A CASE 
OF 
EABID HYDROPHOBIA 
By DOCTOR FEREOL. 
Translated from the French by 
Alumnus of the College of Physicians and Surgeons, New York City. 
BARN A. R D ELLIS, M.D., 
[Reprinted from the Ohio Medical and Surgical Journal.| 
COLUMBUS: 
NEVINS AND MYERS, BOOK AND JOB PRINTERS. 
1878. A C A S E 
OF 
RABID HYDROPHOBIA. 
DOCTOR FEREOL. 
Translated from the French by 
BARNARD ELLIS, M.D., 
Alumnus of the College of Physicians and Surgeons, New York City. 
All that which relates to the disease of hydrophobia has 
the sad privilege of exciting our interest in a high 
degree, not only on account of the terrific spectacle presented 
by such a horrible malady, but on account of the numerous 
questions which arise in general pathology, and in doctrines 
which arise when we contemplate this strange scourge, so 
much studied, and so little understood. 
The case which ‘ I submit for the consideration of the 
Academy merits, it seems to me, special attention. 
The question is, in fact, whether we can attribute to a bite 
given two and a half years before death the disease which 
took the patient off in three days. 
I am the first to acknowledge all the alarm that such a 2 
question is apt to create, and the unpleasant impression 
which one is apt to produce by reading it. But the case 
having been brought before me, I have no right to shun 
that discussion which the subject requires. Then, what 
could I do better than to present it to this learned body 
which contains specially the most competent men in all 
branches of Biological science, and whose works have 
already more than once thrown brilliant light upon the 
pathology of this disease. 
Now, I say, at the threshold of this discussion, that it is 
an extraordinary exception to admit so long a period of in- 
cubation. The average duration of time, at the expiration 
of which a person has the right to believe himself free from 
inoculation, is, happily, much shorter; the limit of from 
forty to sixty days being true in most cases. 
In so delicate a question, I shall be excused if I do not 
omit any of the details which I have been able to gather, as 
the smallest fact may be here of the greatest importance ; on 
it might depend a modification of the diagnosis, and it is 
for this reason that I have been so particular to give all the 
facts I was able to gather. I now present to you the clinical 
notes taken, under my direction, by M. Fourestie, the 
interne in my service. 
On June 18, 1874, at 8.30 o’clock A.M., D , aged 
forty-eight years, at the time doctor of medicine and phar- 
macist, entered the above named hospital. This patient is 
of a robust constitution ; a little above average size; com- 
plexion dark brown. 
Seated in his bed, his eyes brilliant, and very restless, we 
are struck at once by his strange air, and wild looks. His 
answers are short and rapid—his pupils much dilated. He 
affects to be calm, seeing those around are so, but we feel 
that he is internally anxious and agitated. He tells us that 
CLINICAL NOTES. 3 
he has passed the night in a state of extreme surexcitation, 
and, not having been able to sleep, has written more than 
fifty letters. Being willing to give us an idea of his temper, 
he says he seldom puts himself in a passion, but if he ever 
did have a quarrel with any one, he would cut them into 
little pieces. Meanwhile, he pronounces no word incoher- 
ently, and answers very clearly to our questions. 
He complains of a profound aversion to liquids, an aver- 
sion which has already lasted several hours, and he brought 
several oesophageal bougies for us to try, as he said, to make 
him drink in spite of himself. He demands an emetic to 
dear out the bile which is suffocating him, and constricting 
his throat; he also desires a bath, and assures us he will not 
be afraid to go into the water. 
We present to him a mirror, and he turns his head away 
precipitately, and at the same time is taken with a laryn- 
geal spasm, marked by a catching of the breath (like a man 
who has been suddenly surprised by a dash of cold water) ; 
still he lets us examine his throat with a silver spoon, with- 
out manifesting any repulsion. If we present to him a 
glass to drink from, even empty, he refuses it immediately. 
In passing the hand two or three times before his face, so 
as to disturb the air, we produce a spasm, and the patient 
recoils with fright. A handkerchief agitated before his 
face produces the same effect. The fresh air from the win- 
dow produces disagreeable impressions, and he asks that we 
shut the door. We present to him a little bottle of ether 
which he brought, but he cannot support the odor, and begs 
us to close it immediately. He says he has eaten nothing 
for two days, and feels weak, but has no appetite. We pre- 
sent him a piece of bread, of which he eats several mouth- 
fuls, slowly, but without satisfaction. He complains of a 
dry mouth, which, he says, increases the difficulty of swal- 
lowing. He has no sputation. Dr. Fereol discovers a cicatrix 
on the dorsal surface of the left hand, at the level of the 4 
second interosseous space. Asking him its origin, he 
answers rapidly, and without seeming to attach any import- 
ance to it, that he had been bitten by a mad dog a long time 
ago. He tells us that, yesterday, he suffered pairl in the left 
arm, vaguely in all the arm, finally fixing itself principally 
about the biceps. Let us remark here, once for all, that the 
cicatrix did not undergo any appreciable change during the 
course of the disease, and that it was not specially painful. 
Our patient has a little trembling of the lips, and the two 
hands extended, open, show slight oscillations. The tongue 
is gray and a little pasty; the posterior portion of the 
pharynx is of a brilliant red, contrasting with the paleness 
of the palate and of the buccal mucous membrane. No pain 
on pressure, either upon the larynx or upon the sides of the 
neck. No hyperesthesia of the skin; on the contrary, he 
allows us to pinch him very severely without knitting the 
brows, and says he feels it plainly, but that it gives him no 
pain ; and he adds, with a sort of boasting manner, that he 
has often seen danger, but that he don’t cry easily. 
Examination of the chest, discovers a slight pleural friction, 
sound anteriorljr, and on the right side. During this exam- 
ination, the patient prattles without cessation; is much 
agitated, and several times slips out of his bed and in again. 
His features are drawn, his face anxious. At the least noise, 
he turns his head and beseeches for a little calm. We pre- 
scribe an enema of grammes, jv., (about 60 grains) chloral 
and 12 drops laudanum. 
18th June—evening. The day has been calm. The 
enema was not given till nearly 3 P. M. It has been re- 
tained. We are able, by several artifices, (a straw tube in a 
bottle, covered with willow wicker work) to make the patient 
swallow a little beef tea, and half a glass of beer; he has 
eaten several mouthfulls of meat. We offer him cherries, of 
which he swallows several, but trying to get the pit out of 
the cherry, caused a slight spasm and fright. M. F6reol 5 
seeing this, stones several cherries for him, and then he 
swallows without difficulty, excusing himself for the trouble 
he gave us, and saying that before to morrow be will have 
eaten them all. 
