TREATMENT OF HYDROPHOBIA. 
283 
CLINICAL NOTES. 
By Marshall Hall, M.D. F.R.S., &c. 
(Communicated by J. Russell Reynolds, M.D.) 
Hints for the Treatment of Hydrophobia. 
Many years ago I had the opportunity of watching the 
course of a case of hydrophobia. It occurred in a little boy; 
and I scarcely left the room during the eight and forty hours 
that he survived. But I need not detail the series of symp- 
toms which occurred, and which I have described elsewhere* 
on the present occasion. 
It has appeared to me that there are three modes of death 
in this disease: — 1. Sudden death from asphyxia. 2. Sudden 
death from secondary asphyxia. 3. Sudden death (for in all 
the cases I think the death is sudden and unexpected at the 
precise moment at which it occurs) from nervous exhaustion. 
Either of these modes of dissolution would be averted by 
the timely institution of tracheotomy. Indeed, if this mea- 
sure were adopted, the frightful seizures which occur from 
trying to take liquids would be obviated. These seizures 
consist in fearful attacks of laryngismus, and of convulsion 
of the neck and pharynx, but chiefly of laryngismus, with 
threatening of instant suffocation. These seizures would be 
disarmed of their force and terror by tracheotomy. 
Tracheotomy thus obviating the effects of laryngismus — 1. 
The sudden death from asphyxia, the immediate result of 
asphyxia, could not occur; and 2. The sudden death from 
secondary asphyxia, the more remote result of many attacks 
of laryngismus, could not occur ! 
There remains the sudden death from exhaustion. It is a 
question whether this would occur necessarily from the poison 
of hydrophobia. Why should it occur necessarily from this 
poison? No reason can be given for this; and we are not 
to be misled into a conclusion unsupported by facts, since, 
though all cases of hydrophobia have proved fatal, they have 
proved fatal by a mode by which they would not occur if 
tracheotomy were performed. 
Could any measures be adopted to check the violence of the 
spasm, — laryngismus and its effects being obviated, — such as 
the hydrocyanic acid, and so to prevent the subsequent ex- 
haustion ? Or could any remedies be adopted to remove this 
exhaustion more directly, as wine or cinchona ? 
These hints I throw out for the consideration of my pro- 
fessional brethren, in the hope of good. — Lancet , Feb. 12, 18 53. 
