Symptoms

With regard to the symptoms of hydrophobia, they are generally tardy in making their appearance, a considerable but a very variable space of time usually elapsing between their commencement and the receipt of the bite. Out of a table of a hundred and thirty-one cases, none of the patients became ill before the eleventh day after the bite, and only three before the eighteenth. It is pretended by Pouteau that one patient was bitten by a dog in the morning, and was attacked with hydrophobia at three o'clock in the afternoon. But as this account was communicated to that writer a long time after the occurrence, and not by a medical man, it deserves very little confidence. Another case, adverted to by Mead, is deprived of all its importance by the same consideration. These examples, as well as another reported by Astrue, in which the patient is said to have had hydrophobia in less than three days after being wounded on the temples, can at most he regarded only as specimens of symptomatic hydrophobia.

There appears, therefore, to be no determinate or exact period at which the disorder makes its attack after the bite, but it is calculated that the symptoms most frequently commence between the thirtieth and fortieth day, and that after this time the chances of escape daily increase. "Of fifteen patients whose cases Ttolliet was acquainted with, seven were attacked between the fourteenth and thirtieth days, five between the thirtieth and fortieth, two a little beyond the latter period, and one after fourteen weeks." In May 1784, seventeen persons were bit by a rabid wolf near Brive, of Whom bee were afterwards attacked with hydrophobia, as follows; one on the fifteenth day after the bite, one on the eighteenth, one on the nineteenth, one on the twenty-eighth, one on the thirtieth, one on the thirty-third, one on the thirty-fifth, one on the forty-fourth, one on the fifty-second, and the last on the sixty-eighth day. Fothergili and Mosely mention cases in which the disease began four months after the bite, and Matthey details an instance in which the inter-val was a hundred and seventeen days. Haguenot knew of a case in which the interval between the bite and the commencement of the illness was five months. Dr. J. Vaughan mentions an interval of nine month; Mead, of eleven: Galen, Bauhin, and Boissière, of a year; Nourse, of nineteen months; and Lentilius, of three years.

Dr. Bardsley has recorded a case in which the most careful inquiries tended to prove that the patient had never suffered the least injury from any animal except the bite inflicted by a dog twelve years previous, yet the patient died from hydrophobia. Another instance may be quoted, namely, that of a merchant of Montpelier, who was attacked with hydrophobia ten years after the bite of a rabid dog, which also bit the patient's brother, he dying on the fortieth day after the accident. There are also other instances recorded in which the interval is alleged to have been eighteen, twenty, and even thirty years; but it is certainly difficult to attach any credit to these very late periods of attack.

Dr. Hunter considers seventeen months, and Dr. Hamilton nineteen, the longest interval deserving belief.

Exposure to the heat of the sun, violent emotions of the mind, and fear, are believed to have considerable influence in accelerating the commencement of the symptoms. That mental alarm is also of itself sometimes capable of bringing on simple hydrophobia totally unconnected with infection is incontestable. A most convincing case is recorded illustrating the positive effects of fear. A young man was bit by a dog which he fancied was mad, and on the fifth day after the occurrence he evinced the usual symptoms of hydrophobia; indeed, he was thought to be dying, when the dog which had bit him was shown to him perfectly well, and the agreeable intelligence tranquillised him so effectually that he was quite well four days afterwards. Dr. J. Hunter mentions a similar case, in which he says, "Most certainly the patient would have died had not the dog been found and shown to him to be in perfect health."

Now it is to the effects of terror that several modern writers are disposed to refer the instances of very late attacks of hydrophobia after the period when the patients were bitten, though, unless the intellect be changed in the meantime by other causes, it is difficult to conceive why the alarm should not have the greatest effect earlier, while the impression of the danger is undiminished by time.

The idea that the symptoms begin sooner after the bite of a wolf than a dog is not adopted by a writer who has given careful notice to this branch of the present interesting disorder.

Cullen has divided the disease into two stages, "the hydrophobia simplex and rabiosa" or the melancholy and raving stages of some other writers. But as the early stage is frequently unattended with anything like melancholy, it is best merely to adopt the distinction of the first and second stages, one comprehending the effects of the disorder previous to the occurrence of a dread or a decided aversion of liquids, the other the subsequent changes.

The wound, if treated by common and ordinary methods, usually heals up at first in a favourable manner. But at some indefinite period, and occasionally long after the bitten part seems quite well, a slight pain begins to be felt in it or the neighbouring parts, now and then attended with itching, but generally resembling a rheumatic pain. If the bite took on the finger, the pain successively extends from the hand to the forearm, arm, and shoulder, without any redness or swelling in these parts, or any increase of suffering from pressure or motion of the limb. In a great many instances the muscles of the neck on the same side as the bite are the points to which the pain principally shoots.

The place where the wound was inflicted meantime begins to swell, inflames, and often festers, and discharges an ichorous matter. These uneasy painful sensations recur from time to time, and usually precede any dread of water several days, and they are a just reason for very serious apprehension. Sometimes pains of a more flying, convulsive kind are felt in various parts of the body. As the disease advances, the patient complains of the pain shooting from the situation of the bite towards the region of the heart. Sometimes instead of pain there is rather a feeling of heat, a kind of tingling, or even a sensation of cold, extending up to the chest and throat, while it is sometimes observed that no local symptoms take place. Thus Sabatier, in giving an account of several cases, remarks, it is worthy of notice "that the bitten parts did not become painful previously to the accession of the fatal symptoms, nor did any swelling or festering occur." Again, "Dr. Marcot particularly observed that the pain follows the course of the nerves rather than that of the absorbents." In the case which he has related, as well as in one of the cases detailed by Dr. Babington, "there was pain in the arm and shoulder, but without any affection of the axillary glands;" and in another case the pain occasioned by a bite in the leg was referred to the hips and loins without any affection in the inguinal absorbents.