CONTRIBUTIONS TO PATHOLOGY

C FAVELL
1839 The Lancet  
ABOUT two years ago the following two cases of hydrophobia occurred in the practice of my friend Mr. Gregory, surgeon, of this town, by whose kindness and courtesy I had the'privilege of witnessing the symptoms during life, as well as the morbid appearances after death. It is not my intention to occupy the pages of this J ournal with an acconnt of the symptoms which were observed during the progress of these cases, but rather to confine myself to the enumeration of the post-mortem appearances.
more » ... ortem appearances. I only remark that the symptoms were the same in each case; they did not differ from those which are commonly enumerated as characteristic of the disease—those which it had previously been my painful duty to witness, CASE 1. -Wilkinson, a fine, stout man, in robust health, 37 years of age, a grinder by trade, and addicted to habits of internperance, was seized with symptoms of hydrophobia soon after getting out of bed on the morning of the 13th of April, 1837. He had been bitten by his own dog (which, at the time, was not supposed to be rabid), eight weeks previously. He died on the 15th, at 11, A.M.,and on the 17th,at 10, A.M., the body was minutely examined by Mr. Gregory, in the presence of several medical ' , friends. A female attendant stated that nine hours after death the upper-part of the body was so warm as almost to induce her to believe that the niau was not dead ; the lower extremities were, at the same time, quite cold. As the woman had not a thermometer, she judged of the relative temperature by her hand. External appearance.—The body well developed ; face pale; considerable lividity about the lips, anterior part of the neck, clavicles, and posterior parts of the body. Head.-Scalp and calvarium natural; dura mafer slightly congested ; eflusion of bright florid blood upon the arachnoid membrane, where it covers the posterior portion of the left hemisphere; beneath the arachnoid considerable effusion of colourless fluid, the membrane itself slightly opaque; the vessels of the brain much engorged, particularly at the posterior part ; the substance of the cerebrum darker than natural in colour, and exhibited numerous bloody points when incised ; no abnormal quantity of fluid in the ventricles; the pons varolii was of a darker colour than natural, and the substance of the cerebellum was considerablv softer than the cerebrum. When the body was turned over in order that the spinal chord might be examined, the head being sullered to hang down. a large quantity of very dark-coloured fluid blood escaped. The Spinal Canal was opened as far as the fifth dorsal vertehra. The external covering of the chord was injocted with blood, more especially in the cervical poi-tion ; on slitting open the dura mater the pia mater was found extremely injected, and, for a short space, commencing at the third dorsal vertebra, infiltrated with air; the grey substance of the chord was of a darker colour than natural, and the bloodvessels accompanying the nerves were much congested ; when the chord was removed the membrane beneath it was found to be extremely congested, especially in the cervical portion. Thorax.—The muscles on the anterior part of the body well developed, and of a dark-red colour; the vessels of the lungs much congested with dark-coloured blood; in the superior lobe of each lung there wae a deposition of tubercular matter ; the brouchial tubes strongly injected ; the heart natural in size, covered anteriorly with fat ; the right ventricle contained a considerable quantity of dark-coloured blood, mixed with air; in the left ventricle there was a deposition of fibrine. The Pharnyx was livid, and the small vessels were considerably injected; the oesophagus natural; no morbid appearance in the glottis, epiglottis, or larynx. Abdomen.—The right kidney was small, lohulated, and strongly injected; the left kidney larger than the right, but not nearly so much congested ; incipient degeneration of the liver; spleen nature!; stomach aud intestines hen) thy. CASE 2. -Ibbotson, aetat 32, a grinder, of intemperate habits, a friend and companion of the subject of the foregoing case, was bitten by the same dog, and on the same morning, as Wilkinson. At the time of the bite he was in good health. For a few days before the 1-lth of April he complained of being uowel), pain in the head, vertigo and listlessness. On the 14th, having heard that his friend had been taken ill the day before, he went to see him. When he arrived at home again he expressed himself as feeling very poorly, and then, fur the first time, experienced considerable difficulty of deglutition. Symptoms of hydrophobia soon became evident, they rapidly increased, and he died on the morning of the 16th. No unnatural heat was observed in the body a few hours after death. The post-mortem examination took place on the morning of
doi:10.1016/s0140-6736(02)99919-8 fatcat:u5xg5qhptzdqpcuwpa76jcgk3y