He says he is perfectly sensible ; that he is cured; that he 
has slept a little ; that he shall go to sleep to-night; that to- 
morrow there will be no trace of his disease, and he will re- 
sume his occupations. Nevertheless, he cannot drink at 
this moment. He takes, without fear, a glass which we of- 
fer, containing a little beer; he keeps it a long time, but 
cannot decide to carry it to his lips; is calm; prattles of 
things and men ; raises the glass to his cheek as if to scratch 
himself; all this giving him no spasm. But he cannot de- 
cide to attempt to drink, and finishes by depositing the 
glass, saying “this beer is too strong, and what I have 
already taken has gone to my head.” 
His pupils are continually much dilated, but on turning 
them to the light, they contract noticeably. During this 
conversation, which has been pretty long, and quite calm, 
the patient appears a little odd and seems rather eccentric ; 
sucking habitually the stone of a prune, or apricot, or date, 
saying it has been his custom for a long time, because he is 
sensible that his saliva is thick and prevents him from drink- 
ing. He relates to us that he was a student fourteen years, 
and that at that epoch of his life he frequently drank to ex- 
cess, especially of wine. He would drink very often five or 
six bottles of wine, he says, without any inconvenience, but 
never absinthe, and rarely brandy. Since then, say twenty 
years, he has been very sober. He never drinks either wine 
or liquor. He made himself, in his laboratory, with glyeose 
and hops, but without alcohol, a beer, which he says was 
his only drink. He assures us that he feels very well and 
that he sees nothing in his state but a nervous surexcitation, 
which he attributes to his troubles and annoyances, and 
disappointments in business and friendship, and of which 
he will be master in a few days. 6 
He says he has patients whom he is attending, and he has 
not time to be sick. 
He add? that, besides, he has already had an attack anal- 
ogous to this, but he feels this attack is not so severe as 
that; that it was about a year ago; that he had been to con- 
sult Dr. Potain on this subject, but that he did not follow 
up the inquiry. We prescribe a second enema like the fir d. 
19th June—morning. The injection has not been re- 
tained ; sleeplessness absolute. 
The patient has gotten up several times and taken his 
clothes, wishing to go out, but was easily convinced by a 
man whom we had left to watch him, that he ought to lie 
down and rest tranquilly. 
On entering his room at half-past eight A. M., it is easy 
to see that his condition is singularly aggravated. At the 
moment when we open the door, the patient jumped up in 
surprise, and hid himself behind his bed, crying, “ Shut! 
shut the door.” His voice choking, stifling. We heard it 
break between each word. The least gesture near him 
seems to put him in confusion. Seeing a red handkerchief 
which he recognized and whieh he had used yesterday, puts 
him in a state of unconquerable terror. He implored U3 for 
silence and repose. We ask him if he will take a bath. 
He turns away with terror and says it will be impossible to- 
day. 
His air is haggard, his physiognomy terrified. The 
laryngeal spasms have increased in frequency and in in- 
tensity ; the bile is stuffing him up, he says, and he de- 
mands an emetic. 
He complains that something has its claws on his throat, 
and is strangling him; and at the sight of the silver spoon 
we used yesterday, he recoils with fear and has a spasm. 
Nevertheless, he insists that we should examine it, and 
says it will be possiole with an iron spoon. With the 
iron spoon, we press down the tongue without difficulty, 7 
and find the conditions same as yesterday. No sputation. 
The pupils are still more dilated than on last evening. It 
is with difficulty that we perceive the iris, forming a circle 
of extreme tenuity. No cutaneous hyperesthesia, on the 
contrary, there is an absence of all kinds of pain very pro- 
nounced. 
It is absolutely impossible to make him take anything; 
the mere idea causing a spasm and a sensation of unspeak- 
able horror. He has not touched the cherries of last even- 
ing, and cannot look at them without fear. The pulse and 
temperature appear normal; no headache ; no localised pain, 
and only this constriction of the throaf, with the idea that 
he needs an emetic, though he has no nausea, no retching, 
and not the least cough. We find no more the pleural 
friction sound which we so plainly heard yesterday. The 
patient has not been to the water closet. He says he has urin- 
ated, but that appears doubtful, as we find no urine, and he 
has not been seen to urinate. Until the present moment, 
there has been no furor ; only agitation. 
Towards 2 o’clock P.M., an attack of fury sets in. He pre- 
cipitates himself against the doors; he screams out; he 
complains that he is being strangled, and demands that we 
bring instantly a priest. At the same time he commences 
to expectorate. We succeed in getting him to bed, and put- 
ting him in a straight-jacket. We inject twice, two thirds 
grain of chlorhydrate morphine. These injections brought 
a little repose. 
During this fit the patient pronounced no phrase inco- 
herently. He appears to submit blindly to a force which 
makes him vociferate loudly, and which agitates him, but 
he is not delirious, scientifically speaking. An instant after 
giving way to his rage, he asks pardon, excuses himself for 
all the trouble he has given, assures us he is going to be 
calm, be will command himself, etc., etc. He is conscious of 
the gravity of his condition, and asks earnestly that he may 8 
not suffer too much. He wishes us to cover up the mirror o f 
his room, but he cannot bear any longer the sight of a white 
sheet; and we are obliged to surround the bed with colored 
curtains. 
Towards 9 o’clock P.M , the saliva has returned more 
abundantly. Each time that he wished to expectorate he 
warns the attendants not to come near him, as if he had a 
consciousness that his expectorations would be injurious to 
them. He again insists upon having an emetic to “clear 
out the bile which is suffocating him.” 
Dr. Fer6ol remarks that very often the sputation is pre- 
ceded by a special movement. We should say that the effort 
to vomit was circumscribed by the back part of the throat, 
without any action of the diaphragm, or any effort of regur- 
gitation. It is in these moments that the patient is agitated 
the most. He says he wishes to vomit, and asks to be turned 
on his side, and that we loosen the strings of the “camisole 
de force,” (straight-jacket), so that he can “disembarrass 
himself of the bile which is choking him to death.” He 
supplicates us in the most humble, and most touching 
accents, that we take off the straight-jacket which binds 
him and invokes with an emphatic exaltation, but not 
menacingly, the rights of the brotherhood; says he wishes 
to do harm to nobody; that he knows he is going to die, but he 
demands instantly that we do not add to his sufferings by 
keeping him thus bound. Then he speaks of his mother, 
of whom he is the only support, and upon which he weeps 
he speaks of his friends, and calls again for the priest. New 
enema, of morphine 45-100 of a grain. 
