A    C  A   S   E
OF
HYDROPHOBIA
WITH REMARKS.
/
BY THOMAS H.  GAGE,  M. D.,
WORCESTER.
Published by the Worcester District Medical Society.
          WORCESTER:
TYLER & SEAGKAVE, BOOK AND JOB PRINTEK9,
     Spy Job Office, 212 Main Street. 
 
A    C  A   S   E
OF
HYDROPHOBIA
WITH REMARKS.  /
BY THOMAS H.  GAGE, M. D.,

           WORCESTER.
Published by the Worcester District Medical Society.
,&nl1'-"•;?
*%
        * LIBRARY §



         ^'-.  , J*
         WORCESTER:

TYLER <fc SEAGKAVE, BOOK AND JOB PRINTERS,
    Spy Job Office, 212 Main Street. 
1
  The following paper was read before the Worcester Dis-
trict .Medical  Society at the  stated  meeting  in  January
1865.  It is printed by the request and  at the expense of
the Society, for use of the  members.
I 
A  CASE   OF  HYDROPHOBIA:
          WITH  REMARKS.
  Mrs. H. B. W.,  aged 25, an  intelligent, healthy,
and very nervous  lady, was confined  Dec. 23, 1863,
with her first child, which was  still-born.  She had
subsequently much trouble with her  breasts, on ac-
count  of  the  large secretion  of milk,  and a  little
Scotch Terrier  puppy  was obtained  to  suckle them.
This animal became a  great pet, and Mrs. W.'s con-
stant companion.
   On  Wednesday morning, May 18,  1864, this dog
angrily snapped  at his mistress,  making upon the
back of her right hand, with his teeth, a long red
mark, which denuded   the cutis  vera,  but  drew no
blood.  He  had appeared  sick for several days, man-
ifesting  great  irritability of temper, and  a disposi-
tion  to  secrete himself under  the  barn,  where he
 had  been  found   eating swill,  straw,  dirt and  the
 offal of the stable.  In the  afternoon of the same
 day, May  18,  he was carried,  on  account of his
 strange behavior, to the stable of  Dr. W. E. Rich-
 ards,  a veterinary surgeon, where he was  imme-
 diately  placed  in close  confinement  and  died the
 next  night. An  autopsy  was made and the stomach
 found  filled with the filthy mixture  of  substances 
                         4
already mentioned.  He had bitten, previously to his
confinement, two  other  persons,  besides  Mrs.  W.,
more  or  less severely,  and a  large  dog, and was
pronounced  decidedly  rabid by his keeper.
  Beyond these statements concerning the condition
of the  dog  both before and after  the slight wound
inflicted upon Mrs. W., I have been  unable to  dis-
cover anything  throwing material light upon  the
subject.  In regard to the opinion  of  Dr. Richards, I
can only  say that it is expressed  with great  confi-
dence, and that, he claims much familiarity with  the
symptoms of  rabies in the dog.
  Mrs. W. came to see  me Saturday  evening, May
21st,  (four days after the wound,) because she felt
anxious  about it  and  wanted  advice.   There  was
then  nothing  remaining of the scratch  but a  little
dry line which was nearly effaced.   I  found that she
was very  much agitated upon the subject, but I pro-
posed no  treatment,  and only  endeavored to dispel
her fears,  and to persuade her  to dismiss  it entirely
from  her  thoughts.  I  have reason to  know,  how-
ever,  that during  the whole  summer it very much
occupied her mind, and was a  ground of quite con-
stant  apprehension.  I  have learned,  also,  that she
obtained some books, and read  everything  upon the
subject  of hydrophobia which  she  could find.
  Early Tuesday morning, Nov. 8, Mrs.  W. called at
my office  to  consult me  on account of a dull, heavy
pain  in the  right  arm and  shoulder.  She  said it 
5
commenced  the  Friday  previous  with pain in  the
fingers  and back of the  hand,  and had  gradually
extended  up the  arm to  the shoulder and side of the
neck, and had become  really quite severe.  Other-
wise she  said she had felt quite well, though  I ob-
served that her tongue was  considerably furred.  It
was very  plain  to  me  that she was nervous  and
anxious about this pain, and that her mind was upon
the  wound  she  had  received  from  the   dog,  but
neither of us mentioned it, and I spoke of the pain
and advised  for  it as a probable neuralgia.  A wild,
unnatural expression of  her  eye, was so marked at
this time as to  be  noticed and  remarked  upon by
Dr.  Sargent, who happened to be in my office when
she entered, and to whom she was an entire stranger.
