HYDROPHOBIA. 797 



The prodromic term having lasted two or three days, the second 

 or furious stage begins. Its onset is marked by a fit of choking, sud- 

 denly induced by an attempt to drink, which renders the patient in- 

 capable of swallowing a drop. 



The moment the fluid enters the mouth and the motion of swallowing 

 is made, spasmodic inspiratory motions begin ; the thorax rises inter- 

 ruptedly, and remains in the position of deepest inspiration for ten or 

 twenty seconds. During this time the features betray anxiety and 

 terror, the eyes protrude, head and shoulders are thrown back, then 

 comes an expiration, with which the attack passes off. I have satisfied 

 myself that the inspiratory muscles, as well as those of the pharynx, 

 are implicated in these seizures. This combination of spasmodic con- 

 tractions in both of these sets of muscles is a frequent symptom ; it 

 always appears in the straining preceding vomiting, as well as in the 

 retching following irritation of the pharynx by the finger, etc. Retch- 

 ing is always accompanied by a feeling of suffocation, from the contrac- 

 tion of the inspiratory muscles complicating the spasm of the pharynx ; 

 and we are justified in giving the name of retching-fits to these spasms, 

 which form the pathognomonic symptom of lyssa, and are given in 

 every well-recorded case. 



The dread of water is entirely due to the dreadful experience of 

 the patient on trying to drink. This was so, not only in my case, where 

 the patient, an energetic and courageous man, voluntarily made 

 repeated attempts to drink, before he rejected with terror any sugges- 

 tion of the kind, but it is the same in all cases of undoubted lyssa 

 that have been well observed and accurately described. Reports of 

 cases where hydrophobia is given as a primary symptom are worthy of 

 no credence. It is a curious fact that, at first, the act of swallowing 

 solid food is not followed by spasms. Even a draught of air on the 

 skin, or touching any thing cold, sudden irritation of the eye by dazzling 

 light, even sudden mental excitement or surprises, may induce attacks. 

 According to my observation, the pharyngeal muscles do not partici- 

 pate in the reflex spasms induced by irritating other parts, as the 

 mouth or palate. On suddenly arousing my patient, he opened his 

 mouth widely, threw the head back, the thorax was raised as in full 

 inspiration, the epigastrium became prominent, but there was no 

 actual retching. At the height of the disease, it looked as if attacks 

 occurred from time to time, even without cause ; but I think that even 

 these apparently spontaneous attacks must be regarded as reflex 

 epasms, and be referred to collections of tough mucus in the pharynx 

 or to the trickling into it of saliva. This supposition is based on the 

 haste and abandon with which the patients eject saliva and mucus, 



