December, the recorded cases are double and triple those in June, July, and August.

66

That "heat of the weather" is not the cause of rabies, is strikingly proved by the fact that in hot countries the disease is rare, and in some even unknown. M. Du Chaillu notices that although most of the West African villages are crowded with dogs, the natives do not know, even by report, of such a disease as hydrophobia." Dr Watson remarks that rabies is unknown in the Isle of Cyprus and in Egypt. "I fancy that South America is, or was, a stranger to it. It appears to have been imported into Jamaica, after that island had enjoyed an immunity for at least fifty years; and Dr Heineker states that curs of the most wretched description abound in the island of Madeira; that they are afflicted with almost every disease, tormented by flies, and heat, and thirst, and famine, yet no rabid dog was ever seen there. On the contrary, 1666 deaths from hydrophobia in the human subject are stated to have occurred in Prussia in the space of ten years." *

Having attributed the disease to the "heat of the dog-days," men easily came to the conclusion that it was owing to intense thirst that the disease occurred. Inasmuch as this error has forced them to be more careful in attending to the wants of dogs, and secured access to water, it has been a beneficial error. But, viewing the matter scientifically, we are forced to say that thirst, however intense, is incapable of producing rabies. Dogs have been subjected to the cruel experiment of complete abstinence from water, when chained to a wall under a burning sun. They died from thirst, but showed no symptoms of rabies. Thirst will produce delirium in man; but delirium is not rabies, nor in any way related to it.

Another popular error is to suppose that mad dogs foam at the

mouth, and run about snapping wildly at man and beast, or at any rate manifest their madness by furious ferocity. But while healthy dogs often "foam at the mouth," it is only in one stage of the disease that the rabid dog shows any foam. And as to ferocity, most mad dogs are gentle and caressing to their masters and favourites, though they snap at other dogs. It is only the ferocious dog that shows great ferocity when rabid.

It is very generally believed that if a healthy dog should bite a man, and at any subsequent period become rabid, the man will also become rabid-no matter how many months or years may have elapsed. The consequence of this absurd prejudice is, that healthy dogs are frequently killed in order to prevent their becoming rabid. There was an example of this only a few weeks ago in London; and unhappily the bitten man died a victim to the terrors of hydrophobia. It was quite clear, from the symptoms, that he was not affected by hydrophobia; and the magistrate very properly expressed disapprobation at the folly of destroying the dog before it was evident whether or not it was rabid. The rule in such a case is perfectly simple. If the dog is suspected of being rabid, it should be kept chained up, out of the way of injury, until the disease declares itself.

By this plan it may very soon be shown whether the suspicion was ill-founded, and whether the dog was or was not rabid. Such a proof would often greatly relieve the minds of the bitten man and his family, and remove that terrible anxiety which, in spite of every surgical aid, must for some weeks assail them.

Finally, we may remark that it is by no means true, as popularly supposed, that a man or animal bitten by a mad dog will certainly take the disease. The chances are very great against such an event, even if no precautions be taken.

Of course, no sane man would run the risk. But it is comforting to know, after surgical aid has been employed, that even without such aid the chances are against the disease being communicated.

The errors we have just noticed are pernicious in varying degrees, but mainly because they mask the real symptoms, which might otherwise call attention to the danger. And how great that danger is may be expressed in a single sentencethere is no remedy. The physician that cures is Death ἰατρος ἰᾶται

θάνατος.

Man or beast, once infected with the poison, is doomed to a certain and horrible end. This infection may be prevented, even after the bite has been given, either by surgical aid, or by a natural indisposition of the organism to be affected by the poison; but the infection once established, no remedy avails. The records of medical experience contain numerous cases of harmless bites from rabid animals, but no single case of declared rabies having ever been arrested.

We have already intimated that in man the disease is characterised by a singular dread of water; and that this is an invariable symptom. Happily the cases are rare; and as even experienced physicians seldom have the opportunity of witnessing one, we shall briefly state what are the observed symptoms. Dr Wat son, in his Principles of Physic, and Romberg, in his Diseases of the Nervous System, will furnish examples:

A coachman was brought to St Bartholomew's Hospital on a Tuesday. It was stated that, some ten weeks before, the back of his right hand had been struck by the teeth of a terrier, but no wound had been made, no blood drawn, nor was the skin broken-there was merely a mark of the animal's teeth. On the Thursday preceding his appearance at the hospital, his hand had become painful, and swelled a little. On Friday the pain extended into the arm, and became more severe. His wife stated that he had been in the habit of sponging his head and body every morning with cold water, but on this morning he refrained from doing so on account of some feeling of spasm about the throat. His own remark on this was, that he "couldn't think how he could be so silly." On Saturday, the extent and severity of the pain had increased. He got no

