Surgery : its theory and practice / by William Johnson Walsham.

  • William Walsham
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Surgery : its theory and practice / by William Johnson Walsham. Source: Wellcome Collection.

    168/864 page 152
    average perind of incubation varies from six week.s to three months. Although it is said that the incubation IjeriocI has been as short as two clays, and as long as twenty years, two weeks to two years maj' jiractically be given as its limits. There are no sjnnptoms dmiug this period. The vesicles or lyssce said to occur under the tongue fi'om the third to the ninth day after the bite do not appear to be a constant phenomenon. Fat ho] Of/1/.— The principal post-vwriem changes have been founcl in the medulla, especially about the region of the glosso-pharyngeal, pneumo-gastnc and hypo-glossal nuclei, and in the cerebral cortex. They consist in the infiltration of the perivascular .sheaths with leucocytes, thrombosis of the medium-sized vessels with small ha?mor- rhages, and degeneration of the nerve cells. The theory now generally held with regard to the pathology of the disease is that the poison after remaining for a variable time dormant in the woimd, multiplies or matiu-es ; and then that either it or its products slowly enter the blood and set up a specific inflammation in the medulla and cerebral cortex, whereby their power of resistance to reflex irritation is diminished or lost. Hence the occtu-- rence of the spasm on the .sliglitest provocation. Finally, t'jat should the patient not succumb to spasm of the glottis or muscles of respiration, the affected nerve-cen- tres become exhausted and no longer respond at all to the reflexes necessary to carry on life, and the heart's action in consequence coasos. The nature of the poison is not known, though the belief is gaining ground that the disease depends in some way upon a micro-organism, since rod-like bodies have been discovered in connection with the hccmorrhagic lesion in the cerebral cortex, and a micro-organism has been is(datod by inoculating fowls -ndth the virus taken from rabid animals. Si/mptoms.—Tingling or itcliing. and .sometimes iiillam- mation or vesication about the site of the wound, whicli has generally long since cicatrized, enlargement of the neighbourinir lymphatic glands, and nervous irritability, ai-o described a.s premonitory symptoms, but do not ap])car to occur in all cases. The disease is usually, though not invariably, ushered in by a feeling of mental dejiression and melancholia, anxiety and often gastric distiu-bancc. Sometimes a slight (lidiculty in swallowing and a peculiar click in rcs]iirati(in due to spasm of the iliajihragm is noticed. After Uvo or three to four or five days the
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