RABIES AND HYDROPHOBIA.

BY JAMES LAW, F.R.C.V.S.

SYNONYMS.—Canine Madness, Rabidus Canis, Canis Rabiosa. Greek, Lyssa, Lytta, Lyssa Canina, Cynolyssa, Hydrophobia, Pantephobia, Ærophobia, Phobodipsia, Erethismus Hydrophobia, Clonos Hydrophobia, Dyscataposis. French, Tetanus Rabien, La Rage, Toxicose Rabique. German, Wuth, Hundswuth, Tollwuth, Wuthkrankheit, Hundtollheit. Italian, Rabbia, Arabiata. Spanish, Rabia, Rabiosa. Swedish, Hundsjuka. Roumanian, Turbarea.

DEFINITION.—Canine madness is an acute infectious disease, supposed to arise spontaneously in the genus Canis (dog, wolf, fox, etc.) and Felis (cat, etc.), but transmissible by inoculation to the other Mammalia and to birds. It is characterized by a long period of incubation, by exaggerated reflex excitability, by disorder of the intellectual, emotional, and other nervous functions, by change of habits, by extreme irritability of temper, by optical and other delusions, by spasms of the muscles of the eyeballs and throat, by paralysis, and by more or less fever. The disease runs a short and almost without exception fatal course.

HISTORY.—Plutarch claims that hydrophobia was first recognized by the Asclepiadæ, and Homer's allusions to the malign dog-star and to Hector's acting like a raging dog have been quoted as implying a knowledge of rabies. We find no certain reference to the affection, however, until we come to Democritus and Aristotle, in the fourth century B.C. The latter clearly describes the disease and uses the name lytta, but, singularly enough, claims for man an exemption from the general susceptibility to the infection by inoculation.1 From that date to this the successive outbreaks, sufficiently noteworthy to secure a place in history, are so numerous and widespread as to show a continuous prevalence of the malady in the Old World, and, since the early part of the eighteenth century, in the New.

1 Historia Animalium, lib. viii. cap. 22.

GEOGRAPHICAL DISTRIBUTION.—Rabies is more prevalent in temperate regions than in the tropics and Arctic Circle, but this is common to all animal plagues propagated solely or mainly by contagion, and is manifestly due chiefly to the density of population, the activity of commerce, and the free movement of men and animals in the temperate zone. That a hot or cold climate is incompatible with rabies is disproved by its prevalence under the tropics in Southern China, India, Abyssinia, the West Indies, Peru, Chili, and Brazil, and in the Arctic Circle in Northern Greenland, Lapland, Siberia, and Kamtchatka. On the other hand, many islands and secluded regions in the temperate zones maintain a continued immunity or have been invaded only recently by the introduction of infected dogs. We may instance the Hebrides, Australia, Tasmania, New Zealand, South Africa, West Africa, the Azores, St. Helena, and, until the last half century, La Plata, Malta, and Hong-Kong. The disease is well known throughout North Africa, Arabia, Syria, Turkey, and Asia generally, in Ceylon and other of the East Indian islands. It is also notorious that even when unusually prevalent its progress is often abruptly arrested by a considerable river, and Schrader and Virchow both notice that though it ravaged both banks of a river, yet the islands in the river escaped, as was notorious of the islands in the Elbe during the great Hamburg epizoötic in 1852-53. While, therefore, rabies prevails most extensively in the more civilized countries and in large cities, yet we can point to no geographical area in which the contagion has failed to spread among those bitten by rabid animals, nor to any locality in which the disease has been shown to arise spontaneously from unwholesome conditions of climate, soil, or general environment.

ETIOLOGY.—We know of but one efficient cause of rabies—namely, infection. Yet as many conditions are believed to favor its extension, or even to determine its spontaneous eruption, it is necessary to speak of them shortly.

As shown above, climate cannot be charged with the generation nor diffusion of rabies. Many countries formerly thought exempt are now known to suffer. The following may be named: The East and West Indies, Syria, Egypt, Cyprus, Siberia, the lands north of the Baltic, and South America. Others manifestly maintain their exemption only because the morbid germ has not yet been introduced.

Certain seasons undeniably show a far wider extension of the disease than others, but such epizoötics are not limited to a particular season or year, and, unless cut short by human intervention, cover a succession of years of the most varied climatic character, spare inaccessible or secluded islands in the very centre of the outbreak, and the cycles of prevalence will succeed each other, in place of occurring simultaneously, in closely adjacent countries subject to the same climatic vicissitudes, but separated by narrow seas. Even a broad river destitute of bridges usually abruptly arrests an epizoötic, and protects the land beyond lying under precisely the same general influences. In this connection may be quoted the recent great epizoötic of 1856-72 in England, which succeeded, but did not accompany, that of 1851-56 in Germany. Prof. Röll reports the extraordinary prevalence of rabies at Vienna in 1814, 1815, 1830, 1838, 1842, and 1862—years remarkable for diversity rather than uniformity of climatic characters.

Popular opinion refers rabies to the extreme heats of summer, and each year dogs are muzzled or otherwise confined by order of municipal authorities during the dog days, though left at liberty throughout the rest of the year. In 1780, Andry observed that the coldest and hottest months furnished the least number of cases, and later Hurtrel D'Arboval claimed that in France dogs suffered most in May and September, and wolves in March and April. Bouley claims that the majority of dogs suffer in March, April, and May. The following statistics are interesting in this connection:

Cases of Rabies in

WINTER.SPRING.SUMMER.AUTUMN.
Dec., Jan., Feb. March, April, May. June, July, Aug. Sept., Oct., Nov.
Dogs755857788696(Bouley).
Men17254213(Boudin).

The increase of cases of rabies canina in the spring and summer months, as shown by the above statistics (7-15 per cent.), cannot reasonably be attributed to the influence of the weather, since even the strongest advocates for spontaneity would at once decline to claim any such ratio of spontaneous developments. The increase must therefore be mainly, if not altogether, due to the increased number of inoculations; and these latter are provided for in the jealousies and quarrels in the troops of males that follow each rutting bitch in spring, the principal period of oestrum in the canine female. The infection spread in this way in early spring tends to remain more prevalent throughout the hot summer months.

With regard to the greatly enhanced mortality in man during the summer months, as shown in Boudin's statistics for France, in the absence of any genuine hydrophobia in man apart from inoculation from a rabid animal, it may be attributed to three principal causes: 1st. The bites sustained from rabid dogs in spring and early summer, when the disease is most widely spread among these animals, will give rise to hydrophobia weeks or months later. 2d. In the warm season the body is more thinly clad and the hands and other portions are more frequently left bare, so that the teeth are less likely to be cleansed of the virulent saliva by passing through the clothes before entering the skin. 3d. The languor, fever, and nervousness attendant on extreme heat tend not only to hasten the activity of any disease-germs actually present in the system, but also strongly favor the increase of that nervous fear which so often generates a fatal pseudo-hydrophobia (lyssophobia) in persons that have been bitten by dogs.

Hunger, thirst, and spoiled food are invoked as causes of rabies, yet in the East, where the dogs are the scavengers of the cities and often suffer severely from hunger and thirst, eat the most offensive carrion, and drink the foulest water, the disease has a very restricted prevalence, while in South Africa and Australia the outcast and sheep-dogs, often the victims of starvation and thirst, entirely escape. Bourgelat, Dupuytren, Majendie, Breschet, and others have cruelly destroyed dogs by privation of food and water and by exposure under a broiling sun, but no rabies, nor anything resembling it, was produced. Dogs perspire little and suffer severely from heat, but there is no evidence that this can develop canine madness. It is claimed that Rossi of Turin developed rabies in cats by withholding food and drink, but, as he furnishes no inoculation-tests confirmatory of its virulence, the claim cannot be endorsed. Experiments with an exclusive diet of salt meat, putrid meat, and water only have failed to produce rabies.