sleep. He felt ill and drowsy on Sunday, but drove the carriage to Kensington Gardens: he was obliged, however, to hold both whip and reins in his left hand. The pain extended to his shoulder. He was then bled. This relieved the pain. But the next day he complained of feeling very ill all over; and he told his medical attendant that he could not take his draughts because of the spasm in his throat. That gentleman, suspecting the true nature of the disease, pretended that it was the nasty taste of the physic which gave the spasm, and told him to drink some water. But there was the same difficulty with the water. The next day he came to the hospital. When there, water was placed before him in a basin, for the alleged purpose of allowing him to wash his hands. It did not seem to disturb him, nor to excite any particular attention. Water was then offered to him to drink, which he took and carried to his mouth, but drew his head from it with a convulsive shudder. After this, on the same morning, he was much questioned by several persons about the supposed cause of his illness; and water was again brought to him, which agitated him, and he became exceedingly distressed and unquiet, complaining of the air which blew upon him. Dr Watson saw him soon

after this, and describes him as "to all outward appearance well, lying on his back without spasm, without anxiety-his face somewhat flushed. He said he had a little headache, but no pain in the arm. His pulse was 132, full and strong; his tongue moist and slightly furred. He appeared to be a very quiet, goodtempered man; and smiled generally when he was spoken to."

In the evening Dr Watson found him tranquil. Gruel was mentioned, and then he sighed deeply two or three times, but sat up, and after a moment's look of serious terror, took half a spoonful of the gruel in a hurried gasping manner, and said he would not take more at a time, lest the sensation should come on. He was desired to take the last portion of the gruel from the basin. He accordingly seized it with hurry, carried it to his mouth with an air of determination, and then a violent choking spasm of the muscles about the throat ensued. Most of the gruel was spilled over his chin; and he observed that he should have managed it had he not been in too great a hurry. He was quiet, rational, and calm, except when endeavouring to take liquids. On Wednesday, at noon, he was much in the same state, but said he was better. Some morsels of ice had been given him during the night he swallowed two or three with considerable effort; the third or fourth caused so great a spasm that he was forced to throw it out of his mouth by a strong resolution, however, he seized it again, and finally succeeded in swallowing it. He now complained that his mouth was clammy, and he champed much. He requested that a straitwaistcoat might be put on, that he might injure no one. He assisted in putting it on, and was perfectly calm.

Whenever he attempted to swallow liquid in the smallest quantities, it was always with sobbings and hurried inspirations, precisely resembling those we make when first wading in cold water. While taking the basin of gruel in his

hand, he drew back his head to a distance, apparently involuntarily. The next day he was composed, yet more easily irritated, and had lost the power of moving his left arm. His pulse was 140, and much weaker than before. His mental powers were failing. During the last hours of his life, he moaned and tossed from side to side. He sank gradually, and died in the evening.

Dr Watson, in the course of his very extensive practice, both in private and in the hospitals, has only seen four cases of hydrophobia, which proves that the disease must be rare. One of these was owing to the bite of a cat, on the 1st of January 1855 (not by any means one of the "dog-days"). A lady, aged thirty-two, hearing from her brother that a white cat belonging to the stables had been quarrelling with a terrier the day before, and afterwards fighting with another cat, supposed it might be ill, and desired it to be brought to her. She placed it on her lap. It there bit her finger. Had the lady been aware of the suspicious nature of such an act, she would at once have sent for the surgeon. But few people remember that cats are as liable to madness as dogs; otherwise we should not have the many absurd police regulations respecting dogs in the summer months, and complete disregard of cats all the year round. Still fewer are impressed with the necessity of ascertaining what has been the behaviour of an animal that has bitten them. The cat now in question was destroyed, but not before it had scratched the gardener's child, flown furiously at a man, and bitten a whip with which it had been attacked. From the 1st January to the 14th March no alarming symptoms disclosed themselves, but on the 14th the lady began to feel generally unwell. On the 16th, pain ran from the bitten finger along the arm and across the chest. This pain did not last long, nor did it recur. On the 17th she found a difficulty in swallowing. Dr Todd visited her in

the evening with Dr Garrett; and on the 18th Dr Watson met those physicians in consultation. He found the lady in bed, "with a wildish expression about her eyes." Her tongue was dry and furred; her pulse 80, soft, with occasional accelerations for a few beats only. She was extremely weak. A morsel of ice was given her. She hastily put it into her mouth, then drew back her head, and stretched out her arm with a repelling gesture, and sighed many times; but she failed to swallow the ice. Afterwards she succeeded better with some tea, which she took in spoonfuls, yet with a strange hurry, and with sighing gasps, and a rolling upwards of the eyes. It seemed to Dr Watson that she suspected what was the matter with her, for she said that to drink some tea would be a test. She then, without much difficulty, ate a boiled egg; and under encouragement, and our expressions of hopefulness, she swallowed, with seeming ease, a glass of wine in successive tea-spoonfuls, until the last spoonful, from which she recoiled with a look of terror, exclaiming despondently, "It is no better." She died the next morning, her mind having continued perfectly clear to the end.

