Second Stage, Or Premonitory Symptoms

The first thing that attracts attention is a peculiar pain of the wounded part, together with slight heat, redness and swelling. The pain is observed to shoot in the course of the nervous trunks, and has in general a rheumatic character. Sometimes, instead of it, there is a stiffness or numbness, or partial palsy. In some cases it is unattended with redness or swelling:-in others, on the contrary, the wound has thoroughly inflamed, and has broken out into suppuration afresh, although healed long before. In some cases these premonitory symptoms have not appeared at all, or have been so slight as to pass unheeded; in a few instances they have not appeared till after the accession of the genuine hydrophobic symptoms;-but in general they are observed from two to five days previous to them.

Third Stage

The first of the actual symptoms of Hydrophobia is a vague feeling of uneasiness and anxiety. The patient finds himself generally unwell; his mind is irritable, and his countenance gloomy; he experiences a succession of chills and flushes, with transient headache; the appetite fails; there is frequently vomiting, and sometimes a well marked accession of fever. Next, the sufferer complains of stiffness of the neck and soreness of the throat, with severe spasmodic pain at the epigastrium,-the respiration also is embarrassed, and frequently interrupted by sighing. But these symptoms are in most cases attributed to cold, and their real nature is not suspected for a day or two, till all on a sudden, on attempting to drink, the patient is seized with a fit of suffocating spasm, and manifests extreme horror at the sight of fluids.

The most prominent symptoms that henceforth present themselves, are three, viz., difficulty of breathing and swallowing;-extreme irritability of the body;-and peculiar disorder of the mind.

The difficulty of breathing and swallowing depends on spasm of the muscles of the pharynx and larynx. Sometimes the patient can swallow neither solids nor liquids; but more frequently the disability extends to liquids only; because they require a greater exertion of those muscles, and are consequently more likely to excite spasm. It is this circumstance that causes the aversion to fluids, and the alarm at the sight of them, which so generally characterize the disease. At first the spasms are excited only by attempts to swallow fluids;-then they are brought on by the sight or thought of them; or by the motions of spontaneous deglutition;-but as the malady advances they recur in frequent paroxysms,-sometimes spontaneously, sometimes excited by the slightest noise or touch. When the paroxysms have become fully developed, they cause the most frightful struggles for breath. All the muscles are convulsed; the face is black and turgid, and the eyeballs protrude from their sockets. They may come on either during inspiration or expiration, but more frequently the latter;-the patient struggling most violently to expel the air that is confined in his chest through the closure of the larynx. In this disease, as in Tetanus, the fatal termination may ensue from suffocation in the middle of a paroxysm, although it more frequently happens during an interval from exhaustion.

Next to the spasm, the astonishing irritability of the surface of the body is the most prominent symptom of Hydrophobia. The slightest impressions on the senses affect the sufferer most intensely. A look, or a sound;-the opening and shutting of the door of his apartment; the motions of his attendants; the reflections of light from a mirror; the least impression on the skin; the touch of a feather, or impulse of the gentlest current of air, are sufficient to bring on the convulsive fits, and are most earnestly deprecated by the patient.

The state of mind is in most cases extremely characteristic. There appears to be a most profound despair; an utter incapacity for all comfort and consolation; corresponding with the patient's haggard physiognomy and restless movements, and his hurried, desponding tone of voice. He is also in general usually talkative and verbose, as though he attempted to relieve or hide his sufferings by ceaseless conversation. But in some cases he is possessed with wild maniacal fury, and is obliged to be confined in order to prevent injury to himself or others; whilst, as a contrary exception, it occasionally happens, that if he be originally of a strong, resolute mind, he may preserve his composure throughout, and be to the last endued with sufficient courage to attempt drinking, in spite of the impending horrors of suffocation.

Progress And Termination

Where the disease is fully established, its torments are aggravated by extreme thirst; and still more by a peculiar viscid secretion from the fauces, the irritation of which brings on the convulsive fits, and causes a perpetual hawking and spitting-which are very constant symptoms. Not unfre-quently there is vomiting of greenish matter, mixed with blood. As the disease advances, the convulsions increase in frequency and violence; there is constant restlessness and tremor; the lips and cheeks become livid, and perpetually quiver; till at length one fit lasts long enough to exhaust the remaining strength and release the patient from his misery. An entire and remarkable remission (perhaps from the use of medicine) sometimes occurs; and the patient enjoys perfect ease, or perhaps sleeps for some hours; but yet the symptoms return after a time with aggravated violence. Again in some cases there is a perfect calm before dissolution; the patient becomes tranquil, and most of his sufferings vanish or subside;-he can eat, nay, drink or converse with facility; and former objects associated with the excruciating torture of attempting to swallow liquids no longer disturb his feelings. From this calm he sinks into repose, and suddenly waking from his sleep, expires.