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HYDROPHOBIA


valuable in diagnosing the malady; it is so common that it may be said to be present in every case of rabies. When, therefore, a dog, contrary to its habits and natural inclination, becomes suddenly aggressive to other dogs, it is time to take precautions.

In the large majority of instances the dog is inoffensive in the early period of the disease to those to whom it is familiar. It then flies from its home and either dies, is killed as “' mad," or returns in a miserable light, and in an advanced stage of the malady, when the desire to bite is irresistible. It is in the early stage that sequestration and suppressive measures are most valuable. The dogs which propagate the disease are usually those that have escaped from their owners. After two or three days, frequently in about twelve hours, more serious and alarming symptoms appear, ferocious instincts are developed, and the desire to do injury is irrepressible. The animal has an indefinable expression of sombre melancholy and cruelty. The eyes have their pupils dilated, and emit flashes of light when they are not dull and heavy; they always appear so fierce as to produce terror in the beholder; they are red, and their sensibility to light is increased; and wrinkles, which sometimes appear on the forehead, add to the repulsive aspect of the animal. If caged it flies at the spectator, emitting its characteristic howl or bark, and seizing the iron bars with its teeth, and if a stick be thrust before it this is grasped and gnawed. This fury is soon succeeded by lassitude, when the animal remains insensible to every excitement. Then all at once it rouses up again, and another paroxysm of fury commences. The first paroxysm is usually the most intense, and the fits vary in duration from some hours to a day, and even longer; they are ordinarily briefer in trained and pet dogs than in those which are less domesticated, but in all the remission is so complete after the first paroxysm that the animals appear to be almost well, if not in perfect health. During the paroxysms respiration is hurried and laboured, but tranquil during the remissions. There is an increase of temperature, and the pulse is quick and hard. When the animal is kept in a dark place and not excited, the fits of fury are not observed. Sometimes it is agitated and restless in the manner already described. It never becomes really furious or aggressive unless excited by external objects—the most potent of these, as has been said, being another dog, which, however, if it be admitted to its cage, it may not at once attack. The attacked animal rarely retaliates, but usually responds to the bites by acute yells, which contrast strangely with the silent anger of the aggressor, and tries to hide its head with its paws or beneath the straw. These repeated paroxysms hurry the course of the disease. The secretion and flowing of a large quantity of saliva from the mouth are usually only witnessed in cases in which swallowing has become impossible, the mouth being generally dry. At times the tongue, nose and whole head appear swollen. Other dogs frequently shun one which is rabid, as if aware of their danger.

The rabid dog, if lodged in a room or kept in a house, is continually endeavouring to escape; and when it makes its escape it goes freely forward, as if impelled by some irresistible force. It travels considerable distances in a short time, perhaps attacking every living creature it meets—preferring dogs, however, to other animals, and these to mankind; cats, sheep, cattle and horses are particularly liable to be injured. It attacks in silence, and never utters a snarl or a cry of anger; should it chance to be hurt in return it emits no cry or howl of pain. The degree of ferocity appears to be related to natural disposition and training. Some dogs, for instance, will only snap or give a slight bite in passing, while others will bite furiously, tearing the objects presented to them, or which they meet in their way, and sometimes with such violence as to injure their mouth and break their teeth, or even their jaws. If chained, they will in some cases gnaw the chain until their teeth are worn away and the bones laid bare. The rabid dog does not continue its progress very long. Exhausted by fatigue and the paroxysms of madness excited in it by the objects it meets, as well as by hunger, thirst, and also, no doubt, by the malady, its limbs soon become feeble; the rate of travelling is lessened and the walk is unsteady, while its drooping tail, head inclined towards the ground, open mouth, and protruded tongue (of a leaden colour or covered with dust) give the distressed creature a very striking and characteristic physiognomy. In this condition, however, it is much less to be dreaded than in its early fits of fury, since it is no longer capable or desirous of altering its course or going out of its way to attack an animal or a man not immediately in the path. It is very probable that its fast-failing vision, deadened scent, and generally diminished perception prevent its being so readily impressed or excited by surrounding objects as it previously was. To each paroxysm, which is always of short duration, there succeeds a degree of exhaustion as great as the fits have been violent and oft repeated. This compels the animal to stop; then it shelters itself in obscure places—frequently in ditches by the roadside—and lies there in a somnolescent state for perhaps hours. There is great danger, nevertheless, in disturbing the dog at this period; for when roused from its torpor it has sometimes sufficient strength to inflict a bite. This period, which may be termed the second stage, is as variable in its duration as the first, but it rarely exceeds three or four days. The above-described phenomena gradually merge into those of the third or last period, when symptoms of paralysis appear, which are speedily followed by death. During the remission in the paroxysms these paralytic symptoms are more particularly manifested in the hind limbs, which appear as if unable to support the animal's weight, and cause it to stagger about; or the lower jaw becomes more or less drooping, leaving the parched mouth partially open. Emaciation rapidly sets in, and the paroxysms diminish in intensity, while the remissions become less marked. The physiognomy assumes a still more sinister and repulsive aspect; the hair is dull and erect; the flanks are retracted; the eyes lose their lustre and are buried in the orbits, the pupil being dilated, and the oornea dull and semi-opaque; very often, even at an early period, the eyes squint, and it is adds still more to the terrifying appearance of the poor dog. The voice, if at all heard, is husky, the breathing laborious, and the pulse hurried and irregular. Gradually the paralysis increases, and the posterior extremities are dragged as if the animal's back were broken, until at length it becomes general; it is then the prelude to death. Or the dog remains lying in a state of stupor, and can only raise itself with difficulty on the fore-limbs when greatly excited. In this condition it may yet endeavour to bite at objects within its reach. At times convulsions of a tetanic character appear in certain muscles; at other times these are general. A comatose condition ensues, and the rabid dog, if permitted to die naturally, perishes, in the great majority of cases, from paralysis and asphyxia.