The large preponderance of male dogs attacked with rabies has been constantly remarked by writers. Of 1990 rabid dogs reported by different authors, 1746 were males and 244 females—a ratio of more than 7 to 1. This excess of males attacked is much higher than the ratio of males in the dogs of the districts drawn upon. Thus, Bourrel found a ratio of 6 rabid males to 1 rabid female, while in his patients generally the proportion was 4 to 1. Leblanc found that 14 per cent. of the male dogs went mad, while but 1 per cent. of the females suffered. That sex is no protection against inoculated virus is shown by the frequent inoculation of castrated dogs of both sexes. The excess of male subjects may be attributed mainly to the frequency with which these bite each other when following a female in heat, and the respect of all alike for the latter sex. Even in the rabid dog the sexual instinct rises above the propensity to bite in the early stages of the malady.

Toffoli claims that he has caused spontaneous rabies by shutting up several dogs in a loose box with a bitch in heat and allowing them to fight for the prize. Weber and Leblanc have noticed similar occurrences. But Greve and Menecier have repeated the experiments with a contrary result; so that it remains probable that when successful the victims had already been inoculated before they were shut up. Moreover, the seclusion of male canine animals for a lifetime in menagerie cages, often adjoining those of their corresponding females, has never been known to induce rabies.

The bite of the violently enraged dog, and the bites mutually given when following a rutting bitch, are popularly supposed to cause rabies; but if this were the case, the disease must have been universally prevalent. The idea that the bite of a dog will cause hydrophobia should that dog at any subsequent period go mad is a similar delusion. Men doubtless occasionally develop lyssophobia under such an influence, but animals do not contract genuine rabies.

Dogs are alleged to have gone mad from violent suffering after an operation, and cats from being scalded or robbed of their kittens, but all such causes are continually operating without such effect, and when in a solitary case rabies develops, it can only be looked on as a coincidence.

Much popular prejudice exists against certain breeds, and the Pomeranian has been virtually ostracised on account of its supposed liability to rabies; but statistics show that the liability to contract the affection bears a relation to the exposure rather than the special breed. Eckel, Pillwax, and Hertwig found that dogs kept as house- or watch-dogs, and most pampered and confined, are the most liable, while St. Cyr and Peuch found the greatest number of cases among those running at large and allowed the freest exercise.

There is a popular belief that the bite of the skunk (Mephitis mephitica) is always rabific. Rev. H. C. Hovey describes a number of cases of infection from this animal,2 and John G. Janeway has reported other instances.3 Both claim that the disease is spontaneous in the skunk, and Mr. Hovey holds, on very insufficient grounds, that the affection is a distinct variety of rabies (rabies mephitica). The facts seem to warrant only the conclusion that skunks in certain districts of Michigan and Kansas have had rabies communicated to them, and follow the rabid impulse to bite other animals and men. The Mephitinæ abound in the Eastern States, but we never hear of them stealing up and biting men or dogs, nor of the latter contracting rabies from skunk-bite. Eastern dogs frequently kill skunks and sustain bites, but do not thereby contract rabies. Even in Kansas this evil influence of the skunk-bite was unknown until 1870, showing that it is not inherent in the climate nor soil, but has been presumably imported. The spontaneity of the affection is assumed, not proved.

2 Amer. Jour. of Science and Art, May, 1874.

3 New York Medical Record, March 13, 1875.

In the above epitome of alleged causes we find nothing proving the spontaneous evolution of rabies. The prevalence of the affection in wolves, foxes, jackals, cats, skunks, etc. proves nothing for spontaneity, more than its existence in the dog. In all these species of animals the malady develops the dread propensity to bite, and thus in all alike provision is made for the perpetuation and propagation of the malady. Unless a previous attack by a rabid animal has been observed, owners usually insist that their dogs have contracted the malady spontaneously, yet a rigid scrutiny will almost always reveal a strong probability, at least, of inoculation. The rabid dog wanders far from home, and sometimes accomplishes wonderful feats of leaping to reach his victim, so that his presence in a district is not even suspected, and animals thought to be safely secluded inside high walls suffer from his fangs. He is more inclined to bite and rush on than to stay and devour, and thus small animals, like the skunk, when bitten may survive to propagate the disease in places to which a dog could not possibly find access. Much circumstantial evidence makes strongly against the theory of spontaneity. Thus, the immunity of the islands of the Elbe in the very midst of a severe and protracted epizoötic, the continued immunity of the Hebrides and of Malta, each famed for its indigenous race of dogs, for long centuries, during which the malady prevailed at frequent intervals on the adjacent mainlands, and the continued exemption of South Africa and of the Australasian and other islands, in the face of the counter-fact that the affection persisted after importation in the West Indies and South America, speak strongly for the doctrine that the introduction of a pre-existing germ is an essential condition of the evolution of the disease. The following statistics of cases which entered the Berlin Veterinary College furnish further corroborative evidence. There entered the college,

In 9 years,1845-53, inclusive,278rabid dogs.
In1854,4rabid dogs.
In1855,1rabid dog.
In1856,1rabid dog.
In 5 years,1857-61, inclusive,0rabid dog.

The average for each of the first nine years was a fraction less than 31. In the two last of the nine the cases rose to 68 and 82, and this led early in 1854 to an order for the muzzling of all dogs, which was rigidly enforced by the police. The disease was promptly suppressed, the two cases in the two succeeding years being probably due to infected kennels or to importation from without. The results in Eldena (Fuertenberg) and Holland (Van Capelle) are equally conclusive. The inefficiency of some orders for the muzzling of dogs makes nothing against these facts. A law on the statute-book is not always a law in force, as I saw in Alfort and Lyons in 1863; the dogs wore their muzzles only in honor of the periodic visits of the commissionnaire of police, and rabies prevailed.

The great majority of competent observers of to-day deny, or at least strongly doubt, the occurrence of the disease apart from inoculation. Without assuming to decide the question for all times and places, it may be safely asserted that there is no sufficient proof of such an occurrence in any recent time.4

4 Mr. Sâzé, a former student, informed me that boys in Japan produce what is believed to be canine rabies by administering to dogs a fungus (bukeryo) found growing on a coniferous tree. The dogs do not all seem to die, but are usually killed by way of precaution. The symptoms are those of delirium, with a propensity to bite, and the disease is assumed to be communicable, though no facts are given to show that it is so. This popular fancy has all the air of a popular fallacy, but as the counterfeit attests the genuine, it shows the familiarity of the Japanese with true rabies.

The contagion of rabies is usually resident in the saliva, but is by no means confined to that product. Paul Bert found the bronchial mucus virulent in dogs in which the saliva was non-virulent. The flesh has conveyed the disease when eaten, though probably only because of sores or abrasions on the alimentary tract. Smith records the death of negroes in Peru from eating rabid cows;5 Schenkius, that of persons who ate of a rabid pig; and Gohier and Lafosse have infected dogs by feeding the flesh of rabid dogs and ruminants; Rossi and Hertwig have separately induced rabies by inoculating sound animals with portions of nerves from rabid ones. No absolute proof can be adduced that the disease has been conveyed through consumption of the milk. Cases quoted to show its virulence are open to the objection that the dam probably licked the offspring. A similar uncertainty attaches to the spermatic fluid. Women are alleged to have acquired hydrophobia by coitus, but no such case can be adduced among animals, though rabid males have often had connection with healthy females. The alleged cases in women were therefore probably the result of an excited imagination or caused by virus introduced through some other channel. The breath and perspiration seem incapable of becoming media for the transmission of the disease. The blood was supposed to be non-virulent by Breschet, Majendie, Dupuytren, Blaine, Youatt, etc., but has been shown by Eckel and Lafosse to be rabific. Eckel successfully inoculated the blood of a rabid he-goat on a sheep and that of a rabid man on a dog. Lafosse accomplished the same in one of three attempts by inoculation from dog to dog. The blood is probably only virulent in the advanced stages of the disease, and its virulence implies the virulence of all vascular tissues.