I particularly observed that there was no appearance
of recrudescence  in  the  wound, and no swelling or
evidence  of soreness in the hand.   After leaving my
office she turned upon the steps and with hesitation
and emotion said, "do you suppose  I may be  going
to  have  hydrophobia ?"  Subsequently  I met  her
upon the street  during the forenoon and she seemed
in  excellent  spirits,  and  made  no  allusion  to  the
pain  or to her fears.
  After her return home  she spent most of the  day
alone, and when  her husband came home to tea he
found her feeling somewhat  ill,  but making  no spe-
cial complaint except of the pain in the  arm.  He
observed  at  the  tea-table  that she took a  cup  of tea 
                         6
to drink, and immediately  sat it down and  left the
table to go  to  the  back door,  and  that wThen she
came in again,  instead  of  taking  her seat  at the
table, she  went  and  lay down  upon  the  lounge.
He asked what  was  the  matter  and she said, " only
a  little  headache."   About 9 o'clock she and  her
husband retired, and she then told him that the  pain
in the  arm was very severe, and that she had  diffi-
culty in swallowing.  This at once alarmed him and
he got  up and  came for me, and finding  that I was
out of town  called Dr. Clarke.   Dr.  C.  was  not in-
formed  by her or her husband of any special cause
of alarm, and after  careful examination  concluded
that  derangement of the digestive  organs was  the
cause of the  pain  and nervousness.   He advised a
pill of opium  to be taken at once and followed next
morning by Pil. Rhei Co.
  I was called by  Mr. W. about 7 o'clock the next
morning, Nov. 9, but owing  to some unavoidable de-
lays  it  was  nearly nine before  I  reached the  house.
   I  found Mrs.  W.  in  bed, looking  pale  and  dis-
turbed,  and I  could easily see that she was attempt-
ing to  conceal  fear  and  alarm.  She  said  she  had
passed a pretty  quiet night though  she  had slept
but little, and that the  pain had extended from the
arm  and neck across the upper  part of her chest,
and  down  upon the  right side,' and  that  the parts
were  sore.  Her tongue  was  quite  heavily  furred,
and  her pulse about. 100, occasionally intermitting. 
7
Her mind was  perfectly clear.   I asked her- what
specially  troubled her, and  she   said,  "why Dr.  I
can't  swallow,"  adding  that she had  tried to  take
the pills  which Dr. C. left, and  also to drink some
tea and some  water  which had  been  brought, but,
said she, "I cannot swallow, and the very idea chokes
me.
  I supposed  she might  be only nervous  and  hys-
terical, and  replied hastily "we will  see about that."
I then  prepared a pill containing about two grains
of opium, and putting it into a tea-spoonful of cur-
rant jelly,  handed  it  to her and asked her to swal-
low it.   She  started  up  in  the  bed,  and  leaning
upon  her elbow took  the spoon,  with the remark, "I
will  try."  At last,  after a great  deal  of  hesitation
and  irresolution, with a sort  of  shuddering, she put
it to  her mouth, and  with great effort attended with
violent  choking  spasms, in which the muscles of the
throat,  mouth,  face  and  eyes  were simultaneously
and  powerfully convulsed, she finally succeeded, and
then  immediately  asked for  some  water.   When  it
was  brought  she took the goblet and held it  a mo-
ment in her  hand,  and  then  suddenly  pushed  it
from  her with  a shriek, and the  exclamation, "Oh!
I can't,  take it away!"  and then fell back upon her
pillow shuddering and choking violently, the choking
lasting  for  a  minute  or two.
   I  immediately  ordered her room darkened,  and
kept  perfectly quiet,  and a large stimulating purga- 
8
tive  enema to be administered.   This operated  co-
piously  before I  left the house.
