Course and Prognosis. 483 



defined exactly, appear unlike in different cases. Increased 

 excitability is also present in the first stage, and most of the 

 symptoms differ only in intensity from those of the second 

 stage. In the latter stage the desire to bite and the aggressive 

 conduct, when these symptoms are present, are the most charac- 

 teristic. Just as indistinct is the transition from the second 

 to the third stage since, on the one hand, partial paralysis 

 may be apparent in the stage of irritation and, on the other 

 hand, symptoms of irritation, and particularly cases of suffoca- 

 l^ion are not uncommonly observed in the stage of paralysis. The 

 more rapid the course of the disease, the more rapidly the 

 symptoms change and intermingle, wherefore it is nearly impos- 

 sible to make an exact distinction between the various stages in 

 the course of the affection. In cases of dumb rabies striking 

 symptoms of irritation are absent. 



The disease is, with very few exceptions, fatal. The pos- 

 sibility of recovery has been proved in cases where artificially 

 infected dogs have recovered from the typical disease (Pasteur, 

 Eoux, Hogyes, Remlinger, and others). Consequently we must 

 not conclude that the bite is not infectious from the fact that the 

 biting dog has remained alive, but this opinion should only be 

 reached if, during the two weeks following the bite, no sus- 

 picious symptoms are observed in the animal. 



Pasteur observed recovery from rabies in dogs; later Hogyes 

 noticed that out of 159 dogs, which had contracted rabies in different 

 ways, 13 or 8.1% recovered. Of these 6 were not treated at all, while 

 the remaining 7 were given the antirabies vaccination treatment. Kem- 

 linger found the saliva of a cured dog virulent 20 days after the 

 beginning of the disease and 5 days after recovery. 



Cases where dogs were still alive while persons bitten by them had 

 already died from rabies, have been reported by Talko and Johne. 



Diagnosis. The establishment of the diagnosis is not con- 

 nected with any particular difificulties in cases where the various 

 stages are distinctly separated and there has been an opportun- 

 ity to observe the whole course of the disease or at least the 

 greater part of it. An exact diagnosis being extremely impor- 

 tant and necessary, particularly in cases where human beings or 

 other animals have been bitten by suspected animals, it is advis- 

 able not to kill the suspected animals, but to keep them under 

 strict observation and await their natural death. The symptoms 

 of irritation, the aggressive conduct and subsequent paralysis, 

 particularly the appearance of bulbar paralysis form a very 

 characteristic pietilre of the disease, and the diagnosis is made 

 easier by the existing suspicion of infection. Statements to the 

 effect that no bite has been received must be taken with reserva- 

 tion, as light wounds are inflicted not infrequently without the 

 knowledge of the owner. In making the diagnosis the former 

 behavior and temperament of the animal must be taken into 

 consideration. 