5 Peru as it Is.

The saliva of rabid Herbivora and Omnivora, long held to be harmless, is now known to be virulent. Berndt has successfully inoculated it from an ox to four sheep; Eckel from a goat to a sheep; Rey from sheep to sheep; Lessona from an ox to two horses and a sheep; Tombaro from a heifer to a sheep, a horse, and two dogs; Youatt from horse and ox respectively to dogs; Ashburner from an ox to fowls; King from a cow to fowls; and Majendie, Breschet, Eckel, Hertwig, and Renault from man to dog; and Earle from man to rabbits. Besides these are a series of accidental cases, as from horse to man (Youatt), from a sheep to its shepherd (Tardieu), and from man to man (Aurelianus, Enaux, Chaussier).

Experiments by Hertwig and Eckel seem to show that saliva loses its virulence on the supervention of cadaveric rigidity or putrefaction in the dead body. Haubner even believed dried saliva to be innocuous. Yet Count Salm successfully inoculated the dried saliva of a rabid dog, and Schenkius reports a case of hydrophobia produced by a scratch of a hunting-knife that had been used to kill a mad dog some years before. A veterinary student at Copenhagen cut his finger while dissecting the body of a rabid dog twelve hours after death, and died of hydrophobia six weeks later. These cases in man may, it is true, have resulted from fear, but the same cannot be said of the infection of hound after hound placed in empty infected kennels, as recorded by Blaine, Youatt, and others. In the face of this it would require very strong negative testimony, indeed, to prove that the virus of rabies is devitalized in drying—a process which prolongs the vitality of other virulent matters.

Up to the present time the germ of rabies has not been demonstrated. That it is a particulate living organism may be reasonably deduced from its power of indefinite increase—a quality possessed by no mere chemical nor mechanical agent, also from the saliva proving non-virulent after filtration through plaster, while the solid residue left on the filter was virulent (Bert). But, although bacteria have been found in the saliva, those demonstrated up to the present are manifestly ordinary aërial bacteria, such as in Pasteur's experiments produced septicæmia rather than rabies. It still remains, therefore, for some future observer to discover that germ of which we cannot doubt the existence.

The point of election of this germ appears to be mainly the nervous tissue. Pasteur found the brain-matter of rabid animals invariably infectious, and has preserved the moist brain in an infecting condition for three weeks at a temperature of 12° C. He found that by direct inoculation in the brain-substance the period of incubation was abridged, rabies often showing itself in six, eight, or ten days. In the face of Rossi's successful inoculation of nerves and Pasteur's results with brain-matter it is difficult to account for the unsuccessful inoculation of nerve-tissue in six successive experiments by Hertwig. It seems to show that though the virus is concentrated in the brain, and especially in the medulla and pons, yet it does not equally permeate the entire nervous system. This election of the poison for the nervous tissue led Dr. Douboue in 1851 to advance the theory that it is propagated from the seat of inoculation to the brain through the medium of the nerves—a position now assumed by Pasteur. This, we fear, is not well founded. The poison, advancing for a month or more along the lines of the nerves, would probably derange and abolish their functions, as it does so speedily and effectually that of the nerve-centres after it has gained a seat in them, whereas, in reality, the local paralysis only appears in the last stages and after the symptoms of cerebral disorder are well established. Furthermore, a common premonitory symptom of rabies is congestion, swelling, and irritation of the inoculation wound, showing a sudden extraordinary activity at that point as a herald, if not a condition, of the general infection, whereas under a slow propagation along the nerves from the first this irritation would probably have been greatest in the wound at the outset, and would have thereafter kept pace with the progress of the virus along the nerves. Again, the blood is not always infecting. Blaine, Youatt, and others of the older observers had no fear of the blood. Hertwig obtained rabies in two cases only out of eleven inoculations with the blood of rabid subjects. The blood in this, as in some other diseases (variola equina, v. ovina, lung plague of cattle), proves to a certain extent inimical and destructive to the poison. Galtier inoculated nine sheep and one goat by intravenous injection of the saliva of mad dogs, in no case with fatal results nor indeed with any manifestation of rabies, but with the effect of fortifying the system so, that subsequent inoculation into the tissues of the saliva of rabid animals was harmless. Test inoculations made in the tissues of other animals with the same virus used in his intravenous injections, and his subsequent inoculations of the animals so treated, invariably determined rabies. Pasteur repeated these intravenous injections in dogs with the result of rapidly inducing rabies in a fair proportion of cases. One of his cases produced in this way recovered, and thenceforward resisted all further inoculation with the virus. Others that did not perish from intravenous injection afterward died of rabies after inoculation in the brain. Unfortunately, neither Galtier nor Pasteur have reported how much virulent saliva was injected in any one case, so that we have no data as to whether the difference was due to the varying quantity of the virus introduced in the various cases. Lussana, an Italian physician, had already in 1878 experimented on two dogs by injecting into their veins the blood of a physician who died of hydrophobia. The blood was drawn by leeches and cupping-glasses, and five grammes were injected into each dog. One died on the twenty-fourth day, presenting the symptoms and post-mortem appearances of rabies. The second at the end of one hundred and forty days developed symptoms of rabies which lasted a month, when the animal was sacrificed, and nothing special found at the autopsy. The data do not warrant a very positive conclusion, yet they seem to imply that the receptivity on the part of the dog is greater than that of the small ruminants. They suggest, further, a greater relative potency in the battle for life of the blood-globules of the small ruminants with this unknown rabific germ. This antagonism between the blood of the ruminant and the germ of rabies finds a parallel in the case of other disease-poisons in their relations to the nuclei of the tissues. Thus animals may prove refractory to a small dose of the poison of anthrax, yet Chauveau has shown that this virus will overcome all native or acquired insusceptibility when administered in excess. The same is true of the poison of chicken cholera, which Salmon dilutes until it is non-fatal, though still affecting the system and conferring an immunity from its attacks in the future. So with the lymph of variola ovina, which Peuch diluted to 1/50 and injected with the effect of producing slight fever and immunity without vesiculation.

This view would imply that in ordinary cases (inoculation with a moderate amount of the poison) the virus is for a time localized in the vicinity of the wound; and this is further supported by the fact that thorough excision and cauterization of the wound some time after it has been received is still often protective. It is weakened by the fact that bites of dogs in the stage of incubation sometimes produce rabies, but it must be borne in mind that there is still a period between the passage of the living germ to the salivary glands and brain and the growth of the germ in the nerve-centres, so as to produce pathognomonic symptoms, during which both blood and saliva must be virulent.

The ratio of successful inoculations to the bites is very varied. Thus, out of 555 dogs reported to have been bitten by rabid dogs, 188 contracted rabies; out of 183 experimentally exposed till bitten or inoculated, 91 became mad; out of 73 cattle bitten, 45 became rabid; out of 121 sheep bitten, 51 succumbed; and of 890 persons bitten, 428 took hydrophobia (48 per cent.). Of 440 bitten by rabid wolves, 291, or 66 per cent., took the disease. Such statistics are, however, far from satisfactory. Of dogs reported mad, some have only suffered from epilepsy, convulsions, or colic, while of those bitten by the really mad dog, some have sustained simple bruises without any real abrasion; in other cases the teeth have been wiped clean by passing through thick wool, hair, or clothing, or even the flesh of other animals just bitten; in other cases the bite has been inflicted at a time when the virulence of the saliva was at its minimum, or in a subject which was naturally insusceptible. The protective effect of clothing was well illustrated in a case which came under my notice in London. Six animals bitten by a rabid dog all contracted rabies, whilst a man bitten a few hours before through the coat-sleeve, and who did not have the wound cauterized for a full hour after the bite, escaped. Bouley found that in 32 persons bitten in the face, 29 died of rabies (90 per cent.); of 73 bitten on the hands, 46 died (63 per cent.); of 28 bitten on the arms, 8 died (28 per cent.); of 24 bitten on the lower limbs, 7 died (29 per cent.); of 19 bitten on the body (usually multiple wounds), 12 died (63 per cent.). The high mortality from the bites of rabid wolves and skunks is mainly due to this habit of attacking the face and hands. As illustrative of insusceptibility may be quoted the poodle of Hertwig, which was inoculated nine times with unquestionably rabic virus without effect; also the pointer of Rey, which was seventeen times bitten by rabid dogs without harm; also the acquired immunity of Galtier's sheep and rabbits, above referred to.