  At 12 M., I returned  and took Dr. Sargent with
me.  Her face had become flushed, her pulse  quick-
er and  fuller, her tongue dry,  and she was perspir-
ing freely.   There was then sighing respiration, with
frequent paroxysms  of choking, spasmodic  trouble in
the  throat  which were very  fatiguing;  and  any
proposition  to drink  or swallow,  or, apparently, the
mere thought of it,  produced an  agitation,  and ex-
pression of terror which  was really very  painful to
witness.   I believe   Dr.  Sargent  did  succeed, with
much persuasion  and  delay, in  getting her  to  swal-
low  about half  a tea-spoonful  of tea, but  desisted
from any further attempt  in obedience to her fran-
tic  appeals  that  we  would not ask  it  again.   She
said "it seemed  as though she  should  choke to
death if she  tried."   Still, when undisturbed, she lay
for  most of the  time very  quiet, and  in reply to
questions said she felt no  pain.
  She was  ordered  a  tea-spoonful  of laudanum, to
be administered   in starch  mucilage, by the  rectum,
at 2  P.  M.
  At 6  P. M., she was still flushed; her pulse  120;
her  skin hot and perspiring;  and her  mind  clear.
She had not  slept,  but had lain most of the  after-
noon with her eyes  widely open,  fixed and  staring.
She made no complaint of pain or of any  other  sen-
sation except the  "strange feelings"  in her throat. 
                         9
She had made  no attempt  to  swallow.   Once  this
afternoon, while lying perfectly quiet, she had start-
ed  suddenly up with  a look of terrible  fright,  and
a  scream,  and  seizing her  attendant  by the arms
had shaken her violently.  Then she had fallen back
upon the  pillow  and with  a smile said "I don't
know what I did  that for."  She had begun to have
great sensitiveness of the surface  and to  all exter-
nal impressions.   A gentle touch upon her  body,  or
more especially upon her forehead or face with the
hand,   caused  a  shuddering  and  catching  of the
breath, very much like that a man gives when the
cold shower bath first strikes him.  When the lamp
was first  brought  into  the  room, the  light as  it
struck  her produced  a shuddering  and  choking
spasm,  which lasted  for  some  minutes.  She begged
the bystanders not  to  touch her and not to move
 the bedclothes; said  she could  feel their  breath  even
 at a distance.   When  I took  her arm  to  feel the
 pulse it caused a violent shudder.
   She  had shown through  the day very little  incli-
 nation  to  converse, and had made  very few inquiries
 or remarks about her disease.
    I ordered  one  and a half tea-spoonfuls  of  lauda-
 num by enema.                  „
    At  12  P.  M.,  Dr. Sargent  called with me  again-
 There  had been  no  improvement in the symptoms,
 and no material  change.  There  had been no  sleep
 and no disposition to  sleep.  No  severe  pain or  suf- 
10
fering, beyond the  frequent  paroxysms of choking,
and  of  sighing, gasping  respiration.  Her mind  was
perfectly  clear and on  the  whole  tranquil.  No at-
tempt had been  made  to swallow and I especially
enjoined upon the  nurse that  none should be.
   Ordered two tea-spoonfuls of laudanum by  enema.
   Thursday,  Nov. 10, 8  1-2 A.  M.  The nurse  reportr
ed that since  my last visit the  patient had been very
quiet, except a short period of  excitement at about
4  o'clock, when she suddenly  started up as if in a
violent  fright; which,  however, soon  subsided,  and
she relapsed  into her usual  calmness.   She reported
no  sleep, and no  attempt to  swallow  any food or
drink.
  This  morning  Mrs.  W. appeared  decidedly more
natural  and  much  more  inclined to converse. Her
mind was still perfectly  clear,  and  there was no  evi-
dence  that  I could  discover  of undue  agitation.
There was less  acute  sensitiveness to   external  im-
pressions.   The pulse,   condition of the  skin  and
tongue, and  the  respiration,  remained  as they had
been the day before.  She had  called, herself, for a
cup of  cold water  and  a napkin, and  wetting with
her own hands a corner of  the cloth  in the  water,
had frequently wiped  her face  with it, and  moist-
ened  her teeth,  gums,   and  tongue, and had very
much enjoyed  it.   Her  eye  was unusually brilliant
and staring, but the pupils were quite  natural. The
only new symptom consisted in the annoyance  caused 
                        11
by a  very small amount of viscid,  tenacious, white
saliva or mucus,  which collected  in  the  fauces  and
mouth,  and which  she made  constant and fatiguing
effort to expel by hawking and spitting.   When, at
last,  a little of  this was  wiped from  the teeth  and
lips,  or  spit  upon a napkin, it looked like  bits of
moistened  wool caught upon  the cloth.  The  pres-
ence  of this  secretion  in the throat,  and the sensa-
tions  to which it  gave rise, caused frequent  " chok-
ing spasms," like those spoken  of the day before.