At 11 o’clock at night, we find the patient very calm, but 
it is already easy to perceive that he is not conscious of his 
state. He has urinated in the bed. He hardly recognizes 
us. His respiration is heavy and slightly stertorous ; he 
expectorates at each instant without trying to avoid the 
persons around the bed. We are told that he has had a 9 
violent access, during which he has cried, “ Thieves! Mur- 
der!” Another enema, morphine 30 100 grain. After our 
visit, he had two more fits; he broke the cords which con- 
fined his legs, and struggled violently. The patient did not 
succumb sudden'y, but after having labored for breath for a 
quarter of an hour, died at 3 o’clock A M. 
Such is the picture, perhaps a little faint, of the disease 
which was unfolded under our eyes. We will now give 
such information as we w'ere able to get from several mem- 
bers of his family. 
D has twice had typhoid fever, once in his youth, 
and the second time in 1860, (thirty four years old.) This 
last sickness was the only one we could confirm, and was 
very grave. In December last he had the influenza; but, aside 
from sore throat, which he seems to have had frequently, he 
enjoyed habitually excellent health. During his long course 
of study, devoted successively to medicine and to pharmacy, 
he is said to have imposed upon himself many privations. 
Without any resources, he paid for his lectures by working 
as conductor of a locomotive. Since then he has preserved 
a gloomy and little expansive temper. Most of his relations 
and friends have described him as a man very calm, and 
very peaceable; still, one of his friends said he had seen 
him several times dreadfully angry. Endowed with great 
energy, he has saved the lives of several persons under 
diverse circumstances. He was named “ Knight de la Legion 
d’Honneur,” for his brilliant conduct during the siege of 
Paris. The folks around him assured us that, so far from 
having drinking habits, he led an extremely sober life. 
The patient told me, (but he was then already at the be- 
ginning of the period of excitement,) that during the four- 
teen years of his study he drank enormously; but no one 
has been found to certify to the fact; on the contrary his re- 
lations all deny it. They have affirmed, separately, that he 
never had any attack of acute mania, and that if he had 10 
sometimes a singular and quarrelsome temper, with some 
oddities such as old bachelors have, never could any of his 
acts be taxed as folly. We found no trace of mental aliena- 
tion in his family. 
D. told us he had been bitten by a mad bitch. The acci- 
dent occurred in December, 1871, two and a half years ago. 
It was long and deep, and thus took a long time to heal. 
Two other persons were bitten by the same bitch, but our 
patient was bitten first. The other persons and himself were 
bitten several times and at several days apart. Our patient 
cauterized his own and the wounds of the two others, but 
we do not know if it was done immediately. They did not 
use the actual cautery, but simply ammonia and nitrate of 
silver. 
The two persons bitten have not felt any ill effects from 
the bite. The bitch was short haired, small, and of no breed. 
D. found her in a camp during the siege, and he had such an 
affection for her that he allowed her to have her puppies on 
his bed. 
See the circumstances under which the bite was given: 
D. had noticed for several days that his bitch was acting 
strangely, that she snapped at everything she encountered. 
His pupil in pharmacy, trying to prevent the bitch from 
tearing something, the animal rushed at him and tried 
to bite, upon which D. seized it and attempted to whip it, 
and thus was bitten on the hand. The beast was shut up in 
a room with food; she refused to eat or drink for four or five 
days, and had several fits of rage. She tore everything to 
pieces in the room; a Voltaire arm chair, a bed-spread, etc., 
etc. At the end of this time D. decided to get rid of the dog, 
and poisoned her with some drops of hydrocyanic acid mixed 
in some vitriol. 
The autopsy was made by a veterinary surgeon, who de- 
clared that the dog died of “rabies canina.” They told us 
besides, that this bitch for some time previous to the biting 11 
of D., h id licked constantly with her tongue the only one of 
her puppies which was left alive. 
This puppy, three weeks old at death of mother, showed 
signs three weeks afterwards analogous to those of his parent. 
He refused food, springing with furor upon those who ap- 
proached him. He succeeded in biting one of the persons 
who had already been bitten by his mother, and in the same 
place. The new wound was immediately cauterized with 
ammonia. This puppy died soon after, at the foot of the bed 
where he was chained. Before death he was also seen by a 
veterinary surgeon who affirmed that he presented all the 
signs of rabies. Finally. Madame X. says she has a little 
bitch who had been bitten by D.’s dog, but who has never 
shown any rabid symptoms—yet it is proper to add that this 
dog has long, thick hair, which may account for his not hav- 
ing been infected. She probably was not bitten at all, but 
only rolled over by the rabid dog. Be that as it may, the 
accident of December, 1871, had so pre-occupied the mind of 
our patient, that his disposition had become very sombre. 
He had frequent discussions with his friends upon the sub- 
ject of hydrophobia, and endeavored to prove to them that 
there was no such disease; yet, happening to make the least 
bit of a scratch on the scar, he immediately cauterized it with 
ammonia and nitrate of silver; asked to attend one of his nieces 
who had been made sick through fright from a dog. a lively 
sentiment of uneasiness was plainly visible in his features. 
Since January his character has become soured to such a 
degree, that it was noticed by those who approached him that 
he was no longer sociable; his affection fora little niece whom 
he much cherished, was almost changed to aversion, but it is 
true that during this time he had had discussions about 
money matters with his family, and also much family trouble. 
At the same time he returned to religious ideas, and even to 
religious practices, for which he had always evinced some 
aversion. A few days before he came to the hospital, he had 12 
felt general malaise, with lassitude, extreme feebleness and 
insomnia. The 15th of June he was unusually taciturn. 
On the evening of the 17th, he wrote to Dr. Demarquay, 
whose acquaintance he had made in the ambulances (mili- 
tary hospitals) of Paris, begging him to come to see him, be- 
cause he felt very sick; the next morning wriiing another, 
telling the Doctor not to disturb himself as he had decided 
to enter the Maison de Sante. 
So, this morning D. quitted his domicile without letting 
his family know of his sufferings, pretending he was going 
a journey of some days, but coming in secret to the Ma son 
de Sante, where he took a private room on the ground floor. 
Autopsy.—30 hours after death, in a very warm tempera- 
ture. Rigor.—Mortis very pronounced; reddish congestion 
on all the depending parts. 
Lungs.—A little emphysema on the surface; on the two 
apices a few tubercles; from both lungs, which were ve*y 
large, upon being cut escaped very flack blood The trachea 
and the larger bronchii were filled with a rose colored froth 
which completely obstructed the cavity of the vessels; the 
mucus membrane of the same is also red, whereas that of 
the smaller bronchii is normal, the ultimate bronchii < on- 
taining no mucous. No pulmonary oedema. No little ecchy- 
moses in the vicinity of the root of the lung, 
Heart.—Is a little large, loaded with fat; both vet tr eles 
are full of diffluent black blood. No fibrinous val- 
vular lesions. On the internal face of the aorta we f >und 
large ecchymoses. 
