in the muscles, especially in voluntary muscles. 

 The poison leaves intact the sensory nerves of the body, 

 and at least in the early stages of its action, the nerve- 

 centres. An animal subjected to its influence becomes 

 absolutely motionless, and dies rapidly of suffocation 

 from paralysis of the respiratory muscles ; if, however, 



respiration be kept up by artificial means, life may be 

 prolonged for long periods, and, the poison becoming 

 eliminated, recovery may ensue. As long, however, as 

 the stage of complete paralysis continues, the creature 

 is entirely unable to communicate with the external world. 

 There is no proof that external stimuli do not affect it ; 

 that it does not feel— but the channels by which the evi- 

 dence of sensibility reach us are for the time interrupted. 

 Curare has been suggested as a remedy for many diseases 

 of a spasmodic character, but a great obstacle to its use 

 is presented by the danger which attends its employment. 

 A dose which will be sufficient to arrest an abnormal 

 spasmodic contraction of a muscle or group of muscles, 

 will presumably cause a stoppage of respiratory move- 

 ments, and the medical man, if haply he be near the 

 patient, will find himself compelled to keep up artificial 

 respir?vtion — no easy task to accomplish, especially with 

 the means which the physician, as distinguished from the 

 physiologist, could employ. Hitherto the attempts to use 

 curare have been few, and the results (if we except the 

 two supposed cases of cure of hydrophobia) we think 

 worthless. Curare is indeed a drug the employment of 

 which must be attended with so great a risk that a very 

 strong case should be made out in its favour before 

 patients are exposed to it. 



Knowing as we do the physiological action of curare, 

 we may ask whether it is a drug at all likely to be ser- 

 viceable in spasmodic aff"ections generally, and specially 

 in hydrophobia. The majority of spasmodic diseases are 

 due to a central cause, or to a cause acting through a 

 preternaturally excitable centre. Any drug which will 

 cut off" — as curare does— the communication between the 

 nerve-centre and the muscle will prevent its spasm, and 

 will of course obviate any evil results which follow 

 directly from the spasm ; but, necessarily, under these 

 circumstances the abolition of the spasm is no index that 

 any change has been effected in the morbid state to which 

 it owed its existence. In hydrophobia there occur, it is true, 

 as prominent phenomena, spasms of the muscles concerned 

 in inspiration and in deglutition. The administration of 

 curare in doses sufficient to stop the respiratory move- 

 ments would doubtless prevent these spasms, though we 

 must not forget that it would do so at no mean risk. But 

 are these spasms the proximate or remote cause of death 

 in hydrophobia ? We believe not. They are spasms 

 which, as we tried to show, are probably dependent upon 

 a morbid state of the medulla oblongata, with which is 

 connected a morbidly heightened reflex excitability of 

 that portion of the nervous system. But there is no 

 evidence that curare would exert any influence in dimin- 

 ishing this abnormal excitability. 



From our knowledge of the physiological action of 

 curare we should not then be inclined to believe that it 

 could affect in a beneficial manner the progress of the 

 essential morbid processes of hydrophobia ; it could but 

 modify some of the painful phenomena which belong to 

 it. Actually curare has been tried in several cases, but 

 only twice has its administration said to have been 

 attended with success, and these two cases cannot be 

 accepted as having been certainly cases of hydrophobia. 

 We have seen one case of hydrophobia treated with 

 curare without any influence having been exercised by it. 

 There are drugs, however, which the physician is habitu- 