   I made  no attempt to administer anything by the
mouth, but again repeated the laudanum injection;
this  time with  beef tea.
   At 1  P. M., no material change.  Enema of lauda-
num  repeated.
   At 5  P. M., Dr.   Sargent  saw  Mrs. W. for me, as
I  had an engagement out  of town, and he succeed-
ed in  inducing her to attempt to swallow,  and to
take  a  small  quantity of  tea.  This, however, was
accomplished  only by  a great deal of persuasion, and
very  slowly,  with constant recurrence of  spasmodic
paroxysms of choking, and of catching, gasping res-
piration.
   At 10.30 P. M.,  I  found  that  she had exhibited
much  greater evidence  of  fatigue" and  exhaustion
than  before, and that the annoyance caused  by the
viscid saliva, had kept up a continual and  most wear-
ing effort  to  expel  it by constant hawking, spitting,
wiping  and retching,  with all the concomitant chok- 
                         12
ing and gasping.   She lay  upon her back, her eyes
widely  open and strangely staring, perspiring freely,
but with warm  skin, with pulse  still full and dis-
tinct,  and respiring  only  in deep sighs with long in-
tervals  between.  There was now complaint that this
respiration was more painful and tedious than at any
previous time,  and  of distressing sensation of weight
and pressure in the lower part of the chest and epi-
gastrium.  She told me, in a whisper,  that she knew
she was dying,  and  immediately summoned a  num-
ber of  her  friends  to bid them good bye, and to
make  disposition of her affairs with reference to that
event; in all manifesting  a perfectly  clear intellect.
  I thought this state  of nervous  excitement  and
exhaustion might be the  result of  intermitting the
opium, none having been  administered since 1  P. M.,
and I  immediately ordered an  injection of one  tea-
spoonful of laudanum; but at  the  end  of  half  an
hour,  seeing no  effect from it, I  injected subcuta-
neously into the  forearm  1-3 gr. of Sulph. Morph. in
half a drachm of water.   The result of this was, that
in half  an hour  her breathing  became  much  freer
and more natural,  and the  tiresome  efforts to  clear
the mouth and throat much diminished.   I  left her
at 2 A.  M.
  Friday, Nov.  11,  9 A. M.   The nurse reported  no
sleep,  but that Mrs. W.  had been very  quiet.   At
the earnest solicitations  of her friends, she  had  at-
tempted  and   succeeded  in swallowing  several  tea- 
                         13
spoonfuls of tea, and I found her very much pleased
with  the accomplishment.   Except  this there  was
very  little  change  from the  day before.   I imme-
diately urged the great importance of improving her
present opportunity of taking nourishment, to which
she assented, and said she would certainly make every
effort, adding that, if she  could  take food, she did
not  see why  she might  not recover;  and  I,  myself,
felt  quite  sure,  that  whatever might  be  the   true
nature of her  disease, a favorable  change was about
to occur.  Of this I spoke  to  her  in the most  con-
fident  manner,  determined,  if possible, to remove
from  her mind  every nervous anxiety; and  in  this
succeeded to such  an  extent  that  she seemed en-
tirely assured that patience and persevering effort
would  overcome  her  difficulties  in  swallowing,  and
that  when  these were  overcome,  sleep would return,
and  with sleep,  relief  from all her  troubles.  From
this  time she began to  take beef tea,  milk  punch,
and  gruel in  considerable quantities, commencing at
first with a tea-spoonful  at a time, which could  only
be repeated at long, intervals, and after  a great  deal
of preparation for each effort in  clearing the mouth
and  throat,  and in forming  the resolution to attempt
the act of swallowing;  and it was evident that every
such  attempt really called  for this struggle of the
will,  before  it could  be determined  upon.  After a
time,  however,  she mustered  resolution enough to
take her  drinks  in larger quantities, until, before 1 
14
P. M.,  she  would  drink off  a tea-cupful or more at
once.
  Her  manner of drinking was very peculiar.  When
a cup was brought  her she would  ask to be assisted
up in the bed, and then, after  a  long preparation,
like that just  described,  she would  take it in  both
hands and  in a spasmodic, tremulous manner, carry
it suddenly  to her  lips, and  drain  off its contents al"
most at a single  gulp, making no natural  break in
the act;  then she would  fall back upon the  pillow
exhausted, and choking violently for several minutes.
