HYDROPHOBIA, from _____, water, and ______, to fear (Syn. Rabies, Lyssa), an acute infectious disease, occurring chiefly in certain of the lower animals, particularly the can-ine species, and liable to be communicated by them to othet animals, and to man. The main features of the disease are similar alike in the lower animals and men, but that peculiar symptom from which the malady derives its name, viz., the dread of water, appears only to affect the latter. Rabies as it manifests itself in animals belongs to the subject of veterinary medicine; the present notice refers only to hydro-phobia occurring in man. The disease has been known from early times, and is alluded to in the works of Aristotle, Xeno-phon, 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 thedangerc 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, _________ 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 ex-cision 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 unfortu-nate sufferers were generally abandoned by all around them and left to their terrible fate. In later times the investiga-tions of Boerhrave, Van Swieten, John Hunter, Magendie, Breschet, Virchow, Reder, as also of Youatt, Fleming, Meynell, Hertwig, and others, have furnished important information; nevertheless much remains obscure as to the nature and pathology of this formidable disease.
Whatever maybe said as to the spontaneous development of rabies in animals—a view which is now generally dis-credited—there can be no doubt that in man the disease is in every instance the result of the inoculation of the virus contained in the secretions of the mouth of the affected ' animal into a wound or abrasion of the skin or mucous membrane. In the great majority of cases (90 per cent.) 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. There is no evidence that the poison can be introduced into the system without an abrasion of the surface. But it must be observed that even of those who have undoubtedly been bitten by rabid animals, only a proportion subsequently suffer from hydrophobia. Thus where the bite has been inflicted on a part of the body pro-tected by clothing, the virus may be wiped from the teeth of the animal before they penetrate the skin. Hence it is found that bites on exposed parts such as the face are very much more dangerous than on other parts which are ordin-arily covered. But further, individual susceptibility must be taken into account, for it is undeniable that many persons in whom the virus of rabies has been inoculated escape hydrophobia. John Hunter mentions one remark-able instance in which of twenty-one persons bitten by a rabid dog only one subsequently died from hydrophobia; and a comparison of the best authorities would seem to show that the proportion of those who are attacked with the disease to those who are bitten is less than one-half, Numerous popular fallacies prevail on the subject of hydro- | phobia. 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. Another fallacious notion, not alto-gether of popular origin, but maintained by a few eminent professional authorities, is to the effect that there is no such disease as hydrophobia at all, but that the symptoms desig-nated by that name are entirely mental phenomena produced by the effect of fear of the consequences following a bite. It might be sufficient as a reply to this to point to the uni-form sequence of terrible symptoms which mark the pro-gress of the malady when it has commenced, and to its acute course and invariably fatal termination ; but there is the additional fact that very young children, in whom this feeling could scarcely be expected to operate, may suffer and die from 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 remark-able 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. The rare instances of the appearance of hydro-phobia many years after the introduction of the poison are always more or less open to question as to subsequent inocu-lation. During the period of latency, in which the patient seems perfectly well, it is supposed that the poison is under-going a sort of multiplication, both in the previously wounded part and in the system at large, somewhat analo-gous to the fermentive process, and that ultimately it comes to tell with deadly effect upon certain portions of the nervous system.
When the disease is about to declare itself it not unfre-quently 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 restless-ness 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 acknow-ledge 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 in-creased, 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 expira-tion, 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 accumulat-ing 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 attempt-ing 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 constipa-tion, 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.
Post-mortem examination has not hitherto thrown much light upon this malady, but the subject is at the present time engaging the special attention of certain eminent pathologists, and important and valuable information may be anticipated. The chief morbid changes which have been described are evidences of congestion and inflammatory action in certain portions of the brain and spinal cord, but more particularly in the locality known as the " respiratory centre " of the medulla oblongata, where the accumulation of "leucocytes" around the small blood-vessels and in the surrounding nervous substance are a prominent phenomenon. Similar changes have been found in the salivary glands. On the whole, however, it can scarcely be said that the formidable array of symptoms above narrated are accounted for by these appearances, which in the opinion of some are in all likelihood merely the results of antecedent processes of an occult nature affecting the nerve centres and forming the essence of the disease.
That emotional disturbance is present is undeniable, for it is found that those cases of hydrophobia are less severe where there is no suspicion on the part of the sufferer of the nature of his complaint; yet this only represents one of many elements. The function of the eighth pair of nerves (which are largely concerned in the processes of respiration and deglutition) is disturbed in a marked degree, aud it is probable that this is the portion of the nervous system upon which the poison most powerfully exerts its specific action. But that the great nerve centres, viz., the brain and spinal cord as a whole, are profoundly affected, is manifest in the tendency to general convulsion, the remarkable hyperesthesia, and the mental perturbation of the patient.
The treatment of most avail in this disease is that which is directed towards preventing the absorption of the poison into the system. This may be accomplished by excision of the part involved in the bite of the rabid animal, or, where this from its locality is impracticable, in the appli-cation to the wound of some chemical agent which will destroy the activity of the virus, such as potassa fusa, lunar caustic (nitrate of silver), or the actual cautery in the form of a red-hot wire. The part should be thoroughly acted on by these agents, no matter what amount of temporary suffering this may occasion. Such applications should be resorted to immediately after the bite has been inflicted, or as soon thereafter as possible. Further, even though many hours or clays should elapse, these local remedies should still be applied; for if, as appears probable, some at least of the virus remains for long at the injured part, the removal or effectual destruction of this may prevent the dread consequences of its absorption. Every effort should be made to tranquillize and reassure the patient.
When once the symptoms of hydrophobia have declared themselves, little can be achieved by the resources of the physician beyond palliating the agonizing sufferings and rendering easier the inevitably fatal event.
Medicines cannot be administered by the mouth, owing to the impossibility of swallowing and the distress occasioned by the effort to do so; they must therefore be given either by the bowel in the form of enema, by hypodermic injection, or by inhalation. The most approved and potent agents are opium, belladonna, curara, chloral, and chloro-form inhalation. The vapour bath is also recommended. It need scarcely be said that those coming in contact with the patient should guard against the risk of being bitten during the paroxysms of excitement, c-r of being inoculated by the saliva, for although there are few if any well-authen-ticated cases of the disease being communicated in this way, yet the possibility must be admitted.
It should be remarked that occasionally an individual who may have at some time been bitten by a non-rabid dog manifests symptoms strongly resembling in many points those of hydrophobia. These are often simply the effect of fear, and have much of the hysterical element mixed up with them. They are generally of much less severity in every way than those of the true disease, and yield readily to treatment appropriate to the disturbed nervous
condition. (J. O. A.)