CHRONIC INFECTIOUS DISEASES. 



with the hot iron, or with a deliquescent caustic, such as caustic potash, 

 butter of antimony, and the like. It is also advisable not to permit 

 the sore, resulting from detachment of the eschar thus made, to heal 

 too rapidly, but, if practicable, to keep it suppurating for months. 

 These measures are all the more likely to be successful, the earlier 

 they are applied, but they should never be neglected, even though 

 weeks have elapsed since the infliction of the bite. 



As a further precautionary treatment, the exhibition of mercury to 

 the point of salivation, large doses of belladonna, and a series of other 

 so-called antilyssa, are employed ; but it is very questionable whether 

 the disease has ever been averted by the use of any of these articles, 

 and whether the cases in which hydrophobia has not followed upon the 

 bite after the use of anagallis arvensis, gentiana cruciata, rosa canina, 

 genista luteo-tinctoria, cantharides, or may-worm, did not belong to the 

 seventy-seven per cent, of subjects in whom the predisposition to rabies 

 did not exist, and without which hydrophobia never occurs. Inasmuch 

 as, after the establishment of the disease, these measures do not pro- 

 duce even the slightest palliative effect, their prophylactic virtue is 

 more than doubtful ; hence, I by no means regard it necessary to 

 subject a man, who has been bitten by a mad dog, to the baneful in- 

 fluence of mercury, although I should not hesitate to resort to any 

 procedure, be it never so severe or dangerous to the life of the 

 patient, if, according to actual experience, any benefit were to be 

 expected from it. 



If the disease has broken out, there is little hope of curing it, or 

 even of alleviating the sufferings of the patient, for hitherto there 

 has been no accurately observed case of lyssa having any other termi- 

 nation than a painful death. Even the waiting and nursing are very 

 difficult, and should only be trusted to persons who are humane as well 

 as fearless and energetic. Every thing that can induce return of the 

 spasms, and, later, of the paroxysms of madness, should be carefully 

 avoided. To relieve the thirst, small enemata of cold water may be 

 given from time to time. In the case I saw, these were well borne 

 and quickly absorbed. In recent cases, where the patient is young 

 and vigorous, we may bleed, as in some cases this has proved of 

 undoubted benefit. If the patient will bear it, we may also let him 

 inhale chloroform from time to time, and give subcutaneous injections 

 of a strong solution of morphine. The favorable results said to have 

 been attained in some cases of tetanus, by the use of curare, decided 

 me to try it in a case of lyssa under my care. At first -j^th, later 

 ^th of a grain of carefully- tested curare was subcutaueously injected 

 at intervals of three to four hours. Distrustful as we were about the 

 result, this treatment still seemed of palliative benefit, and seemed 