  Still  she had begun to  take nourishment in good
earnest and in sufficient  amount;  her strength had
not become  thus far dangerously impaired;  her pulse
was good;  her mind  clear; and her  spirits, if they
had  been heretofore  despondent,  were now suffi-
ciently hopeful; and when I left her  at 1.30 P. M.,
it was  with  a sincere  degree of confidence  that  she
was better and that she might ultimately recover.
  At 4.30  P.  M., 1 was  called  in great haste, and
upon  my arrival, found Mrs.  W.  in  a condition of
complete collapse.  Her face was pale and   pinched;
her whole  body cold as  marble,  and  drenched  in
clammy  perspiration;  and hei  pulse  imperceptible.
Her mind was clear and  calm.   She was even cheer-
ful.  She said that  about an  hour  previously  she be-
gan to feel  cold,  and  to have a  sensation of terrible
stricture  and  pressure upon the  chest  and  in  the 
15
epigastrium which still continued  and seemed to "al-
most stop her breath."
 ' Hot stimulants were  immediately  given in large
quanties, large sinapisms were  applied over the  chest,
and the  whole body was wiped dry and wrapped in
warm flannels, with  the application of external heat
by  means of hot bottles  and soapstones.  But no
reaction  took place,  and for several hours there was
very little change.  About 9 P. M., she began to be
delirious  and remained so  until  12,  though  at no
time  violent.  Soon  after  that hour  she  vomited  a
very large amount of green, viscid fluid, and shortly
fell into a general convulsion, which  lasted, perhaps,
two  or three minutes.   From this  she emerged un-
conscious, and remained so  for half an hour,   groan-
ing heavily,  when she again vomited, and again  had
a  convulsion.   Before  this  convulsion  had  passed
away she  was dead.  Her death  occurred upon the
178th day from   the wound, and on  the  beginning
of  the fifth day  from the  first manifestation of  the
peculiar  symptoms.

   There is no doubt left   upon  my  mind  that  this
was  a case  of  hydrophobia.   It  is true   there  were
times  in the  progress  of  the  disease when  I felt
doubtful of  my   diagnosis, and uncertain  whether I
might not be  dealing  with symptoms of a nervous
and  hysterical  origin.   I  felt this doubt  more  es-
pecially  in  view of the  partial  remission  of  the 
16
 symptoms upon Thursday and Friday  mornings; but
 the  final result, with  the  phenomena by which it
 was  ushered  in, and a  complete review of the whole
 case  in  the light of other  recorded  cases, leave me
 in no uncertainty.
   I have  made  this report  thus  full, not  only on
 account of the great interest of  the case itself, but
 because it is  the first case  of  the disease which has
 been  reported to this   Society,  and  the  first, so far
 as I  can learn, which has occurred in this immediate
 vicinity.  If I shall seem to have been unnecessarily
 minute and particular,  I have a  two-fold apology  to
 offer; first, that  there   are  many, who, considering
 the rare occurrence of the disease, would be inclined
 to  accept  with  hesitation the  diagnosis,  unless all
 the  facts upon  which   it was founded were  clearly
 and  ingenuously stated; — and,  second,  that there
 have  been  among us   medical  men, and may  still
 be  some, who affect  incredulity as to  the  existence
 of any such  distinct disease as  hydrophobia, result-
 ing necessarily from the poison  of a  rabid  animal.
   This  incredulity and  skepticism form an interest-
ing feature in the history of medical  opinions  con-
 cerning the disease, and are  worthy of notice.   One
 of the theories by which it has been  attempted to
 explain the remarkable  symptoms so  characteristic
of hydrophobia,  has  been, that   they are only  the
manifestation  of exalted and  perverted nervous ac-
tion, caused by  a  disordered state of  the  imagina- 
                         17
tion, which, under the fearful anticipation of the  pe-
culiar  horrors  with which  the disease  is  popularly
invested, has  been wrought up to the highest pitch
of excitement and apprehension.