In dumb madness there is paralysis of the lower jaw, which imparts a curious and very characteristic physiognomy to the dog; the voice is also lost, and the animal can neither eat nor drink. In this condition the creature remains with its jaw pendent and the mouth consequently wide open, showin the flaccid or swollen tongue covered with brownish matter, and a stringy gelatinous looking saliva lying between it and the lower lip and coating the fauces, which sometimes appear to be inflamed. Though the animal is unable to swallow fluids, the desire to drink is nevertheless intense; for the creature will thrust its face into the vessel of water in futile attempts to obtain relief, even until the approach of death. Water may be'poured down its throat without inducing a paroxysm. The general physiognomy and demeanour of the poor creature inspire the beholder with pity rather than fear. The symptoms due to cerebral excitement are less marked than in the furious form of the disease; the agitation is not so considerable, and the restlessness, tendency to run away, and- desire to bite are nearly absent; generally the animal is quite passive. Not infrequently one or both eyes squint, and it is only when very much excited that the dog may contrive to close its mouth, Sometimes there is swelling about the pharynx and the neck; when the tongue shares in this complication it hangs out of the mouth. In certain cases there is a catarrhal condition of the membrane lining the nasal cavities, larynx, and bronchi; sometimes the animal testifies to the existence of abdominal pain, and the faeces are then soft or fluid. The other symptoms-such as the rapid exhaustion and emaciation, paralysis of the posterior limbs towards the termination of the disease, as well as the ra idity with which it runs its course are the same as in the furious form.

The simultaneous occurrence of furious and dumb madness has frequently been observed in packs of fox-hounds. Dumb madness differs, then, from the furious type in the paralysis of the lower jaw, which hinders the dog from biting, save in very exceptional circumstances; the ferocious instincts are also in abeyance; and there is no tendency to aggression. It has been calculated that from 15 to 20% of rabid dogs have this particular form of the disease. Puppies and young dogs chiefly have furious rabies. These are the symptoms of rabies in the dog; but it is not likely, nor is it necessary, that they will all be present in every case. In other species the symptoms differ more or less from those manifested by the dog, but they are generally marked by a change in the manner and habits of the creatures affected, with strong indications of nervous disturbance, in the majority of species amounting to ferociousness and a desire to injure, timid creatures becoming bold and aggressive.

In Human Beings.—The disease of hydrophobia has been known from early times, and is alluded to in the works of Aristotle, Xenophon, Plutarch, Virgil, Horace, Ovid and many others, as well as in those of the early writers on medicine. Celsus gives detailed instructions respecting the treatment of men who have been bitten by rabid dogs, and dwells on the dangers attending such wounds. After recommending suction of the bitten part by means of a dry cupping glass, and thereafter the application of the actual cautery or of strong caustics, and the employment of baths and various internal remedies, he says: “ Idque cum ita per triduum factum est, tutus esse homo a periculo videtur. Solet autern ex eo vulnere, ubi parurn occursum est, aquae timor nasci, ὑδροφοβίαν Graeci appellant. Miserrimum genus morbi; in quo sirnul aeger et siti et aquae metu cruciatur; quo oppressis in angusto spes est.” Subsequently Galen described minutely the phenomena of hydrophobia, and recommended

the excision of the wounded part as a protection against