HYDROPHOBIA AND RABIES. 



221 



culiar feeling?, preceded the manifestation of the 

 hydrophobic condition in three of the four cases 

 seen by myself ; in the fourth case no inquiries 

 appear to have been made on that point. In 

 another instance which Mr. Herbert Mayo wit- 

 nessed and examined after death, he found the 

 inner part of the cicatrix blood-shotten, and a 

 gland in the armpit had swelled at the coming 

 on of hydrophobic symptoms ; and I find among 

 my notes of Mr. Abernethy's lectures another 

 striking case still more to the purpose. A very 

 intelligent boy had been bitten in the finger by a 

 dog. He was taken into St. Bartholomew's Hos- 

 pital. Caustic had been freely used, affecting 

 the sinewy parts, and producing a terrible sore ; 

 yet the boy was recovering himself, and the sore 

 was healing. One day, as Mr. Abernethy was 

 going round the hospital, he saw and spoke to 

 the boy, who said he thought he was getting 

 well, but that he had on that day an odd sen- 

 sation in his finger, stretching upward into his 

 hand and arm. Going up the arm were two red 

 lines like inflamed absorbents. Doubtless they 

 were such. Mr. Abernethy made light of the 

 matter, ordered a poultice and some medicine. 

 Early the next morning he again visited the ward, 

 pretending that he bad some other patient there 

 whom he wished particularly to see ; and when 

 going out again he asked the boy, in a careless 

 tone, how he was. The boy said he had lost the 

 pain, but felt very unwell, and had not slept all 

 night. Mr. Abernethy felt his pulse, told him he 

 was rather feverish, as might be expected, and 

 asked him if he was not thirsty, and would like 

 some toast and water. The boy said he was 

 thirsty, and that he should like some drink. 

 When, however, the cup was brought he pushed 

 it from him ; he could not drink. In forty-eight 

 hours he was dead. 



The symptoms of hydrophobia, stated in 

 broad outline, are these : excessive nervous irri- 

 tability and terror, spasmodic contractions of the 

 muscles of the throat, excited by various exter- 

 nal influences, and especially by the sight or 

 sound of liquids, and by attempts to swallow 

 them, and sometimes absolute impossibility of 

 swallowing them, earnest attempts to do so not- 

 withstanding. 



When fluids are offered to and pressed upon 

 the patient, he will take the vessel containing 

 them into his hand, but draws back his head to 

 a distance from it with a repelling and apparently 

 involuntary gesture ; meanwhile he makes a suc- 

 cession of hurried gasping sighs and sobs, pre- 

 cisely resembling those which occur when one 



wades gradually and deeply into cold water. The 

 sound of water poured from one vessel into an- 

 other, gusts of air passing over his face, the sud- 

 den access of light, the waving of a mirror before 

 his eyes, the crawling of an insect over his skin — 

 these are things which in an hydrophobic patient 

 suffice to excite great agitation, and the peculiar 

 strangling sensation about the fauces. He goes 

 on rapidly from bad to worse ; in most cases 

 more or less of mania or delirium is mixed up 

 with the irritability. Illusions of the senses of 

 sight and of hearing are not uncommon. The 

 sufferer is very garrulous and excited. In some 

 cases, but not in all, there is incontinence of urine. 

 Foam and sticky mucus gather in his throat and 

 mouth, and he makes great efforts by pulling it 

 with his fingers, and by spitting, blowing, and 

 hawking, to get rid of it ; and the sounds he 

 thus makes have been exaggerated by ignorance 

 and credulity into the foaming and barking of a 

 dog. In the same spirit the palsy of his lower 

 limbs, which sometimes takes place, rendering 

 him unable to stand upright, has been miscon- 

 strued into a desire on his part to go on all-fours 

 like a dog. Vomiting is a frequent symptom. 

 The pulse in a short time becomes frequent and 

 feeble, and the general strength declines with 

 great rapidity. Death occasionally ensues within 

 twenty-four hours after the beginning of the spe- 

 cific symptoms. Most commonly of all, it hap- 

 pens on the second or third day ; now and then 

 it is postponed to the fifth day ; and in still rarer 

 instances it may not occur till the seventh, eighth, 

 or ninth day. 



Usually, the paroxysms, becoming more vio- 

 lent and frequent, exhaust the patient ; but occa- 

 sionally the symptoms undergo a marked alter- 

 ation before death. The paroxysms cease, the 

 nervous irritability disappears, the patient is 

 able to eat and drink and converse with ease, 

 those sights and sounds which so annoyed and 

 distressed him before no longer cause him any 

 disquiet. The late Dr. Latham had an hydropho- 

 bic patient under his care in the Middlesex Hos- 

 pital. On going one day to the ward he fully 

 expected to hear that the patient was dead, but 

 he found him sitting up in his bed quite calm and 

 free from spasm. He had just drunk a large jug 

 of porter. " Lawk, sir ! " said a nurse that stood 

 by, " what a wonderful cure ! " The man him- 

 self seemed surprised at the change ; but he had 

 no pulse; his skin was as cold as marble. In 

 half an hour he sank back and expired. 



It has been alleged that tetanus may be mis- 

 taken for hydrophobia, but the differences be- 