   How utterly this  theory fails  to  account for  the
phenomena in question appears  from  the  following
facts:  1st,  that  there are now  upon the  pages of
medical literature a very large collection of reported
cases,  gathered from  all quarters of this and other
countries, the histories of  which exhibit a  degree of
uniformity  in rise, progress,  symptoms, and termina-
tion, of most striking exactness, and  a closeness of
resemblance which could not be imputed to  the  in-
fluence of  morbid imagination  alone, however highly
wrought  upon, when  occurring  under  such widely
various circumstances of time, place,  age,  sex, tem-
perament  and intelligence.  2nd, that  a very large
proportion  of such  cases  have  occurred   in young
children who  were utterly incapable of  comprehend-
ing and  appreciating  the  danger  before  them, or
of acting in  any intelligent  degree under  the influ-
ence of fear  and  apprehension,  even if an attempt
had  been  made to  explain  the   subject  to them.
For example, it would be  obviously impossible  upon
 this theory to explain  the phenomena  presented in
the very  interesting case of  hydrophobia, reported
 by  Dr. Ingalls of Winchester, in the  Boston  Med-
ical and  Surgical  Journal of  Sept. 13, 1860, where
the patient  was  only  two  years  and eight months
       3 
18
 old; or,  again,  those in  the  case  reported  in the
 same  Journal, by Dr. J.  Mason  Warren, in the issue
 of July 14, 1859, where the patient's age  was only
 three  and  a quarter  years; or, yet again, in that
 of Dr. George  Hay ward, same  Journal  of  Jan. 18,
 1854,  where the  subject was a beautiful boy of only
 seven.
   But  another,  and  more sensible  theory has  been
 that hydrophobia is only  a  form of traumatic  teta-
 nus, and  it  is not  to be denied  that a certain de-
 gree of resemblance does exist between  the two dis-
 eases;  yet, however,  with such  radical differences as
 ought  to  make the  diagnosis no very difficult  mat-
 ter  with  an enlightened  and judicious  observer.
   The  points  of resemblance may  be  stated  thus:
 a  common  origin in traumatic lesion;  approximate
 uniformity of duration when  either  disease is fully
 established;  in  both  great  difficulty  of swallowing,
 which, in tetanus occasionally, as in  hydrophobia al-
 ways,  is greater with reference to liquids than  solids;
 occasionally  in  tetanus, as in  hydrophobia always,
 very acute  sensitiveness to external impressions, so
 that frightful exacerbations of the spasms  may come
 on from the most  trivial exciting   causes; and in
both uniform and obstinate resistance to  treatment,
with almost  uniform fatality.  The differences  are__
that the  period  which elapses  between the  lesion
and  the accession of  the disease, is always  much
shorter in tetanus than in hydrophobia, in the former 
                         19
being  seldom  prolonged  beyond two  weeks, while
the  average is considerably  less, and  in the latter
being  seldom  shorter  than forty days,  occasionally
as  long even  as two years,  while  the average  is
from five  weeks to  three months;—that  tetanus
may follow any description of wound  from any va-
riety of causes,  while hydrophobia  only follows the
bite of a rabid animal;—that tetanus is  character-
ized by continuous  and  rigid spasms   of  voluntary
muscles with   scarcely  any   remissions,  while  the
spasms of hydrophobia  are interrupted  and of short
duration, with complete  intermissions and periods  of
entire  muscular repose;—that in tetanus the  jaw
is fixed and  immovable, from spasm of the  muscles
of mastication, while in hydrophobia it  is never;—
that in tetanus  saliva may overflow the mouth  from
 inability to swallow  it, but  in  manner entirely un-
like the distressing  hawking and spitting of viscid,
 scanty,  tenacious  matter,  so  characteristic of hydro-
 phobia;—that in tetanus there  is  rarely  any intel-
 lectual disturbance, the  patient  usually retaining his
 sensibility to  the  last, unless it  is suspended  by the
 remedies  employed,  while in hydrophobia there  is
 almost always some  deviation from  the normal con-
 dition  of the mind, which  in  the progress of the
 disease  often  passes  on to wild excitement and de-
 lirium;—that in  tetanus  the  eye  is suffused  and
 fixed,  and the  features  rigid and  permanently dis-
 torted, while  in hydrophobia the eye  is  unnaturally 
20
briUiant,  prominent, and staring,  and  the counten-
ance  wears an  almost constant  expression of terror
and suspicion;—that in tetanus  the patient articu-
lates  his words  with indistinctness  and difficulty,  and
is generally silent  from choice, while in hydrophobia
the  articulation is  clear,  rapid,  and  often  boister-
ous . — and,   finally,  that,  however   uncertain   and
unsettled may  be  the  true pathology of either, it
is sufficiently obvious that the symptoms  of tetanus
point to lesion,  functional or organic, mainly  of the
spinal cord and  spinal system of nerves, while  those
of hydrophobia  indicate as clearly disturbance of  the
functions  of  the medulla oblongata at  first,  and at
last super-added disturbance of the  brain.