Stomach.—Is empty. At the level of the cadiac office we 
found upon the mucous membrane little cccMm s* s ai d ar- 
borisations very marked. On the superior portion of the 
cul-de-sac, is an ecchymotic spot of an undefined emit ur, 
which is elongated and lies in the middle of a tufnd nd 
dark colored arborisation. Several of the replications of he 13 
mucous membrane are the seat Of brownish discolorations. 
The pyloric orifice healthy. 
Liver.—Healthy. 
Syleen.—Healthy. 
• Kidneys.—Capsule adherent, though putrefaction was al- 
ready very pronounced, and the bladder contained no urine. 
Brain.—Meninges are adherent and congested superiorly 
from the horizontal circumference. On the surface of the 
two lateral ventricles were found several light colored 
ecchymoses. The brain tissue is perfectly sound. The 
cerebellum, Pons varolii, and Mdulla oblongata are all normal. 
Spinal Cord.—The dura mater and pia mater, are both 
congested, principally at the level of the inferior part. The 
vessels were much congested, and, upon several points wre 
found extravasations of blood. Special hardness of the 
“cauda equina.” Ecchymoses at the level of emergence of 
the last intercostal nerves. Upon the posterior and inferior 
surface we remarked upon the pia mater numbers of small 
white star-shaped spots, resembling fragments of virgin 
wax, which were easily displaced under a jet of liquid. 
M. Gomband, preparer of specimens in the laboratory of 
Prof. Charcot, has examined microscopically, the medulla 
oblongata and cord in a fresh state, but jound no lesion. 
When these organs have become sufficiently hardened we 
shall examine them and give results. 
DISCUSSION. 
Summary.—A man of excellent health, non-alcoholic, hav- 
ing no mental alienation either acquired or hereditary, after 
several days of sadness and general uneasiness, is taken sud- 
denly with hydrophobia; all the signs of rage being mani- 
fest; culminating in death in three days. 
The autopsy shows the lesions which up to the present 
time have always been found in cases of death from mad 
dog bites. Two and a half years before the attack, the pa- 14 
tient was bitten by a dog showing all the symptoms of 
“ rabies canina.” The autopsy was made by a veterinaire 
who declared absolutely that the dog was mad; and besides, 
this same bitch was nursing a puppy which died also mad, 
three weeks after its mother. 
Such is, in a few words, the statement of fact, upon which 
we propose to make a diagnosis. 
One thing appears without doubt to be settled; viz: the 
dog which bit D., was mad>. The symptoms observed; the 
communication of the disease to the puppy which she was 
nursing and which she licked in an unusual manner the 
day before she became enraged; the death of the little dog 
with symptoms of rage; and the autopsies; all this 
leaves no manner of doubt.* 
On the other hand, the morbid symptoms observed in the 
case of D., were absolutely those of the true rage—apyrexia 
at the beginning, sadness, insomnia, pain in the bitten 
hand; then the appearance of hydrophobia; the laryngo- 
pharyngeal spasms produced at sight of bright objects; at 
the sole idea of liquids; by the action of trying to drink; 
by the simple agitation of the air before his face; by the 
presenting of a bottle of ether; preservation of his intelli- 
gence and memory; absence of partial delirium; facial ex- 
pression of fright during the spasms; marked secret terror 
betraying it by agitation; by the need to change place, and 
at the same time by the desire for repose, calm, silence and 
obscurity. 
By the aid of reasoning, and of will power exerted over 
him, he, submitting to the influence of those around him, 
who, reassuring him and encouraging him by affecting 
* We know that autopsy gives one infallible proof of the rage in 
the dog—viz: When we find in the stomach, a mass of litter, of wood 
straw, chaff, horse hair, leather, etc., etc., even a year after death, we 
can affirm at once that the animal died of the rage. Then we know that 
the dog of D. did devour a leather fauteuil, a bed spread, etc. 15 
themselves an unconcerned ness they did not feel, was in- 
duced to eat, however little, and also to drink, by the aid of 
several artifices, producing thus a relaxation of the symp- 
toms which has been very often noticed on the second day 
of the rage. A little sleep is obtained by the choral enemas, 
but soon the spasms return; the agitation is augmented 
without either delirium, fever, or contractions. During 
these attacks, the patient seems to obey a blind force, which 
dominates him for several minutes, but as soon as the spasm 
has passed, he excuses himself, asks pardon, assures us he 
will be calm, and recover his self-possession. Soon sputa- 
tion, which so far has been entirely absent, shows itself, ap- 
pearing with the crises of furor, which augment in frequency 
and in intensity. In the intervals, the patient is conscious 
of his approaching end; demands a priest; becomes tender 
towards his relations; has exalted religious sentiments, and 
in those concerning his family, without delirium; at the 
same time imploring us in the most humble and touching 
accents, to disembarass his limbs from the cords of the 
straight jacket, and finally, falling into a sort of paralytic 
coma, he dies three days after the first attack. 
Never do we see the symptoms of hydrophobia which are 
more clear, more complete, or more exempt from all compli- 
cations. It is the unmixed classical type of rage. 
I do not believe that any man can suppose here a case of 
delirium tremens under a hydrophobic form. Nothing in the 
symptoms, the antecedents, nor in the autopsy, authorizes 
any such hypothesis. Without, however, insisting, I pass 
on. 
There is another form of hydrophobia, very analogous in 
its symptomatology and its termination, to the rage vir- 
ulent. 
It is one form of maniacal delirium, sufficiently rare in 
the ordinary conditions of our patients, but well known to 
those who treat cases of mental alienation, and which we 16 
find remarkably described in the excellent work of Brierre 
de Boisment, which appeared in 1843 in-the “Memoires” of 
the Academy of Medicine, under the title of acute febrile deliri- 
um of alienation. This paper, which has been very well an- 
alyzed by M. Labadie Laysane in the article on Hydropho- 
bia in the Dictionaire de Medecine et de Chirurgje Pratiques, con- 
tains, in fact, many observations, wherein hydrophobia is 
noted and described with great care. The same subject has 
been treated by Lelut, Baillarger, Calmeil and Thuler, but 
in all these cases it was discussed as an hydrophobia, en- 
tirely special, which I will call mental and voluntary :; where- 
as, the hydrophobia of the rage is entirely instinctive, and 
suffered by the patient, who wrestles against it, very often 
with a singular energy. 