INCUBATION.—In the dog this varies from 6 days (Pasteur) to 240 days (Bollinger). In the majority of cases it ends in from 20 to 50 days. Pasteur, by inoculating into the brain substance direct, reduced the incubation from 20 days to 6 days. In the horse the limits of reported cases are from 15 days to 92 days. In the ox incubation varies from 20 to 30 days; in sheep, from 20 to 74 days; and in swine, from 20 to 49 days in recorded cases.

In man incubation is believed to be often much more prolonged. In 6 per cent. of all cases it is from 3 to 18 days; in 60 per cent., from 18 to 64 days; and in 34 per cent. it exceeds 64 days (Hamilton, Thamhayn). Quite frequently symptoms of hydrophobia appear from three to six months after the bite; in a few the period is prolonged to one or two years, and in rare instances to seven (Schule), and even twelve years (Chabert). But all such cases of prolonged incubation in man are at the least extremely doubtful. Man often contracts a pseudo-hydrophobia as the result of fear, and is curable by moral suasion alone; and as no such protracted incubations are noticed in the lower animals, and as no one of these abnormally deferred attacks in man has been verified by successful inoculation on animals, it is prudent to reserve a full assent until they are supported by better testimony. A specimen of such cases is that recorded by Chirac, in which a cadet bitten at Montpellier afterward spent ten years in Holland, and then, returning and hearing that his fellow-cadet bitten by the same dog had died of hydrophobia, he also manifested the disease and died. Another is the case of a man who, after having been bitten, spent two years in prison, and then developed hydrophobia and died. A mind naturally erratic and rendered weaker and more susceptible by prolonged confinement would prey upon itself and exaggerate the danger when the subject had been forcibly presented. In all such cases the attending physician should feel bound in the interests of humanity to inoculate a dog or other animal and ascertain whether or not the disease is virulent. The value of such results in dealing with future cases of the same kind cannot be overestimated.

The period of incubation appears to be relatively shorter in the young (average 45 days) than the old (average 70 days), and is believed to be shortened by constitutional excitement from violent passion, fever, the heat of the weather, or electrical disturbances.

During incubation no sign of the disease can be detected; it is even said that the wounds heal with unusual rapidity; but it is certain that toward the end of the latency the cicatrix, alike in man and animals, tends to become sensitive, itchy, congested, and even the seat of papular eruptions. The vesicles (lyssi) which, according to Xanthos, Marochetti, and Magistel, appear near the opening of the sublingual glands within a few days (6 to 20) after inoculation, have not been found by any recent observer.

SYMPTOMATOLOGY.—Three forms of rabies in the dog are recognized—the furious, the paralytic, and the lethargic. The prodromata are, however, the same in all, so that these may be conveniently considered before the different types are noticed.

The premonitory symptoms are by far the most important, as if these are recognized the dog may be safely secluded or destroyed before there is any disposition to bite. Any sudden change in a dog's habits or instincts is ground for suspicion. Bouley well says that a sick dog is always to be suspected. In some cases there is unusual dulness and apathy, in others great restlessness, watchfulness, and nervousness. A morbid appetite, in house-dogs a tendency to pick up and swallow straws, thread, paper, pins, and other objects, or to devour their own dung and urine, is highly characteristic. A desire to lick cold smooth objects, as a stone, a boot, a piece of metal, or the nose of another dog, is often seen. Smelling and licking the anus or generative organs of another dog and the exhibition of sexual desire are frequent manifestations. An increased fondness for the owner, shown by fawning and licking, is occasionally seen, though more commonly there is a change from a formerly amiable temper to a morose, sullen, retiring, and resentful disposition. If a naturally quiet dog flies into a violent passion at the sight of another dog or a cat, and attempts to bite it, he should be carefully watched. If a social dog seeks seclusion and darkness, or if while crouching and shrinking from a blow (hyperæsthesia) he yet bears it without howl or whine, he is to be strongly suspected. Barking without object, constant moving, searching, and scraping, a disposition to tear wood, clothing, etc. to pieces, and, above all, an absence from home for a day or two, should beget grave apprehensions. The rabid bark or howl which is often heard early in the disease is hoarse, low, and muffled, partaking of the nature of both bark and howl, the first running into the second, and consists of one loud howl followed by three or four others progressively diminished in force and uttered without closing the mouth. Some rub the chaps with the forepaws as if to dislodge an offending body from the mouth; others reject bloody matter by vomiting; and others turn the head and eyes as if following imaginary objects, and snap at them. Finally, a tendency to bite, rub, or gnaw the wound is significant, and usually draws attention to the fact that the wound, long healed, is still red, sensitive, and swollen, or even papular. The conjunctivæ are usually congested, there is an increased nasal defluxion, and the skin of the forehead and over the eyes is drawn into wrinkles. This stage lasts from a half to two or three days.

Following one or more of the above symptoms, paroxysms of wicked fury come on, alternating still with periods of quiet, in which prodromata only are observed. The red congested eyes assume a fixed stare, often squint or roll as if following an imaginary object, at which the dog presently snaps. A paroxysm is ushered in by increasing uneasiness, frequent change of position, and a desire to escape, shown in rushing at the door, tugging at the chain, or gnawing the post and walls of the kennel. The tendency to bite and gnaw is further shown by seizing the straw or tearing to pieces wooden and other articles within reach, or even by the victim lacerating its own body.

The rabid howl becomes more frequent, and the rage and disposition to bite strange animals and persons merge into a mischievous desire to worry all that come in the way, the respect for former companions and friends being steadily lost as the paroxysm increases in violence. Yet for a considerable time the voice of a loved master recalls the suffering animal to some degree of self-control. If free to escape during such paroxysms, the dog expends his excitement in wandering, making long journeys of five, ten, or twenty miles, and flying at every animal or man he meets, especially if they increase his excitement by any noise or outcry. If the victim escapes destruction during one of these wanderings, he returns during a lucid interval exceedingly dangerous, for, though he may recognize or even fawn upon his friends, yet the demon of mischief is even more potent within him, and may be roused to sudden violence by any noise or excitement. The intervals of quiet are attended by a prostration proportionate to the violence of the previous paroxysm, and the animal usually seeks seclusion and darkness, where he may lie dull and torpid, but he may be roused at any time to a renewed paroxysm by any noise, disturbance, the presentation of a stick, or, above all, by the approach of another animal. During the paroxysm the animal is manifestly the subject of acute delirium, has hallucinations, snatches and bites at unreal objects, turns on his best friends, even his master, seizes and holds on to a stick or iron bar until the teeth are detached and the gums lacerated, bites his own body, even amputating tail, testicles, or toes with his teeth; a bitch deserts her puppies or worries them, and all follow the unconquerable impulse to wander and to wound living beings. The victim will sometimes manifest incredible strength in breaking his chain and scaling high walls. Twitchings of the muscles of the face, and even general convulsions, are sometimes seen. Food is usually rejected, or if swallowed is soon vomited. In the course of two or three days the furious stage merges into the paralytic one, first shown by paresis of the hind extremities and a swaying motion in walking, then by paralysis of the lower jaw, which hangs pendent and allows the escape of a viscid saliva. The palsy gradually extends over the whole body—a sure precursor of approaching death, which is rarely delayed beyond eight days, and never more than ten, from the onset. In this last stage the animal has become extremely emaciated, with dry withered hair, hollow flanks, and small weak pulse; he may at first rise on his fore limbs when disturbed, and even attempt to snap, but there is now little danger of a bite. Convulsions may alternate with the paralysis. The result is invariably fatal.

