HYDROPHOBIA. 799 



and resigned natures do not become maniacal would also favor this 

 view. But there are some objections to it, especially the fact that, 

 even in persons the most resigned, the absence of mania is one of the 

 rarest exceptions, as well as the excessive height that the madness 

 usually reaches in lyssa patients. It is certainly more probable that 

 the madness in lyssa is not due to moral grounds, but is caused by a 

 propagation of the excessively increased morbid excitability of the 

 motor-central apparatus of the pharyngeal and respiratory nerves 

 to the central organs of the psychical functions. The symptoms of 

 the mania have many analogies to reflex spasms. Trifling mental 

 excitement causes severe outbreaks, violent motions, and excited 

 actions in manaical patients, just as slight irritation of the skin causes 

 severe reflex spasms in patients with tetanus. 



TREATMENT. We shall only make the following brief remarks 

 about the sanitary measures by which the state should try to protect 

 its subjects. The only prophylaxis is by confinement of dogs. No 

 attention should be paid to the lovers of dogs. Any one who 

 expends sympathy on the "poor dog," and petitions against his 

 being tied up, or wearing a muzzle, should be made to watch a patient 

 with hydrophobia for half an hour, and he would soon be cured. 

 Most muzzles that dogs wear do not prevent their biting, and they are 

 only protective when they do so. It is very important not to kill 

 dogs suspected of madness, but to shut them up and observe them 

 closely. Death, which soon takes place spontaneously, and the 

 symptoms under which it occurs, are far more important in deter- 

 mining that the dog was mad, than are the results of autopsy ; for, 

 from the latter, especially if the dog was killed by violence, it cannot 

 be said with certainty whether the dog was mad or not, and harm 

 has been done by such unreliable, demonstrative assertions. The 

 most we can say is that negative results of an autopsy, where no 

 changes have been found in any organ of a dog suspected of rabies, 

 to explain the symptoms and death, go to prove the probability of 

 the diagnosis especially if we find hair, straw, rubbish, etc., in the 

 stomach ; for, while a healthy dog would not be apt to swallow 

 them, a mad one would. 



If a man has been bitten by a dog suspected of rabies, prophy 

 laxis requires a destruction of the spot with which the poison may 

 have come in contact ; and every dog that has bitten without pro- 

 vocation, or without previous inclination to bite, should be sus- 

 pected. 



The object of prophylactic treatment should be to destroy the por 

 tions of skin which have come in contact with the virus. It consists 

 in excision of the wound, and in the vigorous cauterization of the part 