In the hydrophobia of alienation, there is much of spasm, 
and of furor; there is also more of anger and of agitation 
than there is in the real rage; and there is also sputation, 
but there is nothing which resembles the special spasm of 
the rage. It is much less the hydrophobia, than the re- 
fusal of drinks, which coincides the most often with the re- 
fusal of all species of alimentation; on the contrary, the 
really enraged one taxes his own ingenuity to help those 
who take care of him, to find some means by which he 
may drink. Our patient brought different forms of sesopha- 
geal bougies for the purpose. 
Many patients, in fact, imagine that if they can only 
drink, they will be cured. 
Mental hydrophobia alone is capable of being happily 
influenced by the deglutition of liquids; the true rage is not 
at ail modified. 
It is not unusual to see the enraged ones, by force of will, 
manage to drink. They are not the less liable to die for 
that, nor is the disease, the least in the world, retarded 
by it. 
My colleague, at the Maison de Sainte, Dr. Demarquay, 
has communicated to me a remarkable example. 17 
During the siege of Paris, an old professor, his neighbor 
and friend, contracted the rage from a little dog who bit him 
on the lip, and died, enraged, at the house of M. Meunier, 
veterinary surgeon. The cause of the death of the dog was 
not told to his master, who, twenty days later, was himself 
taken with the rage. 
“ I closed the curtains of the bed,” said M. Demarquay, 
“ and tried to make him drink. From nothing but the idea, 
he was taken with internal convulsions, which seemed to 
affect the heart and the respiratory passages. After one crisis 
of these spasms, he managed at last to swallow some beef tea 
and some wine. During forty-eight hours, I made him 
swallow, four times a day, a glass of beef tea and of wine and 
water. The deglutition was always preceded by a crisis of 
alarming spasms, but, finally, lie would drink. At the end 
of 48 hours, a few seconds after he had drank, he was taken 
with a violent spasm, during which he died.” 
But we contrast this hydrophobia (rage) with that of the 
merely alienated patients, who defend themselves like 
demons when we try to make them eat or drink ; who close 
the mouth tightly, twisting themselves and striking out all 
around them ; and uttering ferocious cries. There is such a 
capital difference between the two conditions, that in the 
chapter differential diagnosis, Briere de Boismont mentions 
meningitis, tetanus, epilepsy, etc., but does not mention 
rage, as if he judged that such a mistake was impossible. 
Two years since, when I was physician at the hospital 
St. Antoine, a very curious case occurred in the service of 
Doctor Mesnet, who was so good as to ask me to examine it 
with him. This note is not yet published, but it has been 
read recently to the Society of Practical Medicine, and will 
soon appear in the Union Medicale, under the title of Delire 
aigu hydrophobique, (acute hydrophobic delirium.) 
The patient exhibited all the signs of classic rage : respi- 18 
ratory spasm, special sputation, constriction of the throat, 
efforts to drink, rapid death, etc. 
Nevertheless, at the beginning of his affection, certain 
signs appertaining to the delirium of persecution or trouble, 
struck my learned colleague. Dr. Mesnet soon found out 
that the patient had had several accesses of mental aliena- 
tion, with attempts at suicide. He was, moreover, a proved 
drinker; he had already once had symptoms of hydropho- 
bia, and there had been mental alienations among his rela- 
tions. Then the delirious conceptions increased, and im- 
printed upon the disease an entirely special type. The 
patient told us that a woman was the cause of his sickness. 
This woman was a fortune-teller. He had lived with her for 
ten years. He left her two weeks since. At this time this 
woman had great power over him. She shuffled the cards, 
then suspended in the fire-place a beef’s heart, pierced with 
pins; and so long as it remained thus, the patient would be 
condemned to suffer. By employment of analogous means, 
she had already made a man suffer, by making him walk 
six hundred and seventy-five miles, without stopping or 
eating. 
We see in this case that alienation occupies, in the gen- 
eral picture, a place almost as important as the hydrophobic 
symptoms, and I comprehend, up to a certain point, that if 
we depend upon this morbid element, we make of the hydro- 
phobia a symptom of mental alienation. Nevertheless, I 
shall permit myself to make to my excellent colleague of St. 
Antoine some observations, not upon the title of his pam- 
phlet, which is unassailable; it is, perhaps, too much so— 
but he is not specific enough. Unquestionably, the patient 
died with some delirium, and of hydrophobia But did M. 
Mesnet intend to draw his observations as nearly like those 
of Brierre de Boismont as possible? The reflections which 
accompany it tend to make us think so. Then, I have re- 
read the memoir of Brierre de Boismont, and, as I said 19 
before, I cannot find in the special hydrophobia of aliena- 
tion anything but distant and superficial analogies to the 
hydrophobia of true rabies. On the contrary, in the case of 
Dr. Mesnet, it was entirely the respiratory spasm rabies, 
and all the habitual symptoms of the rabid virus, 
which we find entirely with the characteristic physiognomy. 
There is no fev. r, while it plays an important part in the 
observations of Brierre de Buismont, who entitles his me- 
moir Delire auju febrile des alienes, without introducing the 
word hydrophobia. Finally, it is impossible not to remark 
in the observations of M. Mesnet that there is absolutely 
nothing said upon the probability or improbability of a 
rabid innoculation. In the face of symptoms of rabies, 
one is led to inquire if there is not a combination of the two 
affections, rabies and mental alienation ? In this hypothesis, 
rabies should be the initial malady, and pertinently to 
which condition the mental alienation might set itself up, 
in a subject predisposed, anel would have the appearance of 
complication. 1 add that this observation is so different 
from those of de Buismont, 1 shall give the preference to 
this interpretation. 
I will say the same thing of an observation gathered by 
Durante, in the service of our common master, M. le docteur 
Gueneau de Mussy, (thesis of Gras., Paris, 1860) There, 
also, was apyrexia at the beginning, symptoms identical 
with those of rabies; but the patient had delirium, and com- 
mitted extravagant acis; he was alcoholic, like the patient 
of M M.snet. We have no certain indications as to his 
antecedents, as to his mental alienations, and we are igno- 
rant if he did, or not, have any rabid innoculation. There, 
again, the union of symptoms of the rage, and of mental 
alienation, to me, appears to implicate a combination of the 
two morbid elements, and which we do not find thus united 
in the observations cf Eoismont. f 
It is not enough that a hydrophobic patient should have 20 
even systematic delirium to entitle us to declare that his 
hydrophobia is symptomatic of madness ; and I believe that 
we can often find in the symptomatic characters, and in the 
evolution of the malady, reasons sufficient to decide the 
question, whieh, nevertheless, I confess, may be extremely 
embarrassing in certain cases. But, in the case of D., 
there was nothing like this. Neither as an initial malady, 
nor as a complication, did madness appear. The preserva- 
tion of his intelligence, and the absence of hallucinations, 
were no,ed nearly up to the period of paralysis. We know 
of no mental alienation in his family. As for himself, he 
had certainly oddities of character, and the fancies of an old 
bachelor; but every one agreed in representing him as a 
man of good sound sense, and of great energy of character ; 
one who, by dint of intelligence and will, had succeeded in 
rising from the ranks of the workmen, and had, at great 
pains, obtained his diplomat There is nothing, either in 
the past or present, which authorizes us to call the symp- 
toms those of mental alienation, any more than those of 
alcoholism. 