  The  truth  is  hydrophobia  is  a disease of  unus-
uaUy  distinct and  well  marked  features,  and  very
little  liable  to be  confounded  with  any  other.  Its
sequence  upon the  bite of a rabid animal, or  upon
innoculation in some other form  with  its  saliva; its
stage of  recrudescence, using  this term  not  strict-
ly to  describe the occasional and exceptional reopen-
ing of  the  wound,  but  in  a  more general way to
signify  the train of symptoms which  usually,  for a
few   days, precede   the  characteristic  phenomena;
the final  accession  of these  phenomena in the  form
of spasms of the muscles  of  deglutition,  rendering
the act of swallowing  one of great difficulty if  not
utterly  impossible, with consequent horror of attempt-
ing the act,  and aversion to  all  sights  or sounds 
21
which  suggest it;  the spasmodic pain, stricture, and
distress across the  chest, and at the  epigastrium, with
interrupted sighing, gasping  respiration;  the viscid,
tenacious,  annoying  secretion of  saliva,  with  the
wearing and  painful  process by  which  the  sufferer
endeavors  to  expel it;  the  acute and   astonishing
irritability of  the  surface,  by which influences  so
slight  as  to  be  inappreciable  to  others  become  to
the  patient  the  source  of  agonizing  paroxysms of
distress;  the exaltation and  perversion of the  men-
tal faculties,  which often rises  to  wild  and uncon-
trollable  fury;  and  at last  in  most  cases  collapse,
general  convulsion, coma, and death;—all these com-
bine  to constitute  a  disease as distinct  and unmis-
takable  as it  is  terrible  and  intractable.
   But it  is  not my  purpose to enter  upon  a full
description of the disease, or  offer  any extended  re-
marks upon its  history, causes, nature, pathology, or
treatment. All  this  has  been so  well  and  compe-
tently done  by  authors accessible to every one, that
any attempt  on  my  part would  be superfluous, and
at best  but a  poor  repetition.
   There is, however,  a single point to which I would
like to  call  your  attention briefly, and  that is, the
impression which prevails in the public mind, and to
some  extent  among physicians, that the hydrophobic
patient  is always delirious,  violent,  and  dangerous.
I  have  heard surprise expressed, by persons of both
classes,  at the  mildness  of  the  symptoms  in this 
                         22
respect,  and  the  general  tranquillity  of  mind of
Mrs. W., with an implied doubt  of  the diagnosis on
this  account.  It would require but  a brief reading
of the  reported  cases  which  are readily accessible,
to correct  this  impression entirely.   I have already
alluded to  the varying condition  of  the mind in  the
different subjects of  the disease, and to  the wide
range  of  its  morbid  manifestations  between  the
slightest departure from  a normal  state and one of
wild and uncontrollable mania.
  There have  been  not  a  few cases in  which  the
patient has gone on  to the fatal termination in  full
possession  of  his mental faculties.   Dr. Rush, quoted
by  Dr. James Thacher, relates a case in which  the
patient " retained his  reason  and  a  playful humor
till  the last  minute  of his  life."   In  another of  Dr.
Thacher's cases  the patient "appeared to possess a
considerable  degree  of reason  through  the  whole
scene; was perfectly  able to  distinguish  and speak
to every  acquaintance around him,  and  was  appa-
rently  sensible that his dissolution was fast approach-
ing;—showed no disposition at any  time  to do  the
smallest  injury  or  mischief  to any  person,  but was
constant in expressing  the warmest and most benev-
olent wishes for the welfare of his family and neigh-
bors;"   Dr.  Charles D. Homans,  in  a very  fully  re-
ported case,  says of  his  patient,  only three  or four
hours  before  his death, "intellect still  remarkably
clear,"  and makes no allusion to subsequent change 
23
     in this respect.  Dr. Fogg of South Boston, reports
     a  case  and  records  the  patient's death, "reason
     continuing to  the  last."  Dr. George Hayward says
     of  his little patient  that  he " showed  a  wonderful
     degree of resolution  for  a child of his  age;" and
     again, " as  long  as he  could  make  himself  under-
\     stood he  seemed to be in possession  of his reason."