The peculiarity of dumb or paralytic rabies in dogs is that the last or paralytic stage supervenes at once on the prodromata, without any intervening period of acute delirium and fury. The animal is throughout dull, quiet, and depressed, and shows little tendency to bite, to wander, or to restless movement. The excitement of the sexual passion is the same as in the furious forms, and the howl is still emitted, though much more rarely. Soon the lower jaw drops from paralysis, allowing the saliva to drivel from the mouth, and the animal can only succeed in closing it momentarily under the greatest provocation to bite. Paralysis of the hind limbs and of the whole body speedily follows, and death ensues in from two to three days. As soon as the jaw is paralyzed the subject is unable to drink, eat, bite, or bark, and emaciation advances with extraordinary rapidity.

The lethargic or tranquil form of rabies in dogs is manifested neither by furious madness nor by palsy of the jaws, but the nervous prostration is shown in a profound lethargy and apathy. The patient curls himself up, and will not be roused by his master's voice, by any noise, disturbance, or even punishment; he makes no response to the caresses of his friends, and pays no attention to the food or drink they bring him, but remains in his place, growing daily more emaciated and lethargic, until relieved by death toward the tenth or fifteenth day of the illness.

Besides the three typical forms there are intermediate varieties, which are classed with one or other according as the symptoms of that type seem to predominate. The same virus, inoculated, will produce different types in separate individuals, the result seeming to depend more on the susceptibility of the subject than any special quality in the poison. With many notable exceptions it may be stated that, on the whole, furious rabies predominates in hounds, bull-dogs, and other less domesticated or naturally vicious and courageous breeds, while the paralytic and tranquil types attack especially house and pet dogs.

POPULAR FALLACIES.—It is a dangerous delusion to suppose that mad dogs have a dread of water and polished surfaces, that they will not eat or drink, that they froth abundantly from the mouth, and that they run with the tail drooping between the hind limbs. There is no hydrophobia in the dog or other domestic animal. The rabid dog drinks freely in the early stages of the disease, lapping even his own urine; later, he still laps, and even plunges his nose in water, though often unable to swallow; and in his wanderings he swims rivers without the slightest reluctance. The appetite is not entirely lost, though greatly impaired and usually depraved, all sorts of unsuitable, noxious, and disgusting objects being picked up and swallowed with avidity. Frothing from the mouth is exceptional in rabies, and the flow of saliva is rarely seen unless when the jaw is paralyzed and pendent. Carrying the tail between the legs is a symptom of all diseases attended by abdominal pain, and is by no means constant in rabies. During the paroxysms the tail is usually carried erect.

Foxes, jackals, and badgers attacked by rabies lose their natural shyness, enter villages, follow and bite other animals and men, and, like rabid dogs, die in an unconscious and paralytic condition. Wolves are affected like foxes, but are more dangerous because of their power, the ferocity of their attack, and their habit of flying at the face and hands. Rabid cats are more retiring than dogs, and show less disposition to attack, but when they do, use both claws and teeth, and especially on bare portions of the body. The cry is hoarse like that emitted during the period of rut. They usually die about the third or fourth day.

The rabid horse is the subject of violent excitement, nervousness, and fear. There are trembling, loss of appetite, rubbing and eversion of the upper lip, neighing, sexual excitement, and inclination to bite and kick. Delirium may be suspected, but during the paroxysms the true nature of the disease is betrayed by the unconquerable desire to bite, kick, and otherwise injure those about him. He will even gnaw the manger and kick the stall to pieces, or lacerate his fore limbs and flanks with his teeth. In the early stages there is the same tendency to lick and rub the wound, which becomes red and irritable, the same red glaring or squinting eyes, and the same jerking of the muscles, as seen in the dog, and the affection winds up in the same way, in paralysis and death in four or five days.

Rabid cattle lose appetite, become very restless and excitable, grind the teeth, lick the cicatrix, evert the upper lip, and otherwise show sexual excitement, bellow often in a loud, terrified manner, as if still apprehensive of the attack of the dog, paw and scrape the ground with the fore feet, butt and kick viciously, have twitching of the muscles, and finally paralysis and death in from four to seven days. When paralysis is coming on the hind feet are often drawn forward as in inflammation of the feet. The pulse and breathing are accelerated during the paroxysms, but I have not found the temperature raised.

Rabid sheep and goats present the same general symptoms, bleat hoarsely, but viciously, have sexual excitement, nibble the cicatrix, have muscular weakness, emaciation, and paralysis, and die in from five to eight days.

Rabid swine show much fear, restlessness, and excitability, hide under the litter, start violently at noises, grunt hoarsely, champ the jaws, show a great disposition to bite and to gnaw and tear objects to pieces, have dark red, glaring eyes, gape and yawn, and become weak and paralytic. Breathing is often labored, and the mucosæ and white skin assume a dull red or leaden hue. Death ensues as early as the fourth or fifth day.

In Herbivora and Omnivora a paroxysm is usually induced by the sight of a dog—a fact of importance in diagnosis.

Rabid skunks have naturally received but little study. They tend, however, to steal up to men and animals and bite some exposed part of the body, like the finger, ear, or nose, and as stealthily retire. It is claimed that their odorous secretion is suppressed.

Symptoms of Hydrophobia in Man.

In some cases the prodromata are altogether omitted, the disease setting in suddenly with spasms of the pharynx and inability to swallow. More commonly, the premonitory symptoms last from one to three days. The first symptom is often an itching, prickling, or more or less violent aching in the seat of the bite, and even of an aura, a numbness, or shooting pain extending from that point toward the heart. In such cases the wound is red or bluish, and even swollen. In other cases there is chilliness, a general feeling of headache, malaise, and prostration, with lack of appetite or nausea, gloomy forebodings, taciturnity, nervous excitability, and restlessness. That restlessness which in patients cognizant of the consequence of the bite often induces insomnia during incubation, now often shows itself in an inability to keep quiet or to remain in one position or place—the exact counterpart of the initial restless stage shown in the canine patient. The sleep is now even more broken and unrefreshing and disturbed by fearful dreams. The restlessness soon merges into intense nervous irritability. Though devoured by thirst, the patient is afraid of water, and the attempt to drink will cause slight spasms with a sensation of filling of the throat and difficulty of deglutition. Even the air blowing upon his surface produces nervous irritation and apprehension, and a sudden glare of sunshine or other strong light is still more injurious. The pulse is increased in frequency, hard, and small; the breathing accelerated, oppressed, with at times yawning, sighing, or sobbing; there is some redness of the fauces, vascular injection of face and eyes, with, in some cases, dilated pupils; nausea or oppression at the epigastrium, sometimes vomiting; and usually constipation, which cannot, as in dogs, be referred to the earth, sand, and unsuitable materials swallowed. Intelligence is unimpaired.

