116 
A CASE OF HYBROPHOBfA. 
fluenced by the view of the pathology of the disease which he 
had now given, namely, that the seat of local irritation was the 
spinal system, but mainly the medulla oblongata. He was, there- 
fore, anxious to keep the patient as quiet as possible, and as free 
from all external excitement as was consistent with due attend- 
ance on him. He soon found, however, that this part of his 
plan was impracticable, as it was impossible to deny access to 
the great number of students who were actuated by a laudable 
curiosity to see the case. 
As a medicine admitting of a ready absorption, and capable 
of acting as a sedative on the spinal system, it was determined 
to try hydrocyanic acid. This drug will act as well if applied to 
a mucous surface, the lip, the tongue, or the conjunctiva, as when 
introduced into the stomach ; and its influence seems to be 
mainly on the cerebro-spinal system. It was applied on a brush 
to the lip or tongue, and thus the act of swallowing was rendered 
unnecessary. The doses ordered were larger than those actually 
given, for, in consequence of the constant retching and foaming 
at the mouth, it was necessary to allow for considerable loss. 
A fair trial had now been given to this plan, but without any 
success ; indeed, we were not without fear that the acid in large 
doses might contribute to increase the spasmodic condition. 
Knowing the powerful sedative influence of cold, he gladly 
availed himself of a suggestion of his colleague, Dr. Guy, to try 
its local application. Some ox-gullets were procured, and filled 
with pounded ice and salt, and two were applied along the whole 
course of the spine, and one in the shape of a collar round the 
neck. To their great surprise, the boy also greedily devoured 
solid ice in great quantity. A marked effect speedily followed 
this treatment. The spasms of the throat, the frothing at the 
mouth, the rattle in the chest, and the difficult deglutition, all 
gave way. At the same time, however, the heart’s action was 
very much depressed, both in force and in the number of beats; 
so that it was found necessary to remove the ice in the course of 
a quarter of an hour. After seme time, when the spasms began 
to return, the ice was again applied with the same effects. It was 
evident that the ice had a most powerfully sedative influence, 
and therefore it was found necessary to use stimulants freely ; 
and Dr. Todd expressed his belief that cold applied along the 
spine was a remedy of great power, and deserving of a full and 
fair trial. He regretted that it had not been used at the com- 
mencement, instead of losing time with hydrocyanic acid ; and 
he stated his determination, should another case occur, of em- 
ploying it, carefully watching the patient, and administering 
stimulants to counteract the too- depressing influence of the cold. 
