W. Simpson
1831 The Lancet  
years of age, tall and I muscular, complained on the evening of the 28th of August of pain in the neck and right shoulder. He with much reluctance went to work early in the morning of Monday, but was unable to do any-thing, and came home in the afternoon, when the pain had extended into the right axilla. He procured some volatile embrocation with which the parts were well rubbed. He was much distressed with pain and restlessness during the night, and on Tuesday morning the pain had extended
more » ... in had extended down the arm, and across the chest ; he endeavoured to drink some porter but was unable ; tried to take it from a teapot but without effect. About noon he was seen by Mr. Graham, an intelligent practitioner of Turnham Green, who, not having been informed of his inability to swallow liquids, very naturally attributed the symptoms to rheumatism, and ordered some calomel and colocynth and a black draught. He wasunable totake the draught; the pills operated freely ; during the afternoon and evening symptoms of great perturbation of mind manifested themselves, and in the night lie became very outrageous, ahd required three or four men to restrain his violence. About noon on the Wednesday I saw him ; he approached me with clenched fists in a menacing attitude, accompanied with an hysterical laugh, and a kind of howling noise, and great contortions of the countenance. I naturally stepped back a little, when he composed himself, sat down, and told me I had no occasion to be frightened. I felt his pulse, which was but slightly quickened ; he had no fever, and answered my questions rationally. In about a minute he got up and rushed furiously across the room, then threw himself across the table like a person labouring under a violent fit of the colic. He said he had no pain during the paroxysms, only a slight pressure at the lower part of the abdomen, and a sensation like a ball rising in the throat, and of suffocation. I began to suspect hydrophobia, and ordered some water to be given him ; before it approached his mouth he ran back and had a violent fit; porter was tried but with the same effect ; and he said, raising his clenched fist, if auy more were offered him he would knock them down. On asking him to what cause he attributed his complaint, he said he was bewitched, or labouring under an evil tongue." He denied having been bitten by a dog. About four in the afternoon he began to vomit dark matter like coffee-grounds, after which he could drink peppermint-water and other liquids, but which did not remain on an instant. He became calmer, but vomiting continued till within half an hour of his death, which happened about twelve o'clock at night. Upon inquiry 1 found that he had been bitten by a puppy about three months before, but in so slight a manner as not to attract notice at the time. This puppy had also been bitten by another dog, and was killed soon after accidentally. A post-mortem examination was not allowed. So far as my observations go, I should say that this disease approaches nearer to hysteria in its symptoms than any other complaint. The patient did not appear to suffer uear so much as in those cases of tetanus I have witnessed. All speculations on the cause or pathological condition on which hydrophobia or tetanus depends are idle. The primary symptoms are evidently to be traced to the nervous system, the minute anatomy of which remains for the preseut in obscurity.
doi:10.1016/s0140-6736(02)93271-x fatcat:muousr3aofey5ps4if7iykgmea