798 CHRONIC INFECTIOUS DISEASES. 



and their attempts to introduce the finger far into the throat, for the 

 purpose of removing mucus and sputa. 



Various authors name tetanic or epileptiform spasms among the 

 symptoms of lyssa ; but, on careful examination, I have not been able 

 to discover a case where the detailed description of the spasms fully 

 convinced me that they were tetanic or eclamptic. It is nowhere 

 stated that the muscles of the back were tense, except during the 

 attacks, or that consciousness was lost during the general convulsions. 

 In my patient, there was also opisthotonos he threw his hands and 

 feet about, and pitched around, so that he frequently fell on the floor. 

 But these symptoms reminded one far more of hysterical spasms, or of 

 the actions of a tortured, despairing man. 



The above symptoms are soon accompanied by attacks of 

 boundless rage, in which the patients are hard to manage, destroy all 

 tfiat comes in their way, strike, kick, scratch, and bite, if held fast 

 and, not unfrequently, kill themselves, if they are carelessly watched. 



The biting, inarticulate howling, and barking sounds, are not made 

 more frequently by a hydrophobic patient than by another madman 

 in the maniacal stage of chronic cerebral disease.* The patient often 

 warns his attendants between the fits, which seldom last longer than 

 a quarter or half an hour, and begs pardon for his misbehavior toward 

 them, and sets his worldly affairs in order, in perfect consciousness of 

 the near approach of his end. The paroxysms of madness and convul- 

 sions, having steadily grown more frequent for two or three days, now 

 begin to diminish in violence as the patient loses strength. Rarely, 

 it happens that death occurs at the height of the malady, during a 

 severe and long-continued choking-fit. The exhaustion and collapse 

 usually augment from hour to hour; the voice grows hoarse-and feeble, 

 the respiration shallow, the pulse small, irregular, and very frequent, 

 and death ensues with the signs of a general paralysis, which is some- 

 times preceded by a deceptive amelioration of the symptoms. 



It might be supposed that the attacks of madness occurring in 

 lyssa were simply a result of the despair that would affect even a 

 person not having this disease, if he suffered from retching at short 

 intervals for a day or two. I once attended a patient suffering from 

 severe pharyngitis, who, when I asked him to try to drink, hurled the 

 glass from him, and acted like a madman. 



We find something like this, too, in patients with croup or oedema 

 glottidis. The fact, also, that sometimes patients of very temperate 



* Romlerg says that a great inclination to bite, along with the absence of charac* 

 teristic reflex spasms, is one of the diagnostic points between true lyssa and those 

 hypochondriacal and maniacal conditions that fear of the disease not unfrequently 

 develops in persons that have been bitten. This state might be termed lyssophobia. 



