A CASE OF HYDROPHOBIA

WilliamH. Crowther
1878 The Lancet  
43 both sides is thickened. He suffers also from slight tendency to rupture on both sides. Ordered to rub mercurial oint ment into both groins every night. July 9th.-Thickening remains only in left epididymis pain but sligntly relieved. Ordered one ounce of quininE and iron mixture three times a day, and to continue using the ointment on the left side until the thickening dis appears. Sept. 15th.-No thickening remains, and pain almosi gone, but slight towards the end of the day. Both tester
more » ... ay. Both tester much drawn up, so much so that he believes the righi testicle will be drawn into the abdomen, and refuses to take a cold bath in consequence. Undoubtedly hypochondriacal, having broken his matrimonial engagement in the belief oi incompetence. No discharge from urethra or any nocturnal emissions. Oct. 24th.-Has pain now but seldom; no particular spot painful ; pain affects him suddenly, shooting up into the groin. Suspending the scrotum has no effect in relieving pain. Nov. 26th.-Pain has now disappeared, but he states that "the cup and ball position of the right testicle is distressing to him," and is certain that the testicles being drawn up taut into the neck of the canal-in fact, almost lost-is not the normal condition of matters." Still taking tonic remedies. Remarks.—This case is interesting when compared with cases of varicocele, the pendulous scrotum being due to a paralysis of the muscular dartos, the taut condition to a hyperæsthesia of the nerves supplying the same muscle. The reason why more anxiety was expressed about the right testicle was on account of its being situated higher, and had consequently the appearance of being the first to be pushed out of the scrotum. PINE-APPLES, peaches, apricots, and other fruits pre served in tins and imported from America, constitute at thE present time a considerable supply of food in this country. The advantage accruing from delicate fruits being obtain. able at all seasons of the year at a moderate price needs nc comment. I feel it my duty, however, to direct attention to the fact that the benefit anticipated is of a doubtfu] character, since the juices of the fruit are, under certain conditions, able to dissolve portions of the tin from the tinplate in sufficient quantities to cause sickness. The following facts are of sufficient importance, both to the medical profession and to the general public, to warrant their being made known. Having lately had occasion to examine some liquid vomited during sudden sickness, with the view of detecting a poison of an unknown nature, either organic or metallic, I submitted it to a very complete chemical analysis. -The absence of any poisonous alkaloid was proved by the process of Stas. Arsenic, antimony, and mercury, were proved to be absent as well by Reinsch's process as by subsequent operations. A small quantity of a brown metallic sulphide was obtained, soluble in sulphide of ammonium, and reprecipitable from this solution by acids. The actual amount of precipitate was inconsiderable, only sufficient in fact to cover a very small filter. It was impossible to attempt any quantitative estimation of this substance, but it was decided to put its identity beyond doubt. This was done by reducing the sulphide to the metallic state by means of the blow-pipe. The minute globules of metal, which could not have weighed more than a few thousandths of a grain, possessed the colour, hardness, malleability, and other properties of metallic tin. The minute quantity found was that only which had escaped absorption by the system, and in all probability much less than the whole amount taken. Having no further information concerning the case, I cannot say decidedly what was the source of this metal, but I was previously aware that it is occasionally present in the juice of fruit preserved in tins-as, for instance, peaches. My friend, Dr. C. R. A. Wright, Lecturer on Chemistry at St. Mary's Hospital, informed me that he had detected it in the remains of a can of fruit to the eating of which in a tart an attack of sickness was attributed. One of the students in the chemical laboratory of King's College-Mr. A. E. Menke-has lately been estimating, under my direction, the amount of metal present in two or three samples of tinned provisions. In the syrup from a tin of pine-apple, of about a pint in capacity, there was found agrain of tin (015 grm.) In a large tin of apples, a little less than 4-100ths of a grain, and in the liquor from a tin of lobster mere traces, of the metal were found. (See Chemical Ncws, July 6th.) No information of importance concerning tin-poisoninghas been recorded ; hence it is difficult to say what quantity of the substance may be looked upon as dangerous. It will be advisable in future to throw away the syrup contained in fruit-tins, and indeed the whole contents of every such vessel the surface of which is at all corroded. Regarding the cause of the occasional solution of the tin, a careful examination has shown that at the point where the drop of solder seals the aperture made for the escape of steam during the preserving process a galvanic action is set up between the lead of the solder and the tin of the tinplate. A possible remedy exists in sealing the can with a drop of pure tin. ASSISTANT MEDICAL OFFICER TO THE GENERAL DISPENSARY, ACTON. EARLY on Saturday morning, June 29th, 1878, I was called to G. K-, aged fourteen, the brother-in-law of a publican of this place. I found him suffering from frequent convulsive movements, during which he sat up in bed and clasped the arms of the person nearest him. He complained of want of air, pain in the throat, in the right shoulder, and in the præcordial region, and of palpitation of the heart. His pupils were dilated, pulse rapid and irregular. I ordered him a mixture containing the bromide of potassium and tincture of valerian. At 6 P.M. I saw him again. He had taken, I was told, two doses of the mixture, but nothing else, as the difficulty of swallowing was so great. I noticed that the convulsions seemed now rather more frequent and violent, and that breathing upon him immediately induced them, also that what his relatives said about his difficulty of swallowing was true. When I offered him a strawberry he entreated me to wait a little, and said he felt that if he could only swallow one he could eat a hundred. Neither the bowels nor the bladder had been evacuated since yesterday (the 28th). Both at this and at my former visit he answered questions quite intelligently, but appeared to have some difficulty in speaking. '* I ordered him a gruel enema. My next visit was at midnight. I found he had passed about two ounces of urine, and was informed that he had been somewhat quieter, and had sucked a couple of pieces of ice. But whilst I was with him the convulsions were very strong. He was somewhat incoherent in his speech, retched occasionally, and spat frequently; he was also in a very desponding state of mind. Pulse 130. I made him inhale some chloroform, but he was so violent that it took two men to hold him down before I could manage it. Ordered ice to the spine, and fifteen grains of chloral by the rectum. His history was as follows :-He had always been a fairly healthy lad, but had complained of feeling somewhat poorly for about a week. However, on the 27th of June, he took charge of the beershop during the landlord's absence, but in the evening he felt so unwell that he was sent to bed. On the morning of the 28th he had a dose of castor oil given him, but it was noticed that at first he expressed his inability to swallow it, and asked the attendant to let him wait a little. Shortly afterwards a cup of tea was brought him, but he was unable to take it, and expressed dislike at seeing it, and as soon as he was left alone he got out of bed and put it out of sight. He had never shown any fear of hydrophobia, and he denied that he had ever been bitten by a dog. There were two dogs in the house, one of which was said to have been "queer" " at times, but nothing more, and to have
doi:10.1016/s0140-6736(02)42864-4 fatcat:nllxxc72prbuzg6d543mfusqj4