With or without some or all of the premonitory symptoms above described the patient is sooner or later seized with constrictive spasms of the pharynx and respiratory muscles, the immediate occasion being an attempt to swallow liquid or some sudden fright or excitement. So great is the agony produced by this attack that, though consumed by thirst, the patient will rarely afterward attempt to drink, and the mere sight or offer of water, the noise of liquid flowing from one vessel to another, or even the sight of the vessel in which liquid was contained, suffices to bring on a violent paroxysm. This hydrophobia is peculiar to the human being suffering from this disease, being rarely seen in rabid animals; and it serves to enormously enhance the agony and horror of the affection. During a paroxysm the dyspnoea is usually extreme; there is a gasping or sighing respiration, and shrill, inarticulate sounds or screams are emitted which have been likened to the bark of a dog. These are manifestly due to the threatened suffocation rather than to an attempt to bark. The sensations have been described as a rising of the stomach into the throat, while others felt as if the throat had turned into bone and could not admit nor pass on the liquid. The abdominal contractions are often well marked, and retching and vomiting ensue. This reflex irritability of the nerves of deglutition and respiration is followed or attended by a condition of the most intense hyperæsthesia and a great exaltation of the special senses. A deaf and dumb child is said to have heard distinctly at this stage. There are, besides, during a paroxysm, general muscular trembling and clonic spasms of the muscles of the trunk and extremities. The facial muscles are contracted, the nostrils dilated, the face and eyes red and injected, and the pupils dilated, producing a spectacle of the most intense agony. Even in the intervals the hyperæsthesia is so extreme that the slightest touch of an attendant, a current of air, the approach of a candle, or even the ordinary tones of conversation, produce extreme agitation and may precipitate a violent convulsive paroxysm. The duration of the paroxysms and of the intervals varies much, but in general terms the former increase rapidly in number and severity, while the latter are correspondingly shortened. Restraint serves to aggravate the paroxysm, while, according to Hunter, the earlier and lighter ones may be relieved by running. The intense excitement sometimes becomes manifest in the persistent talking, and it is noticeable that the patient is free from mental delusions. As it is impossible to swallow, the patient spits out the now viscid saliva on all sides—a feature, like the fear of water, peculiar to man. As the disease advances the paroxysms are marked by the most perfect hallucinations and delirium, which impel the victim to acts of insane violence toward every one and every thing about him. In these fits he will use every available means of offence, even to the snapping of the jaws, though on the subsidence of the fit he will often express the greatest regret and warn his victims to be on their guard when he finds another paroxysm coming on. In some few instances the delusions continue even during the remissions, and the patient remains possessed of a sense of suspicion and horror of all about him, and yet the fear of being left alone is usually greater still. The convulsions may become tetanic (as opisthotonos). They are habitually more severe in men than in women and children. During a convulsion the victim will at times become black in the face, and may die from suffocation, apoplexy, or nervous exhaustion.

Should he survive this danger the final paralytic stage sets in. The spasms gradually become weaker, reflex irritability is lessened, and a period of quiet, and even comparative composure, may ensue, during which the former sights and sounds fail to produce a paroxysm, and some patients even recover the power of deglutition; but muscular weakness and prostration become more extreme, the lower jaw may even drop, and the viscid saliva drivel from the lips; finally, stupor supervenes, and the patient dies in a state of profound coma or complete exhaustion. This last stage lasts from one to eighteen hours.

Cases are met with in the human subject, as in the dog, in which the paroxysmal stage is omitted in greater part or entirely. The patient complains only of oppressed breathing, and sighs deeply when he attempts to swallow, and paroxysms, if they occur at all, are very mild. Decroix indeed claims that if a person suffering from hydrophobia is kept in a dark room and perfectly quiet, no paroxysms appear. The malady is, however, none the less fatal.

DIAGNOSIS.—The diagnosis of rabies and hydrophobia is not usually difficult if the disease has progressed to its paroxysmal stage. The most pathognomonic features are the fact of a bite by a rabid animal and the evidence of lesions and an extraordinary irritability of the medulla oblongata, inducing severe reflex spasms of the muscles of deglutition and respiration under the influence of any peripheral irritation. The clonic nature of the spasms and the entire absence of trismus serve to distinguish it from tetanus. From pharyngeal anthrax and diphtheria attended with spasm it is diagnosed by the extreme exaltation of the special senses and the absence of any marked febrile reaction; from acute mania by the difficulty of breathing and deglutition, the more rapid heart-beats during a paroxysm, and by the marked hyperæsthesia and exalted reflex susceptibility, as well as by the perfectly lucid intermissions; and from epilepsy, in that the latter is not associated with the same hyperæsthesia, that the paroxysm is not developed by noise, movement, attempts to swallow, sight of water, etc., that the spasms are more universal, and that they do not recur often, nor can they be roused by the causes immediately producing those of hydrophobia. Hysterical cases can usually be recognized by the imperfection of the symptoms; the subject, not knowing all the manifestations of hydrophobia, naturally fails to produce them.

The most difficult to distinguish from the genuine disease are those cases in which hydrophobia occurs as a disease of the imagination, the result of fear—the lyssophobia or hydrophobie non-rabique of the writers. In these there is always the history of a bite; the cicatrix even may have become the seat of congestive redness, itching, or neuralgic pains, and these, acting on a susceptible brain, develop a disease which is hardly distinguishable from true hydrophobia, and which is quite as fatal if left to run its course. These cases have usually less reflex susceptibility than genuine hydrophobia; the attack mostly occurs shortly after some conversation on the subject, and especially about the effects of the bites on others; and the victim is seen to have a nervous organization, and may even be known to have been subject to hysteria or other nervous disorder. At the same time, the concentration of the mind on this subject sometimes produces even structural changes in the medulla, and the reflex susceptibility in co-ordination with the other symptoms may be almost perfect. In a case reported a few years ago by Hammond the symptoms appeared perfectly characteristic, and at the necropsy circumscribed points of congestion were found near the roots of the vagus; yet the dog that bit this man was said to be alive and well, and in the absence of any successful inoculation from biter or bitten the case must be presumed to have been lyssophobia.

Many cases with a more favorable issue are recorded. Bellenger had a patient who had been bitten by his cat, and manifested violent paroxysms of hydrophobia, but was instantly cured by the sight of the animal in good health. Bouardel records that a man was bitten by his dog, which afterward disappeared. He was seized with severe hydrophobia, which continued for two days, when the lost dog was found and presented to him, and the symptoms disappeared. Trousseau speaks of a magistrate whose hand had been licked by his hound, which immediately after attacked a flock of sheep, so that many of them died of rabies. The master then manifested hydrophobia, but as death was deferred beyond the usual time, he concluded it was not genuine and recovered. Prof. Dick was called to visit a man who had been bitten by a favorite dog while suffering from distemper, had manifested severe hydrophobic symptoms, and had been given up by the attending physicians. He succeeded in convincing the subject that as the dog had had distemper, and as no two great diseases could coexist in the same system, it could not have had rabies. In spite of the false premises, this reasoning had the desired effect and the patient recovered. A few years ago a boy twelve years old in Ithaca, N.Y., was bitten by a dog supposed to be rabid, and in due time manifested hydrophobia, which advanced rapidly until he was having a violent paroxysm every half hour, and it was pronounced impossible for him to survive another day. At this time I saw him, observed that he had a nervous organization, and was somewhat lacking in the hyperæsthesia of rabies, learned that he had recently been gorging himself with Christmas delicacies, and was now very costive; and, as there was no satisfactory history of the dog, I at once suspected lyssophobia. The friends and strangers who had come to condole with the parents and feast on the horror were excluded, and the boy's attention fully engaged in amusing pictures and conversation; the paroxysms were omitted, and in two hours the patient, overcome by weariness, went to sleep. Next morning he was still kept secluded and quiet, and two enthusiastic students took up the rôle of keeping his attention constantly engaged on whatever would interest him. The prima viæ was relieved by medicine, and under a course of tonics the boy quickly recruited, and at the end of a week went back to school.

In doubtful cases the test by inoculation may be tried. Inoculation with the saliva of a man suffering from hydrophobia is manifestly useless, since he must die before we can hope for the development of the disease. But in the case of a dog having bitten one or more people the inoculation of the virus on the brain of one or two other dogs would ensure the development of the affection in the course of one or two weeks, provided the first was rabid. The non-success of this operation when practised on two dogs would provide the best possible medicine for the diseased mind of the person bitten.