Shall we here agitate the question as to whether we have 
a nervous hydrophobia? That to me appears impossible, if 
we take the word in the sense generally taken, as applicable 
to special nomenclature—of hypochondriacal hydrophobia, 
which Dr. Brouardel has called imaginary hydrophobia, that 
which we might call lyssophobia, if this word had not been 
badly used by Dr. Bellenger, (thesis, Paris, 1845), to desig- 
nate the true rage, of which he made, with Bosquillon.a sim- 
ple nervous affection caused by terror. 
In this sense, imaginary hydrophobia is an affection not very 
rare, of which certain examples have become famous, (le 
President de Trousseau, l'observation de Barbantini, 1817), 
but this affection is always cured, or at least, alrrtost always. 
My colleague of the Maison de Santo, Dr. Demarquay, has 21 
communicated to me a very interesting case which I am 
happy to relate briefly here: 
In 1843, a man with rabies was brought into the service 
of M. Hueson, at the Hospital Hotel Dieu. It was necessary 
to put him in a straight-jacket; and in this operation at 
which M. Demarquay, the Directeur, and a volunteer infirm- 
ary overseer named Guerin, proceeded with much trouble, 
the patient defended himself, trying to strangle those who 
held him, and covering their faces with slaver. The next 
day he died. 
Young Guerin, eighteen or nineteen years old, being greatly 
frightened with the case, asked leave of absence to go home 
in the country to recruit, thinking he was sick. As he left 
the He tel Dieu, he was violently bitten on the leg by a dog 
who was passing. He re entered quickly the ward. Dr. 
Demarquay put a constrictor bandage above the bite, which 
he cauterized deeply with the actual cautery. 
Guerin, profoundly troubled, then set out, saying he should 
return in six weeks to die in the service. Forty days after- 
wards he came back to die, as he had said. The sight of 
water and of brilliant objects provoked in him a violent 
spasm. He could swallow nothing. We were all anxious 
about this poor lad. All these phenomena lasted forty- 
eight hours. At the end of this time, as he was still alive, 
Dr. Demarquay said to him in a spirit of pleasantry : u You 
have not rabies,” because the other patient died in forty- 
eight hours; and M. M. Husson, Rastau, and Vigla spoke to 
him in the same strain. He recoveied hope, he djank, and 
was cured. 
It is in these cases of pseudo-rabies that Dr. Barth aflirms he 
has never come across the symptoms described under the name 
of eereophobia. Now, then, it is impossible to liken the case of 
D., so rapidly fatal, and so absolutely like the most virulent 
rage, to those imaginary hydrophobias, which may have soma 
analogies to the virulent hydrophobia, more or less close, but 22 
which differ radically by their termination. Still it can be 
objected that nervous or imaginary hydrophobia may termi- 
nate in death. This I do not deny absolutely, though I do 
not know of orife authentic case. But, in a word, we can con- 
ceive that the imagination, over-excited by this train of 
ideas, may tend to a fatal nervous affection, only that what 
to me appears so difficult to believe, is, that this nervous 
affection assumes so absolutely the clinical signs of true 
rabies that it may be impossible to differentiate them. 
In support of my opinion, I find an extremely curious fact 
published by a veterinary surgeon, M. Deluc., in a paper upon 
rabies, which he read to the Society of Medicine and Sur- 
gery, of Bordeaux, the communication of which I owe to the 
kindness of Mr. Bonley. This case, 1 must say, did not re- 
ceive from me the same interprffation as from the author, 
M. Deluc, in fact, resuscitates tbe paradoxes of Bosquillon 
and of Bellinger, who hold that r bies is an effect of terror, 
and not of virulent innoculation. His conviction does not 
go so far, however, as to counsel a -staining from the cautery 
in cases of bites. But his paper is very interesting from the 
large number, which he has reported, of bites by dogs evi- 
mad, without tainting the persons bitten. This is 
another proof that the rabid contagion has less hold upon 
man than animals, and it is a fact too consoling not 
to be noticed in passing. But I come to the observation of 
M. Deluc, which I wish to analyze : 
A young girl was bitten on the knee and licked on the lips 
by a dog evidently rabid, on the 9th of March, 1868. 
Thirty six days afterwards they came to find M. Deluc. She 
had had delirium eight days. She had eaten nothing; had 
horror of drinks, and tried to bite. Bite if you will,” said M. 
Deluc, and good-humoredly offered his cheek to her. This 
gesture, the inspiration of the moment, had its full effect; the 
patient cheered up, finished by drinking, and recovered, after, 
however, ten days of sickness. Certainly, in this case, the 23 
patient was in a condition to die. But in what manner will 
she die ? M. Deluc has told us: “ Her exaltation wTould 
have augmented. Very weak from loss of nourishment, she 
would have decided to take nothing.” That is to say, she 
would have died of mental alienation, and not of rabies. The 
hydrophobia of M’lle. X., wTas in the refusal of drinks, com- 
plicated with the refusal of food. Her delirium and her men- 
aces to bite, give toher illness the true stamp of mental aliena- 
tion. The duration of her sickness is not favorable to the 
hypothesis of rabies. We can not too much admire the cool 
courage, the conviction, and the excellent inspiration of M. 
Deluc; but if he flatters himself that he cured a case 
of rabies, he is mistaken. He has only cured a case of im- 
aginary hydrophobia; and without proof to the contrary, I 
shall not admit that we can pass from the one affection 
to the other, nor that a patient having nervous hydrophobia 
can become affected with rabies, or true hydrophobia. All 
my clinical observations forbid me to admit that a concur- 
rence of conditions so characteristic as those of rabies, can 
be sometimes the manifestation of a special virus, and some- 
times the result of a simple functional deviation of the organ- 
ism. 
