HYDROPHOBIA 127 there are only from two to three cases of death from this disease annually in the department of the Seine; and, according to these results, not more than 3 in 60, or 5 per cent, of the persons bitten by rabid dogs, afterward become hydrophobic. But even this proportion of cases constitutes a terrible danger, considering the nature of the disease with which the individual is threatened. For some time after the inflic- tion of the wound no symptom manifests itself. The poison may have found its way into the tissues, but it is quiescent, and it remains so usually for several weeks. The exact period during which it may thus lie dormant, and afterward become fully developed, undoubtedly varies in different cases. Instances have been related in which hydrophobia has declared itself after an interval of several years, but these statements are evidently wanting in au- thenticity, and are almost universally regarded as extremely doubtful. It seems positive, how- ever, that the period of quiescence may be ex- tended to one year, and possibly to 17 or 18 months. Nevertheless these instances, if they exist, are very rare exceptions ; and in the im- mense majority of cases the disease shows itself, if at all, between the end of the first and the end of the third month ; so that after the lapse of three months from the date of the injury, the chances of escape increase rapidly with every succeeding week. By the end of six months the patient may be pronounced prac- tically safe. When, however, the disease is to show itself, usually during the second or third month, its first manifestation is a sense of itch- ing or discomfort at the seat of the wound. The cicatrix may become swollen and reddened, and a red line, following the course of the lym- phatic vessels, is said to appear upon the limb, between the cicatrix and the trunk. This is the preliminary period of the disease, and may last for two or three days, rarely more than six, during which the patient is only slightly uncomfortable. Then the unmistakable signs of hydrophobia come on with great rapidity, and are aggravated from hour to hour. There is a feeling of stiffness about the neck, extend- ing to the jaw and the base of the tongue. An indescribable anxiety and agitation of mind takes possession of the patient, often accom- panied with paroxysms of momentary delirium and hallucinations. The breathing is hurried and irregular. There is great thirst ; but there is also a difficulty of deglutition, apparently consisting in an irresistible spasm of the pha- rynx or glottis, which is so distressing that the patient sometimes rejects fluids after vainly attempting to swallow them, with violent de- monstrations of irritation and despair. This is what has given rise to the idea that the pa- tient dreads the liquid itself, and has unfortu- nately attached the name hydrophobia to the disease in question. The saliva becomes re- markably viscid and tenacious, and appears to odd much to the distress of the patient, who endeavors constantly to detach it and expel it 422 VOL. ix. 9 from his mouth. This condition of nervous irritation rapidly exhausts the strength of the system, and death takes place, usually on the second or third day. Such are the symptoms and course of hydrophobia in man. The treat- ment includes only a single measure, but this must bo adopted at once on the receipt of the injury, and must be carried out in the most thorough manner. It consists in neutralizing the poison by cauterization of the wound. Some authorities recommend first cutting out the wound by an incision passing all round it through the sound flesh, and subsequently cau- terizing the fresh surface. The objection to the procedure is that it requires some time and skill to perform it thoroughly, particularly as the wound is generally narrow and deep ; and also that if the knife or the blood happen to penetrate the wound itself, they may become themselves contaminated with the virus and thus bring it in contact with a new and larger surface. It seems desirable to cauterize thor- oughly the original wound without delay. Then, if thought proper, the eschar :nay be cut out, and the caustic again applied to the fresh sur- face of the new wound. On the whole, the particular caustic which is recommended by the highest authorities for this purpose is a solid stick of nitrate of silver. Its advantages are : 1, that it can almost always be readily pro- cured ; 2, that it can easily be cut into a form adapted to penetrate to the bottom of a deep and narrow wound ; 3, that it readily dissolves in the animal fluids, and, when held for a few minutes in contact with the tissues, forms a tolerably deep and firm eschar, and coagulates thoroughly all the organic matters which may be present. It has been thought that during the period of quiescence the virus remains lo- calized in the original cicatrix, and does not begin to disseminate itself through the sys- tem until the appearance of signs of irritation in the part. If this be so, it would of course be highly proper to cut out the cicatrix and cauterize the wound, in cases where this operation had not already been performed at any time between the receipt of the in- jury and the first manifestations of the dis- ease. But for the protection of the communi- ty from hydrophobia, the prevention of the bite of a rabid animal is much more important than its treatment. Any well educated surgeon, if within reach and called in time, will apply the proper remedies after the wound is inflicted. But he may not be applied to in season. The animal may not be suspected of rabies at the time of the injury ; and even if everything be done for the sufferer which circumstances per- mit, he must still pass through several weeks or months of anxious uncertainty, until the extreme limit of possible incubation has been reached. The most important thing, in every point of view, is to diminish as far as possible the chance of a bite being inflicted at all ; and by far the best means of accomplishing this object is to put the public on their guard by
