DIAGNOSIS 603 



maniacal excitement may set in. This stage of excitement lasts 

 from one to a few days, and then the paralytic stage sets in; the patient 

 loses consciousness, goes down rapidly, and dies. The stage of 

 excitement in man, as in dogs, may be very short, not well marked 

 at all, and then the paralytic state develops almost immediately after 

 the slight prodromal symptoms; this form of the disease is known 

 as paralytic rabies or dumb rabies in dogs. Death in man from rabies 

 generally occurs two to five days after the outbreak, or the terrible 

 struggle may be prolonged to eight to ten days. 



Pathologic Lesions. There are no characteristic anatomic lesions 

 from which a diagnosis of rabies in dogs or other animals could be 

 made solely upon postmortem examination without the proper micro- 

 scopic examination. Dogs dead from rabies generally show the 

 paralysis of the muscles of the lower jaw, which hangs down and is 

 not firmly closed as is generally the case in consequence of rigor 

 mortis. The stomach in dogs and other carnivora frequently contains 

 instead of remnants of food, undigestible foreign substances, such as 

 wood, coal, pebbles, hay, straw, leather, etc. The mucosa is strongly 

 congested, swollen, sometimes superficially ulcerated and hemorrhagic 

 at the free margin of the folds. Foreign bodies are sometimes found in 

 the esophagus or in the intestines. However, the presence of foreign 

 bodies in the gastro-intestinal tract varies and their absence does not 

 at all exclude a diagnosis of rabies. Mortley Axe made postmortem 

 examinations of 200 rabid dogs. He found foreign bodies in 90 per 

 cent, of the cases, but Galtier, in 1 304 autopsies on rabid dogs found 

 foreign bodies in the stomach in only 657 cases. The bladder is 

 usually empty or contains a small amount of urine only, which generally 

 contains glucose. Sometimes the bronchial mucosa is hyperemic, 

 and the salivary glands are frequently swollen. The internal organs, 

 such as the liver, spleen, and kidneys, are congested and sometimes 

 show evidences of parenchymatous degeneration. The cerebrospinal 

 meninges are edematous and hyperemic; the gray matter on section 

 shows many bleeding points, indicating its congestion. Hart states 

 that he has seen quite a number of cases of rabies in dogs where the 

 postmortem examination showed the presence of food in the stomach 

 and a normal mucous membrane. 



Diagnosis. Changes in Nerve Ganglia. For a number of years 

 attempts have been made to find changes in the central nervous 

 system that would give a reliable diagnosis of rabies. Babes was the 

 first to describe certain characteristic lesions. Schaffer, in 6 cases 

 of hydrophobia in man, found in that part of the spinal cord where 

 the nerves arise which go to the region where infection took place, 

 also in the anterior gray horns, around the central canal, along the 

 neuroglia bands of the white matter, in the perivascular lymph 

 channels and in the vessel walls themselves, inflammatory round-cell 

 infiltration and hemorrhages, both large and capillary. He also found 

 in these regions hyaline degeneration of ganglion cells and vacuo- 



