Rabies and Hydrophobia. 281 



shining surface of glass or metal is likely to bring on a paroxysm. 

 This hydrophobia is peculiar to man being rarely seen in rabid 

 animals. During a paroxysm dyspnoea is extreme, respiration is 

 gasping or sighing, and in the attempt to dislodge the tenacious 

 mucus which is present in the throat, hoarse or shrill inarticulate 

 sounds are emitted which have been supposed to resemble the 

 bark of the dog. There is a sense of closure of the throat and of 

 rising of the stomach, and retching or even vomiting may ensue. 

 Hyperaesthesia, reflex irritability, and exaltation of the special 

 senses, now become extreme, so that a paroxysm may be brought 

 on by the slightest disturbance, a current of air, a bright light, 

 the rustling of a dress, the noise of a footfall, the noise even of 

 talking, or a slight touch. The "tendon reflex" and skin 

 reflex are often much encreased. During a paroxysm there are 

 muscular trembling and clonic spasms, — sometimes opisthotonos. 

 The intervals of complete relaxation, however, serve to distin- 

 guish from tetanus. The face is red and drawn, the eyes con- 

 gested and sometimes squinting, the pupils dilated and the 

 expression one of suffering, apprehension and horror. Mental 

 disorder appears sooner or later, the speech is disconnected, with 

 indication of delusions from which the patient may at first be 

 recalled by the attendant. There is, however, a constant disposi- 

 tion to be reticent, morose and above all, suspicious, as shown by 

 the absence of a direct look, and the frequency of side glances as 

 though in expectation of a hidden danger. This may even rise 

 to mania, the patient charges those about him with having caused 

 his sufferings, or with conspiracy to injure him, and he may seek 

 to defend himself with hands, feet, teeth or any available object. 

 The necessary restraint aggravates and prolongs the attack. On 

 its subsidence the patient collects his scattered senses, regrets, 

 apologizes, and warns against future occurrences of the same 

 kind which he realizes to be beyond his control. Sometimes the 

 delusions continue during the remission as well. Sexual excite- 

 ment is common in man as in animals. 



The convulsive paroxysms may last ^ to 1 hour, and they 

 tend to encrease in duration and force. A violent paroxysm 

 may cause sudden death from asphyxia or apoplexy. 



Sooner or later exhaustion and paresis appear. The convul- 

 sions become gradually weaker, the reflex irritability and hyper- 