     In a  case reported by  Dr. Herron of  Ohio, " there
      were  only occasional aberrations of intellect; so that
      with  the utmost   imaginable  suffering,  there was
      combined a consciousness almost  perfect."   In a case
      reported  in the  American  Journal of Science,  the
      patient is "represented  as  having  been  from this
      moment" (the first  appearance of  the  symptoms,)
      "fully  conscious   of  his  danger; he  was a  pious
      man,  and  was  supported  by  religion  in his  ex-
     ■ tremest  suffering,  and in the  hour  of  dissolution."
      Dr. Peckham of  Providence, reports a case in  which,
I      only   24  hours   before  death,  "a magistrate  was
      called in, and the patient made his  will, exhibiting
      no  excitement or  delirium."    Dr.  Armington   of
      Providence,  relates one  of which  he  says  at the
      close, "her mind   seems to  have  remained clear  to
      the  end."
         Such   instances might be  multiplied, but  these
      are  sufficient  for  my purpose.   They  show   that a
      good  degree  of  intellectual  soundness   is  not  in-
      compatible   with   other   unequivocal   signs  of  the
      disease.   Yet,  such cases  are  to be  looked upon  as 
24
exceptional.  They  constitue  but a  small  fractional
part of  those  which  are reported,  and  bear only a
small proportion  to those in  which  mental  aberra-
tion and violence are  present.  Most  generally, how-
ever,  delirium  and  violence  do  not  manifest them-
selves  in any  marked  degree during the  first  day
or  two  of  the  disease, but  sooner or later  do ap-
pear,  and  often  constitute the  most  appalling  fea-
ture of  this terrible malady. 
Note.
  For the convenience of any who may be induced  by a pe-
rusal of this paper, or led, as I have  been, by a practical ne-
cessity, to inquire further concerning hydrophobia, I append
directions to a few of the more generally accessible sources of
information.
  In the Boston Medical and Surgical Journal are numerous
reported cases.  Of those which  seem best authenticated the
following is  a correct  list:—Vol. 14, page 341, by  Dr. Otho
M.  Herron  of Ohio ;  A^ol. 39, page  532,  by Dr. Abner  II.
Brown of Lowell; Vol. 49, page 493,  by Dr. George Hayward
of Boston ;  Vol. 50,  page 115, by Dr. Charles D. Homans of
Boston ;  Vol.  50, page 240, by Dr.  J. S.  H. Fogg of South
Boston ;  Vol.  50, page 509,  by Dr. Thomas W. Blatchford of
Troy, X. Y.;  Vol. 54,  page 452,  by Dr. F. H. Peckham of
Providence ;  Vol. 54, page 455, by Dr. Armington of Provi-
dence ;  Vol. 57, page 209, by Dr. J. P. Maynard of Dedham ;
Vol. 59,  page 399, by  Dr.  S. D.  Townsend  of Boston ; Vol.
60, page 409, by Dr.  J.  Mason Warren of Boston ; Vol.  65,
page 129, by Dr. William Ingalls of Winchester.  In many of
the old medical libraries may be  found Thacher on Hydro-
phobia, a volume of about 500 pages; a quite elaborate treat-
ise upon the disease,  and containing reports of quite a large
number of cases, some of which are very valuable.  In  the
published Transactions of the American Medical Association
for 1850, is a  " Report upon Hydrophobia," by  a committee
consisting of Drs. Blatchford and Spoor, to which is appended
a table of 106 cases,  giving  the patient's name, the authority
       4 
26
upon which the  case is reported, the date of the bite, the date
of sickening, and the date of death.  As a supplement to this
report,  and immediately  following it, are  given  detailed re-
ports of a large number of the cases collected in the table,
most of which had never been published elsewhere.   Some of
these are very valuable contributions to our knowledge of the
disease.  The article upon  hydrophobia in  the Cyclopedia of
Practical Medicine, by Dr. J. L.  Bardsley, is a full and syste-
matic treatise, including an interesting sketch of  its history,
and is evidently  regarded  by writers since its publication, as
authority upon the subject.
  It would,  of course, be  superfluous to refer to the works
upon Surgery and  Theory and Practice now in general use
among Students. 
i