I cannot say whether i have been influenced by the im- 
pression I have felt about the unhappy patients* I have 
seen, (this is the fifth); but it seems to me that the cases of 
true rabies, carry in the highest degree the seal of specific 
virus; and it also seems to me that nothing in the world, 
unless from the same cause, is capable of producing in so 
short a time, effects so formidable, and so identical to that 
in all these cases. Have we ever seen the neuroses repro- 
duce thus faithfully the effects of a virus? Have we ever 
seen the syphilitic hypochondria, so tenacious, so deplora- 
ble, so overwhelming, terminate in syphilis? 
I find moreover, analagous conclusions in a dissertation 
by Dr. Christian (Oaz. des hop. 1st May, 1869.) For him, as 24 
for myself, nervous hydrophobia is but a variety of hypo- 
chondriacal delirium. 
This delirium may be calm or furious; it may terminate 
in death; but we never see established the rabid spasm, 
properly so called. The hydrophobia which is there pro- 
duced sometimes, has no similitude with that of the true 
spasm of rabies. 
I do not know for my part any authentic fact which may 
be contrary to these conclusions. 
The note upon hysterical hydrophobia by Burgraeve of 
Gand (Gaz. des hop., 23 Sept., 1854), terminating in death, 
is too incomplete to enable us to affirm that it was in all 
points like a case of rabid hydrophobia. The phenomenon 
of sputation is not mentioned. 
And in any case, if the symptoms had been absolutely 
those of rabies, I should conclude it was a true rabid hy- 
drophobia, of the cause of which we are ignorant. 
I can say as much of a fact which we find in the thesis of 
Matton (Strasburg, 1862). 
A gardener thirty years old succumbed in forty-eight hours, 
with all the signs of rabies. As we could after the most 
minute researches establish that the patient had been bitten, 
and that on the other side he had experienced very severe 
chills the day before his attack, we have no hesitation in 
attributing the rigors to the outbreak of rabies. It is 
simply noted that the patient had never had any preoccupa- 
tion particularly upon the subject of rabies, which made 
the author of the observation, M. Jacquier, entitle it with- 
out hesitation “Rage Spontanee” (spontaneous hydrophobia). 
Nevertheless a fact described in the notes gives us a 
thought. 
At the beginning of his affection he experienced a pretty 
lively pain in the right arm. It is therefore possible that 
this member had been the seat of an innoculation which 
had escaped the notice of the patient, or that he had dis- 25 
guised it, as is not rare with such patients, who always 
strive Against evidence. 
Then, to conclude, in the presence of a pretended essential 
hydrophobia, terminated by death, I will submit this dilem 
ma, viz: either the patient has presented all the signs of 
rabies, and it is in fact a true rabies, of which the cause re- 
mains unknown, or, he died with symptoms which were not 
absolutely those of rabies, and which might be referred to 
some variety of mental alienation. 
Pertinent to this I remark in the history of D., certain 
circumstances and a little fact which has its importance. 
It appears certain that following the bite in Decembf r, 1871, 
D. had had his imagination extremely excited; he was un- 
quiet, preoccupied; for a long time watching the cicatrix, 
and many times wrongfully torching it with lunar caustic, 
at the same time, whether he knew or not the works of Bos- 
quillon and of Bellenger, he pretended to deny the reality of 
rabid innoculation, saying that the patients died onty of 
fear. Before us, also, during the first hours at least, and 
until his reason was vanquished by frightful evidence, he 
affected a confidence which be did not really possess. He was 
not willing to appear to attach the slightest importance to 
his malady, neither to appear the least in the world preoc- 
cupied with the cicatrix on bis hand. This affectation 
which has been so many times noticed in these patients, 
was here well characterized; but this is not all; he told us 
that a long time back, but could not renumber the date, he 
believed he had felt some symptoms analogous to those he 
experienced when he decided to enter the Mahon de Sante; 
but added he, ‘‘They were not so strong.” \ 
He at that time consulted a doctor of the hospitals, M. 
Potain, who bad no remembrance of the fact, and after all I 
believe it was not M. Potain whom he consulted. What 
significance must we attach to this little fact? For me, I 
see in some degree a rough draft or sketch of imaginary hy- 26 
drophobia coming in unexpectedly, pertinent to an insignifi- 
cant malaise; one of those common sore throats to which he 
told us he had always been very subject. 
If imaginary hydrophobia showed itself in our patient D. 
at all, it ought to have been at this moment. It should have 
b%en at a time nearer that of the bite, when he was able to 
rely on his own judgment at least, under the shock of the 
incubation. 
However, he had nothing, for nobody around him I am 
assured had any knowledge of the fact; and those who were 
living intimately with him, have ignored his story of inqui- 
etude and his visits to M. Potain. 
How can we allow that a nervous hydrophobia, not mani- 
fested under these conditions, waited a year or more later, 
before breaking out; tint is to say, at an epoch when the 
security was greatest, not to say even complete, as in the 
case of D. ? In general, it is one of the most constant 
characteristics of imaginary hydrophobia, that it appears 
very near to the time of the cause of it; and without speak- 
ing of the characteristics of D., which became a case of 
true, rabid hydrophobia, the time of its appearance does 
not well agree with the hypothesis of an imaginary hydro- 
phobia. 
Now, outside of imaginary hydrophobia, as we are able to 
define it, and as it is generally defined, there exists a certain 
number of cases badly defined, which have not yet a 
well established place in medical science, or which, at 
the least, only figure there as rare species, of which the 
classification is not yet well determined. 
M. le Docteur Gros has dedicated a special division to 
these cases, of which there are six, in his Thesis, arranged 
under two categories. In the first, we find four cases of 
mortal hydrophobia, developed in subjects who had been 
bitten by dogs who did not go mad; and in the second, we 
find two cases of mortal hydrophobia developed in individu- 27 
als who do not appear to have suffered any species of innoeu- 
lation. 
These are not the only gases known to day in science. 
I have mide an abstract of those which I have baen able 
to find, and which I analyze briefly here. No doubt others 
exist, but which have escaped me. 
(1) A —Cases of Mortal Hydrophobia following the Bite of a Dog not Mad. 
1st. Obs. IX. (Thesis of Gros.) Roziere Journal de 
Sedillot, 1806: Child, thirteeen years; hydrophobia; con- 
vulsions; sputation not noticed; death in two days. The 
child had bsen whipped the evening before, and was bitten 
on the cheek thirty or forty days before by a butcher’s dog, 
who did not become afterwards rabid. Symptoms complete. 
Obs. dubious. 
2d. Cases announced by Virey (Acad, de Med., Feb. 15, 
1827). 
3d, 4th and 5ih. (Acad, de Med in Arch., Gen. de Med., 
1827, p 440) Three cases; one each by Leveille, Longet, 
Villermay, and Marc, briefly reported; mortal hydrophobia 
in two cases, bitten by non-rabid dogs. The third case of 
Mire is more than diubtful, because the malady lasted 
twenty days. 