It is worthy of remark, that not only are hydrophobic patients uniformly terrified at water (unlike rabid dogs), and this terror increases with the attempt to swallow water, but also the mere sound of liquid falling in a vessel, sometimes the mere sight of it, and in a few cases even the mention of it, causes terrified gasps. A draught of cold air will also produce similar effects; and even the sight of a mirror. Dr Beddoes relates a case of a patient who sobbed convulsively when a mirror was presented to him. "I gave him money to induce him to look at it a second time, and endeavoured to gain his attention by desiring him to point out in the mirror the sores which had given him most uneasiness; but before he had looked a minute, the same

effect was produced as before." In the case quoted from Dr Watson just now, there was nothing of this observed; indeed, the sounds of liquids had no appreciable influence on the patient; nor was she disturbed by sudden access of light, nor by currents of air: she could even bear to be fanned.

Nor

There is a not unwarrantable supposition that many of the effects of hydrophobia in human beings are due to imagination, and are suggested by what the patient has heard of the disease. would it be possible very accurately to draw the line between the effects directly produced by the disease, and those indirectly produced by the patient's imagination. Yet that the very remarkable phenomena of terror at water, or at the sight and sound of water, are direct consequences of the disease, and are not due to any opinions the patient may hold, is satisfactorily proved by the fact that quite young children exhibit them no less manifestly than adults. We will give in illustration the case observed by Romberg (the only case which ever came under his eye). A boy, aged six, was bitten by a dog on the finger. In accordance with a popular superstition ("a hair of the dog that bit you"), a few of the dog's hairs were cut off and placed upon the wound, which was completely healed in a week. The boy continued perfectly well and in good spirits till the 30th of August-that is, twenty-eight days after the accident-when he complained of pain in the bitten finger. The day after, the pain extended to the whole hand. The boy's father observed that his breathing was laboured. He passed a restless night. In the morning, instead of his usual coffee, he asked for water, but on seeing it, shuddered, and pushed it forcibly away. He was unable to swallow any liquid or solid food: the mere sight of it was repulsive to him. During the following night he was extremely restless, complained constantly of thirst, and yet was unable to swallow any

liquid. On the 2d September the pains extended to the arm and ear; a current of air produced by the mere elevation of the bedclothes, or the sprinkling of a few drops of liquid on his skin, excited the same paroxysms as the attempts at drinking. His consciousnsss was unimpaired; his eyes were brilliant, his face red, and his features expressed distressing anxiety. "I offered him," says Romberg, "a cup full of beer, and challenged him to drink; the mere aspect of the cup startled him, and as soon as I approached it to his lips, sobbing respiration and a convulsive movement of the entire body ensued; he turned his head in the opposite direction, and rolled his eyes wildly. Three times the experiment was repeated, and each time the same phenomena occurred. When he caught sight of a glass of water, the restlessness was greater, and the shudder more violent." It is quite clear that this child of six had never read any books about hydrophobia, nor is it likely that he had ever heard of the behaviour of patients; yet his manifestations were precisely similar to those observed in other cases. When urged to drink, and told that unless he drank he would die, he seized the cup with a trembling hand, and carried it to his mouth, shuddered,

and wanted to return the cup; but on being threatened he once more took courage, and, in spite of the hiccup which intervened, swallowed about half a tea-spoonful hastily and with extreme difficulty. "I then dipped the handle of a tea-spoon in water, and for several minutes dropped the water off it upon his tongue. This trifling quantity he swallowed without much trouble or shuddering." He could see water in a basin, and even wash his hands in it, without terror. The sight of a mirror, or of the polished surface of a watch, produced no effect.

This is in many respects an instructive case. We have cited it mainly to show that the symptoms of hydrophobia are not due to the imagination of the patient; and before quitting this part of our subject, we may observe that the popular notions of hydrophobic patients barking, and trying to go on all-fours like a dog, are simply the wrong interpretations of phenomena which admit of rational explanation. The "barking" is nothing more than the violent efforts of the patient to rid his throat of the sticky mucus which irritates him; and the trying to go on "all-fours" is the inability to stand upright which is sometimes seen when the spinal chord is affected.

It is as yet undecided whether rabies now occurs spontaneously, or only as the result of direct inoculation. Inasmuch as the disease must have occurred spontaneously at first, there is a natural tendency to suppose it must continue to manifest itself spontaneously. Against this supposition some argue that there are diseases which in our day never occur except through contagion, or transmission of some kind. The smallpox is cited as an instance. Proof of this must necessarily be difficult, if not impossible. When smallpox breaks out in a nursery, it is always attributed to the child

Be

having been taken past a certain alley or street; or else, some beggarwoman, with her baby, stopped the nurse to beg. An external cause is always sought, and as the seekers are not critical, they do not verify the truth of their supposition. this as it may, Mr Youatt certainly the greatest authority on rabies-thinks that rabies does not now occur spontaneously, and might be thoroughly extirpated if a wellenforced quarantine could be established, and every dog (let us also add, every cat) could be confined separately for eight months.

Those who believe the disease