PATHOLOGICAL ANATOMY.—Post-mortem lesions are rather remarkable for their inconstancy than for their specific characters. Hardly a single lesion can be specified which may not be absent in particular cases, yet some are so characteristic that, when taken along with the symptoms during life, they very materially assist in diagnosing the disease. Of the pathological appearances common to man, dog, and other animals the following may be named: The body is greatly emaciated; the rigor mortis is normal or nearly so; decomposition usually sets in early; a white skin is livid, cyanotic, or petechial; the cicatrix is often hardly noticeable even after the animal has been shaved; the superficial veins, especially those of the neck and head, are filled with black inspissated blood; the external mucous membranes are of a dark livid hue, those of the mouth and nose being covered by a tenacious mucous or muco-purulent secretion (in dogs they are usually covered with earth or dust); the fauces, pharynx, and tonsils are usually of a dark livid hue, and sometimes swollen; in other cases the dark red hue and manifest swelling that obtained during life disappear after death; similar lesions are found in the larynx, and I have seen extensive erosions; the bronchial mucous membrane is reddened and coated with a muco-purulent secretion (and in dogs with earth and foreign bodies); the lungs are usually congested, often to the extent of showing death by asphyxia; the heart and large blood-vessels are filled with a black thick, venous blood, and the muscles, charged with the same blood, have a dark reddish-brown hue; the stomach is usually congested, sometimes to a port-wine hue, and is the seat of blood-extravasations and even erosions; this congestion is often present, though to a less degree, in the intestines; the mesenteric glands and those in the vicinity of the pharynx are not unfrequently enlarged and congested; a very constant feature is the entire absence of proper food in the stomach and of chyme in the small intestine; the liver is usually hyperæmic, exuding on pressure the characteristic dark blood, and it may be the seat of some granular degeneration, but it usually retains its normal consistency; the spleen is normal; the kidneys are hyperæmic and leaden or bluish gray, and slightly cloudy on the surface (in dogs fatty degeneration of the inner cortical layer is common even in health); the urinary bladder is usually empty or contains a little turbid, yellowish, slightly albuminous urine, while the mucous membrane is often covered with dark reddish-brown petechial spots; the brain is usually hyperæmic, and, together with its membranes, slightly oedematous, yet the lesions are not constant either in kind or degree; the medulla oblongata usually shows a similar condition, and even minute points of acute congestion, but neither these nor the hyperæmia and oedema of the spinal cord can be found in every case.

Some conditions are especially pathognomonic in the dog. In nearly all cases of furious rabies the stomach is gorged with foreign bodies, such as hay, straw, wood, coal, leather, portions of textile fabrics, fæces, earth, sand, stones, pieces of iron, lead, etc., and the same materials are usually found in the small intestine, while the large intestines are empty. Portions of these foreign bodies are often found in the bronchia as well, giving rise to circumscribed lobular pneumonia. The significance of such matters when found in large amount in the stomach of a dog which has been given to biting or other symptom of rabies is very great, and if the stomach contains none of the natural food of the animal and the duodenum no chyme, it may be held pathognomonic of rabies. If, however, the materials are small in quantity and mingled with natural food, and if the duodenum contains chyme, the dog was probably not rabid. Dogs frequently chew and swallow fresh leaves of grass, and those in detention gnaw and swallow pieces of wood, cloth, horn, etc.; but these are used either as an emetic or a teething-ring, and virtually imply that digestion is not entirely abolished. Their presence, therefore, along with food does not indicate rabies.

PROPHYLAXIS.—In view of the almost or quite constantly fatal issue of rabies in man and animals, the main attention should be given to the question of prevention. As the disease is perhaps never in our time developed except as the result of contagion, we have the most perfect guarantee that by suitably devised measures it may be absolutely suppressed and excluded from any country. Even if we allow that a rare case is at long intervals developed spontaneously, it is none the less certain that the disease can be practically abolished, as nothing can be easier than to nip the disease in the bud in the locality where it first shows itself. Thus in Australia, Tasmania, and New Zealand rabies has not yet appeared, though prevailing in the same latitude and climate in both hemispheres. It reached Mauritius in 1813, and has prevailed uninterruptedly since, while in Bourbon, immediately adjacent and almost identical in geology, climate, flora, and fauna, it is still unknown. The same truth is told in the entire extinction of rabies in Berlin by the universal muzzling of dogs, as recorded above. The immunity lasted for nine years, during which muzzling was enforced. A more recent example of the same kind is found in Holland. In 1875 universal muzzling was made obligatory in all communes where rabid animals had been and in adjoining communes. From 1877 on the disease was unknown save on the borders of Belgium and Prussia and in a very few dogs recently imported. Nearly all cases of hydrophobia in man and animals being due to bites by rabid members of the canine fraternity, a fundamental condition of all success in prevention is the prohibition of its diffusion by dogs. For this reason the following measures are requisite: 1st. All dogs should be registered and heavily taxed. The number of useless dogs kept in every community affords the greatest opportunity for the speedy diffusion of the rabid germ whenever that has been introduced. Whatever tends to reduce this number directly tends to the restriction and extinction of rabies. 2d. Every dog should be made to wear a collar with plate bearing the name and residence of his owner. All stray dogs without such badge should be summarily shot by the police. This will secure the payment of the taxes and the destruction of superfluous and dangerous dogs. 3d. In all cities and counties where rabies has existed within a year, and in the counties adjoining them, every dog should be muzzled except when securely shut up or tied. All dogs found at large without a muzzle should be promptly shot by the police. The objection to muzzles is satisfactorily met by the use of the wire muzzle, which impedes neither breathing nor drinking. 4th. Dogs and cats suspected or known to have been bitten by rabid animals should be at once destroyed, or if considered sufficiently valuable may be confined in a secure cage for six months under veterinary supervision. 5th. Dogs which have bitten and are supposed to be rabid should be similarly caged and placed under veterinary supervision. If rabid, the symptoms will be fully developed in a few days, whereas if destroyed at once the bitten party is liable to develop lyssophobia. 6th. Dogs imported from countries where hydrophobia is known to exist should be subjected to a period of quarantine of six months. 7th. Foxes, wolves, badgers, martens, skunks, must be indiscriminately destroyed in localities where they have become infected with rabies. 8th. The disinfection or burning of the kennels where rabid dogs have been is a natural corollary of the above.

Other measures less thorough and efficient are often advocated and resorted to, but should be discarded whenever it is possible to practise a method of absolute extermination. Among these may be named the flattening of the teeth, and especially of the canines, with a file, as advocated by Bourrel, and later by Fleming. While this is a measure of protection, it does not remove the desire to bite, nor the power of wounding the skin when that is delicate or tender. Another method is to hang a block of wood from the neck, so that it may impede the movements of the forelegs and prevent a rush and sudden attack. The futility of such a resort need hardly be remarked upon. The emasculation of dogs is another preventive measure advocated. The single advantage of this is that it does away with the host of suitors that follow a rutting bitch, and the mutual worrying and biting that ensue. But it is not yet proved that the disease is produced by privation of the generative act, while if it were it is still certain that cases of spontaneous rabies are extremely rare; that the rabid dog bites the castrated one as readily as the perfect male; that the emasculated one contracts rabies as readily as others when bitten, and that he communicates it no less persistently. Galtier's method of intravenous injection of the rabic saliva, which seems to have proved effectual in sheep and rabbits, utterly failed in the hands of Lussana and Pasteur in dogs. Besides this objection, that it is useless for the animal which is beyond all comparison the main propagator of rabies, it has the serious disadvantages that its practice would necessitate the maintenance of a constant succession of cases of rabies, that great danger attends this production and handling of the virus, and the expense and risk of a general application of the measure must absolutely forbid it.

More recently Pasteur has found that the virus when transmitted through several monkeys in succession becomes so weak as to be harmless to the animal inoculated, and yet protects the animal against the more virulent poison. This fact he utilizes by inoculating this mitigated ape-virus on the brain of the animal just bitten, so as to render that refractory to the disease when the poison from the bitten wound shall reach it by its ordinary slow channel. At the time of writing, the method is being attempted on a man bitten by a mad dog.

Another precautionary measure which is always in place is the diffusion among dog-owners of correct information as to the premonitory symptoms of rabies, and the necessity for careful seclusion when any such symptoms are manifested.

