314 
PATHOLOGY. 
ginning is not quick, nor is the ficin hot; and there is 
none of the mufcular debility fo remarkable in fever; 
but, as the difeafe proceeds, there is fome feverifh heat, 
and the pulfe becomes quick ; varying, however, exceed¬ 
ingly as flight caufes of irritation influence the patient: 
as death approaches, it ufually becomes very quick and 
tremulous. Sicknefs and vomiting often occur, when a 
little phlegm, tinged with brown or yellow bile, is brought 
up. There is often a fenfe of great oppreflion and ftric- 
ture about the bread, or what has been called anxiety 
about the prtecordia ; and which is probably an affeXion 
of the .heart; for it is accompanied with fighingand deep 
irregfilar infpirations, and the patients find fome relief 
from motion, as running and walking, which thow the 
lungs not to be the feat of the oppreflion. The counte¬ 
nance is generally forrowful, and often exprefllve of a 
great degree of horror and diltrefs. 
There is a confiderable variety in the fymptoms in dif¬ 
ferent conftitutions : even the hydrophobia, or dread of 
fwallowing liquids, occurs in very different degrees. 
But there is no part of the difeafe that admits of greater 
variation than the degree of mental derangement, which 
in fome does not amount to more than extreme irritabi¬ 
lity and impatience ; in others to muttering and incohe¬ 
rent talking, yet giving rational anfwers when queftions 
are afked ; and in a few it rifes into fhort fits of the moft 
violent rage and fury, in which the patients bite and tear 
themfelves and every thing near them. In general they 
manifelt no difpofition to mifchief; yet popular prejudice 
is ftill on the watch for the “ barking and biting like a 
dog,” as the difeafe advances. In a cafe related by Dr. 
Marcet, the byftanders confidently expeXed the fyntp- 
tom of barking , which they “ thought at laft to have 
clearly difcoveredin the peculiar noif'e which he made in 
breathing.” Dr. YVavell, fpeaking of this fort of refpi- 
ration, fays, “the noife he made in drawing air into his 
lungs was undoubtedly peculiar; but neither in my opi¬ 
nion, nor in that of any other, medical gentlemen who 
attended him, did it bear the leaft refemblance to the 
barking of a dog,” (Med. Records and Refearches, p. 
151.) Were this notion of the canine metamorphofis, 
•which the difeafe has been fuppofed to effeX in man, 
merely fpeculative, it would be lefs important to confute 
it; but it is to be lamented, that the praXical refult of 
It, in the cruel and murderous plan of fuffocating the 
patient, has been followed, both in France and in this 
country, within the laft twenty years of the eighteenth 
century. See Hamilton on Hydrophobia, vol. ii. p. 140. 
and App. p. xxviii. 
The duration of life, after the commencement of the 
fymptoms of hydrophobia, has been on an average about 
Jour days; it varies from thirty-fix hours to five, fix, or 
many more, days. The termination of life is likewife va¬ 
rious in different inffances: death is often very fudden, 
being produced by one of the convulfive attacks, fuch as 
occur on the attempts to drink; at other times, more 
general convulfions carry off the patient; while in other 
inffances, again, the ftrength finks gradually, and the pa¬ 
tient dies comatofe. 
Difl'eXion of hydrophobic cafes difplays inflammation 
of the fpinal marrovr, and, in a flight degree, of the 
membranes of the brain. The ftomach, efpecially at its 
cardial extremity, and alfo at the cefophagus, is ufually 
found in the fame ftate. The obfervance of rednefs and 
other marks of phlogofis on the mucous membrane of 
the bronchia: has induced Trollet to infer, that this mem¬ 
brane is the feat of hydrophobia, and that the infeXious 
matter is a morbid fecretion from it: but this opinion, 
like every other on the etiology of Lyffa, refts on very 
flight grounds. Some other inconfiderable changes have 
been obferved; but they feern to have been moftly adven¬ 
titious,. 
