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 tall, 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 cornea dull and semi-opaque; very often, even at an early period, the eyes squint, and this 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, showing 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 unfrequently 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 rapidity 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 autem ex eo vulnere, ubi parum occursum est, aquae timor nasci, ὑδροφοβίαν Graeci appellant. Miserrimum genus morbi; in quo simul 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 the disease. Throughout many succeeding centuries little or nothing was added to the facts which the early physicians had made known upon the subject. The malady was regarded with universal horror and dread, and the unfortunate sufferers were generally abandoned by all around them and left to their terrible fate. In later times the investigations of Boerhaave, Gerard van Swieten (1700-1772), John Hunter, François Magendie (1783-1855), Gilbert Breschet (1784-1845), Virchow, Albert Reder, as also of William Youatt (1776-1847), George Fleming, Meynell, Karl Hertwig (1798-1881), and others, have furnished important information; but all these were put into the shade by the researches of Pasteur.
The disease is communicated by the secretions of the mouth of the affected animal entering a wound or abrasion of the human skin or mucous membrane. In the great majority of cases (90%) this is due to the bite of a rabid dog, but bites of rabid cats, wolves, foxes, jackals, &c. are occasionally the means of conveying the disease. Numerous popular fallacies still prevail on the subject of hydrophobia. Thus it is supposed that the bite of an angry dog may produce the disease, and all the more if the animal should subsequently develop symptoms of rabies. The ground for this erroneous notion is the fact, which is unquestionable, that animals in whom rabies is in the stage of incubation, during which there are few if any symptoms, may by their bites convey the disease, though fortunately during this early stage they are little disposed to bite. The bite of a non-rabid animal, however enraged, cannot give rise to hydrophobia.
The period of incubation of the disease, or that time which elapses between the introduction of the virus and the development of the symptoms, appears to vary in a remarkable degree, being in some cases as short as a fortnight, and in others as long as several months or even years. On an average it seems to be from about six weeks to three months, but it mainly depends on the part bitten; bites on the head are the most dangerous. The incubation period is also said to be shorter in children. The rare instances of the appearance of hydrophobia many years after the introduction of the poison are always more or less open to question as to subsequent inoculation.
When the disease is about to declare itself it not unfrequently happens that the wound, which had quickly and entirely healed after the bite, begins to exhibit evidence of irritation or inflammatory action, or at least to be the seat of morbid sensations such as numbness, tingling or itching. The symptoms characterizing the premonitory stage are great mental depression and disquietude, together with restlessness and a kind of indefinite fear. There is an unusual tendency to talk, and the articulation is abrupt and rapid. Although in some instances the patients will not acknowledge that they have been previously bitten, and deny it with great obstinacy, yet generally they are well aware of the nature of their malady, and speak despairingly of its consequences. There is in this early stage a certain amount of constitutional disturbance showing itself by feverishness, loss of appetite, sleeplessness, headache, great nervous excitability, respiration of a peculiar sighing or sobbing character, and even occasionally a noticeable aversion to liquids. These symptoms—constituting what is termed the melancholic stage—continue in general for one or two days, when they are succeeded by the stage of excitement in which all the characteristic phenomena of the malady are fully developed. Sometimes the disease first shows itself in this stage, without antecedent symptoms.
The agitation of the sufferer now becomes greatly increased, and the countenance exhibits anxiety and terror. There is noticed a marked embarrassment of the breathing, but the most striking and terrible features of this stage are the effects produced by attempts to swallow fluids. The patient suffers from thirst and desires eagerly to drink, but on making the effort is seized with a most violent suffocative paroxysm produced by spasm of the muscles of swallowing and breathing, which continues for several seconds, and is succeeded by a feeling of intense alarm and distress. With great caution and determination the attempt is renewed, but only to be followed with a repetition of the seizure, until the unhappy sufferer ceases from sheer dread to try to quench the thirst which torments him. Indeed the very thought of doing so suffices to bring on a choking paroxysm, as does also the sound of the running of water. The patient is extremely sensitive to any kind of external impression; a bright light, a loud noise, a breath of cool air, contact with any one, are all apt to bring on one of these seizures. But besides these suffocative attacks there also occur general convulsions affecting the whole muscular system of the body, and occasionally a condition of tetanic spasm. These various paroxysms increase in frequency and severity with the advance of the disease, but alternate with intervals of comparative quiet, in which, however, there is intense anxiety and more or less constant difficulty of breathing, accompanied with a peculiar sonorous expiration, which has suggested the notion that the patient barks like a dog. In many instances there is great mental disturbance, with fits of maniacal excitement, in which he strikes at every one about him, and accuses them of being the cause of his sufferings—these attacks being succeeded by calm intervals in which he expresses great regret for his violent behaviour. During all this stage of the disease the patient is tormented with a viscid secretion accumulating in his mouth, which from dread of swallowing he is constantly spitting about him. There may also be noticed snapping movements of the jaws as if he were attempting to bite, but these are in reality a manifestation of the spasmodic action which affects the muscles generally. There is no great amount of fever, but there is constipation, diminished flow of urine, and often sexual excitement.
After two or three days of suffering of the most terrible description the patient succumbs, death taking place either in a paroxysm of choking, or on the other hand in a tranquil manner from exhaustion, all the symptoms having abated, and the power of swallowing returned before the end. The duration of the disease from the first declaration of the symptoms is generally from three to five days.