TREATMENT OF BITES.—The treatment of bites by animals supposed to be rabid consists mainly in seeking the elimination of the poison or its destruction by caustic. The first object should be to prevent absorption of the poison. If the bite has been on a limb, a tourniquet should be instantly placed above it. A stout cord or handkerchief is always at hand, and may be tied around the limb and twisted with a piece of wood until circulation is arrested. Sucking the wound is usually effective in withdrawing the poison, and can convey no additional danger to the person bitten. If the patient cannot reach the wound with his own mouth, another may volunteer to suck it, though in these days of diseased teeth and gums the act is pregnant of danger. This may be largely obviated by alternately sucking and rinsing the mouth with a solution of carbolic acid, or, better, by applying such a solution to the wound before sucking, or finally by sucking through a tube. Cupping over the wound is highly commendable, though less effective than sucking. When cupping can be combined with wringing of the wound, there is an approximation to sucking. Cupping is especially valuable in wounds of the trunk, where a tourniquet cannot be applied. Intermittent squeezing and wringing of the part and steeping in warm water is an excellent resort when no better measure can be had. Cutting the wound open to its depth, while it may in certain cases be necessary to allow of the thorough application of a caustic, is objectionable as multiplying the points of infection and absorption. Drinking of liquids to excess temporarily retards absorption by overfilling the vascular system. Ammoniacal, alcoholic, and other stimulants are resorted to for the same purpose, being held to cause plenitude, not only by quantity, but by rarefying the animal fluids.

No such measures should, however, be allowed to delay for an instant the use of caustics. This is the one effectual means of destroying the poison, and the choice of caustic is of less consequence than its thorough application. The hot iron in the form of a skewer, nail, poker, or other available instrument, at a white heat, may be brought in contact with all parts of the wound to its utmost recesses.

Of chemical caustics, solid sticks of nitrate of silver, chloride of zinc, and potassa, or the crystals of cupric or ferric sulphate, are to be preferred to the liquid forms (mineral acids, butter of antimony, etc.), because of the greater thoroughness with which they can be brought into contact with all parts of the wound. Lastly, the galvano-cautery may be used if within reach. If the liquid caustics are employed, they may be introduced into the depth of the wound by means of a pipette, a piece of porous wood, or a pledget of tow. For a great number of small wounds a bath of corrosive sublimate has been recommended.

In some cases the amputation of a badly-lacerated member or one with a compound fracture offers the only measure of protection.

But although nothing should be allowed to delay cauterization, yet the impossibility of an immediate application should not be accepted as a reason for its neglect at a later date. On the presumption that the virus is localized in the seat of inoculation until it has increased largely and is poured into the blood in sufficient quantity to subjugate the blood-globules to its influence, it is logical to excise the cicatrix and cauterize the wound, though days or even weeks have elapsed.

If it should be shown by further experiment that Galtier's intravenous injection of virulent saliva is harmless and protective to sheep, rabbits, and it may be other Herbivora, it would be logical to employ this in these animals just after they have been bitten, as there will be ample time to establish the systemic influence of the intravenous injection before the poison shall have accomplished its recrudescence in the cicatrix. The constantly fatal result of rabid bites in these animals would at least warrant such an attempt, the main precaution being that the liquid shall be most carefully preserved from contact with any of the tissues, including even the coats of the injected vein.

In addition to the local treatment of the sore, certain general medication has usually been resorted to, though its real value may well be questioned. Thus, the elimination of the poison has been sought by profuse perspiration induced by warm, Turkish, and Roman baths, and by the use of medicinal agents, sudorifics, sialogogues (mercury), laxatives, and diuretics (cantharides). The neutralization of the poison has been attempted by ammonia, the sulphites and hyposulphites, chlorine, etc. Besides these are used nerve-sedatives and tonics, such as venesection, belladonna, prussic acid, tartar emetic, sulphates of copper and zinc, arsenic, strychnia, etc.

What is probably of greater importance is a sound hygiene. Stimulating food eaten to excess is injurious alike to man and beast, and by inducing digestive disorder and cerebral congestion will tend at least to precipitate the attack. Costiveness or biliousness from sedentary habits and lack of exercise in the outer air and sunshine, exposure to intense heat or cold and over-exertion, are all to be guarded against.

Finally, psychical treatment is of the highest importance. Those about the person who has been bitten should preserve a calm, equable, and cheerful demeanor and avoid all allusion to the occurrence. The patient should be protected against all sources of excitement, and should not be allowed to see that he is an object of solicitude. If the matter is referred to incidentally, he should be impressed with a conviction of the efficacy of the treatment adopted.

THERAPEUTIC TREATMENT.—Almost every agent in the Pharmacopoeia has been employed as a remedy for hydrophobia, but, up to the present, it must be acknowledged, with no measure of success. The agents supposed to be prophylactics are those also resorted to as therapeutic remedies. To these may be added the potent nerve-sedatives and anti-spasmodics—chloroform, chloral hydrate, ether, bromides of potassium, sodium, and ammonium, curare, Calabar bean, and the sialogogue diaphoretic pilocarpine.

Chloroform is one of the most appropriate, as it may be taken by inhalation, though with much excitement to the patient, and it at once relieves the oppressed breathing and pharyngeal and other spasms, while it acts as a cerebral sedative and anæsthetic; and if it cannot be held up as a curative agent, it at least secures euthanasia. Chloral given as an injection, so as to induce its soporific action, is equally soothing, though nothing more. Curare injected hypodermically overcomes the spasms, but does not usually, if ever, retard death. Three cases of hydrophobia in man treated in this way recovered, but we have no proof that even these exceptional cases were rabies. Pilocarpine has been used in a number of cases, but, with the exceptional case of a young man reported by Denis Dumont, all terminated fatally. The committee of the Paris Academy of Medicine reported in 1874 that in three experimental cases "it hastened death by the fits it brought on." Morphia is often of great value in calming the excitement and giving rest and sleep during the intervals of the paroxysms. Daturia and atropia, administered hypodermically, are somewhat less effectual. Inhalation of oxygen is said to arrest the convulsions and delirium, but not to retard death. Vaccine virus and the venom of the viper have each been tried, but with no good effect.

Of non-medicinal therapeutic measures the following are among the most promising: Perfect seclusion, quiet, and darkness serve to abate the hyperæsthesia, the painful acuteness of the senses, and the convulsive and delirious paroxysms. It can no longer be doubted that a very few cases of genuine rabies recover, but those that do so have almost all had special advantages in the way of quiet and seclusion, and few have had the excitement of medicinal treatment. Eight cases of the recovery of rabid dogs are reported by Menecier, Decroix, Laquerriere, Rey, Harold Leiney, and Pasteur. The two first were attested by successful inoculation on other animals; Decroix's second case was caused by inoculation with the saliva of a hydrophobous man; the next three had been bitten by dogs undoubtedly mad; while Pasteur's was inoculated with the brain-matter of a rabid cow. All in due time presented the characteristic symptoms of rabies, yet all recovered, without any record of medicinal treatment. Pasteur's case, when again inoculated, resisted the disease. A certain number of recoveries of men from pronounced hydrophobia under medicine and without it are on record, but in the absence of successful inoculations it is impossible to tell how many were cases of infecting rabies. The parallel between rabies and tetanus in the intensity of the reflex excitability would demand darkness and quiet as a sine quâ non of any rational treatment. Faradization has produced a temporary relief, but no permanent improvement. Warm baths, steam baths, and hot-air baths serve to abate excitability and spasm, and have been lauded as specific in hydrophobia, but have proved useless in the lower animals.

Intravenous injection of warm water (two pints) in a hydrophobous man reduced the pulse from 150 to 86 and restored the power of deglutition. Life was prolonged for nine days, but in great agony, from the supervention of suppurative arthritis (Majendie). In another case the dread of water disappeared, but death ensued in fifty-four hours. In the hands of Youatt and Mayo it proved equally unsuccessful in dogs. A cold bath with submersion to unconsciousness is an old remedy now abandoned. Venesection to fainting, with or without mercury, mitigated the symptoms, but seemed to hasten paralysis and death. The excision and cauterization of the cicatrix, or the cutting of the nerves proceeding from it, has been useful in delaying, or even absolutely preventing, the paroxysms. When, therefore, the premonitory symptoms of hydrophobia have set in, and when an aura or shooting pain is felt proceeding from the seat of the wound toward the heart, one or other of these measures may serve to prevent the immediate occurrence of reflex convulsions. When the poison has actually invaded the brain, this can be looked on as a palliative measure only, but in the many cases of lyssophobia it may put an instant stop to the affection.