From the peculiar nature of the fymptoms above de¬ 
tailed, it might be conceived that no difficulty could 
occur, in diffinguifliing rabies canina from every other 
difeafe to which the human body is liable. But this is 
very far from being the cafe ; for many hiftories are re¬ 
lated, in which, although the difeafe was the confequence 
of a bite, it partook more of the nature of tetanus ; and 
others are detailed, in which no bite had preceded the 
difeafe, or had occurred at fo diftant a period as to render 
its influence in exciting the difeafe extremely queftiona- 
ble. It muff be obferved, however, that the tetanic fpafins 
generally commence within a few days after the injury, 
or in a much ffiorter period than thofe of rabies ; that the 
jaw is commonly rigidly locked in tetanus, and the muf- 
cles of the neck and back moft particularly affeXed ; that 
the fpafmsare of a more fixed or “tonic” fpecies, (in 
the language of Cullen,) confiding of rigid and long- 
continued contraXion, rather than of fliort convulfive 
aXion, and are relieved rather by remiffion of their 
violence than by a complete folution of the fpafm; that 
there is lefs feveriffinefs, quicknefs of pulfe, and third, in 
tetanus; and, above all, that there is little of that ex¬ 
treme mobility of feeling, and anxious, impatient, and 
apprehenfive, date of mind, which marks the hydropho¬ 
bic condition. 
It mud be obferved, that many inffances are recorded 
of patients who have aXually frightened themfelves into 
a ftate very clofely refembling hydrophobia. Indeed, Dr. 
Percival has remarked, that it has fometimes been brought 
on by the imagination alone; and Dr. Ferriar fays, “I 
met with an inftance of this kind lately, in which it was 
very difficult to prevent a perfon from rendering himfelf 
completely hydrophobic. Himfelf and his wife had been 
bitten by a dog which they fuppofed to be triad. The 
woman thought herfelf well; but the man, a meagre hy¬ 
pochondriacal fubjeX, fancied that.he had uneafinefs in 
his throat, and that he could hardly fwallow any thing. 
When he fil’d applied to me, a medical friend who was 
prefent, aiked him whether he had any fenfation of heat 
at the pit of the ftomach. He anfwered in the negative, 
doubtfully; but, next day I found him in bed, com¬ 
plaining of heat in the pit of the ftomach, difficulty of 
fwallowing, tremors, and confufion in the head. He 
continued to perfuade himfelf he was ill of rabies, and 
confined himfelf to bed, expeXing death for near a fort¬ 
night. At laft I remarked to him, that perfons who 
were attacked by rabies never furvived more than fix days; 
this drew him out of bed, and he began to walkabout. 
By a little indulgence of his fears, this might have been 
converted into a very clear cafe of fpontaneous hydro¬ 
phobia, ana the patient would probably have died.” We 
are inclined to doubt the fatality of this fpontaneous hy¬ 
drophobia, which is, in faX, nothing more than a nervous 
diforder. 
As to the treatment of lyffa, we have but one remark 
to make; viz. that the bitten part rnuft be cut out as 
foon as poffible; for on that practice only can we rely. 
As to the time at which it is expedient to perform this 
operation, little can be faid with certainty. Of courfe it 
is of no ufe when hydrophobic fymptoms are manifeft. 
Often it is of ufe before that period; and fo irregular 
are the cafes of the abforption of animal poifons, that we 
are juftified in cutting out the part at any period before 
the coming-on of the fymptoms. With regard to the 
operation itfelf, we fliould firft afcertain the extent of 
the wound, and the direXion it has taken; and, as a 
precautionary meafure, the punXmre may be duffed full 
of lint. The part is to be dried from blood ; and the in- 
cifion carried completely under the punXured or lace¬ 
rated wound. The excided piece muft then be examined, 
left the knife ffiould not have completely taken away the 
whole of the lacerated cavity. Should more than one 
wound be made, they can be cut out feparately, ufing the 
precaution to take a clean knife foreach cut, left that be¬ 
fore ufed, having touched the part imbued with the ca¬ 
nine virus, fliould again inoculate the fufferer with the 
difeafe. As to prophylaxies for hydrophobia, we en¬ 
tirely dilbelieve their exiftence; and of remedies notone 
1 is 
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