Clinical Features.—­There is almost always a history of the patient having been bitten or licked by an animal supposed to suffer from rabies.  The incubation period averages about forty days, but varies from a fortnight to seven or eight months, and is shorter in young than in old persons.  The original wound has long since healed, and beyond a slight itchiness or pain shooting along the nerves of the part, shows no sign of disturbance.  A few days of general malaise, with chills and giddiness precede the onset of the acute manifestations, which affect chiefly the muscles of deglutition and respiration.  One of the earliest signs is that the patient has periodically a sudden catch in his breathing “resembling what often occurs when a person goes into a cold bath.”  This is due to spasm of the diaphragm, and is frequently accompanied by a loud-sounding hiccough, likened by the laity to the barking of a dog.  Difficulty in swallowing fluids may be the first symptom.

The spasms rapidly spread to all the muscles of deglutition and respiration, so that the patient not only has the greatest difficulty in swallowing, but has a constant sense of impending suffocation.  To add to his distress, a copious secretion of viscid saliva fills his mouth.  Any voluntary effort, as well as all forms of external stimuli, only serve to aggravate the spasms which are always induced by the attempt to swallow fluid, or even by the sound of running water.

The temperature is raised; the pulse is small, rapid, and intermittent; and the urine may contain sugar and albumen.

The mind may remain clear to the end, or the patient may have delusions, supposing himself to be surrounded by terrifying forms.  There is always extreme mental agitation and despair, and the sufferer is in constant fear of his impending fate.  Happily the inevitable issue is not long delayed, death usually occurring in from two to four days from the onset.  The symptoms of the disease are so characteristic that there is no difficulty in diagnosis.  The only condition with which it is liable to be confused is the variety of cephalic tetanus in which the muscles of deglutition are specially involved—­the so-called tetanus hydrophobicus.

Prophylaxis.—­The bite of an animal suspected of being rabid should be cauterised at once by means of the actual or Paquelin cautery, or by a strong chemical escharotic such as pure carbolic acid, after which antiseptic dressings are applied.

It is, however, to Pasteur’s preventive inoculation that we must look for our best hope of averting the onset of symptoms.  “It may now be taken as established that a grave responsibility rests on those concerned if a person bitten by a mad animal is not subjected to the Pasteur treatment” (Muir and Ritchie).

This method is based on the fact that the long incubation period of the disease admits of the patient being inoculated with a modified virus producing a mild attack, which protects him from the natural disease.