6th. Obs. VIII. (Thesis of Gros.) Communicated by 
Velpeau (1835) to the Med. So. of Emulation: Young boy, 
thirteen years, bitten in the cheek ; cicatrix healed in 
eighteen days; one week later rabies declared itself; dead in 
three days. The dog was not mad, and was killed the even- 
ing before the death of the child. Diagnosis of Velpeau. 
Symptoms not noted. 
7th. Obs. X. (Thesis of Gros.) Obs. of Putegnat, of 
Suneville, Gaz. hebd., 8th June, 1860. Child nine and one- 
half years ; all the signs of rabies; dead in three days ; 
had been bitten six weeks before, by a dog who was driven 28 
away with a stick from a house where he was following a 
rutting bitch. The dog has not become rabid since. 
8th. Obs, XI. (Thesis of Gros.) Young man twenty- 
nine years; died rapidly with all the signs of rabies; had 
been bitten seven or eight months before bv a dog who had 
not gone mad up to the death of the patient. 
9th. Obs. of Decroix. (Abeille Med., 14th Sept., 1863.) 21st 
June, 1862.—The dog Tom is bitten by the dog Black. 10th 
July, 1862.—Tom bit a horse and several dogs, among them 
Black. 13th July.—Tom died in rabid. 15th May, 
1863.—The horse died mad; Black has not been rabid. 
M. Bouly, in the discussion in theAcad.de Mfdecine, ad- 
mitted that Tom must have been bitten by a rabid dog, 
but not the dog Black. 
10th. Obs. of Delpech. (Gaz. des hop., 1869.) A dog ex- 
cited by a rutting bitch, who was too small to take him, bit 
a porter who came to prevent him, and drive away the 
bitch; also bit a carter, under the same circumstances, and 
tried to bite his master. They drowned the dog, who showed 
no signs of rabies. Ninety two days after the bite, the porter 
died of hydrophobia. 
B.—Cases of Mortal Hydrophobia without Probable Jvnoculation. 
1. Obs. XII. (Thesis of Gros Gaz. des hop., 1858, p. 75.) 
Soldier thirty years; libidinous andblenorrhagic, spermattorr- 
ha3; rabiform hydrophobia; hallucinations; sputation. Pa- 
tient retained his reason. Emphysema around the trachea. 
At the end, hydrophobia diminished. He drank, with diffi- 
culty, a pint of wine and water. Coma. Dead in four days. 
2. Obs. XIII. Thesis of Gros. (Gaz. Med. de Valgeric, 20th 
of September, 1868, and Journal du progres, p. 278, Dr. Tis- 
seine, 1856) Soldier of the train; hydrophobia; moderate 
fever; access of furor; sputation. Dead in three days. 
Bronchial froth. He denied being bitten. 
3. Obs. of Jacquier (Bulletin de therap, 1857, p. 549). Gar- 29 
dener thirty years; all the symptoms of rabies; pain in 
the right arm; no bite; no belief in hydrophobia. Dr. 
Jacquie gave his observation the title : Rage spontanee. 
4. The thesis of Mondville, spontaneous hydrophobia pro- 
duced by moral causes. De la rage spontanee produite par des 
affections morales, 1821, No 197, contains six observations, 
with few details, very doubtful as to symptomatology. 
Among others, that of a servant girl violated during her 
menstruation. A fact relative to a young soldier seems 
much more like the rabies (spasms, sputation, begs that 
everybody will withdraw when he feels the access coming.) 
f>. Obs. of Durante (VII du la these deGros.) All the 
signs ot the rabies; signs mixed up with thoseof mental alien- 
ation. No innoculation established. 
7. Obs. of Mesnet (Union Midicale, 1874.) Same circum- 
stances. 
We can, grouping together all these cases, and without 
touching here even incidentally upon the question of spontan- 
eous hydrophobia in man, leave them until we have more 
ample information upon the action of essential hydrophobia. 
It is that which makes M Brouardel, (loc. cit.) apply the 
name of imaginary hydrophobia to all the preceding group. 
And now, see the objections that can be brought against 
my argument. 
They say: ‘ Your patient did not die of innoculated rabies: 
it is out of all possible limits of incubation ; and a bite which 
bad run back two and one half years, was as though it had not 
been made. That which contributes to prove this, is, that 
neitherof the two persons bitten at the same time had hydro- 
phobia. It was, therefore, death caused by a particular species 
of imaginary hydrophobia, as are all the deaths of patients 
who have been bitten by non-rabid dogs, or who have not been 
bitten at all. To establish that your patient died of virulent 
rabies after an incubation of two and one-half years, there was 30 
one single proof which you have not furnished. It was 
to innoculate one or more dogs with the spittle of the patient 
while he was still living. If the experiment had succeeded, 
no body could have denied the virulence of the rage; at least, 
it would have been an argument in favor of the incubation 
of two and one-half years; and in the absence of this proof, 
we shall always insist that the patient died of imaginary 
hydrophobia.” 
Here is the objection in all its force. At all events I have 
have not attempted to weaken it. But let us see if it cannot 
be answered. Firstly : The argument held that the two per- 
sons bitten at the same time as our patient, retained their 
health, is not absolutely good. We know, thank God, that a 
rabid dog does not make as many innoculations as bites. 
The administration statistics from I)r. Brouardel (loc cit), 
gives, it is true, forty-seven per cent., but our colleague 
remarks that the greatest part of the cases, not followed by any 
accident, escape the notice of the administration. The King- 
dom of Wurtemberg gives twenty-eight deaths in one hun- 
dred and forty-five bites; the General Hospital in Vienna, 
in I860, twenty five in one hundred and fifteen. “In thirty- 
six persons,” says M. Leblanc (Documents jrnir servir a Vim- 
toire de la rage, Paris, 1873), “ bitten by rabid dogs who died 
under my eyes, thirty-one escaped with no symptoms, and 
five died.” 
I have already produced the numerous cases of non conta- 
gion, which the paper of M. Deluc contains. In the reply 
which he made to this paper, Dr. Dupont, (Soc. de Med. etde 
chir, de Bordeaux, April, 1874), confirmed the statement of 
M. Deluc, and said he could bring a large number of cases to 
bear upon the same point. It is nothing, then, out of the 
ordinary to see two out of the three escape. 
I come to the question of incubation. Now, what do we know 
to day upon this point ? Very little. We ignore absolutely 
the nature of the rabid virus; how it has spontaneous birth 31 
in certain animal spscies; how it acts in organisms which it 
has penetrated through innoculation. In this regard, our 
forefathers, or the ancients, were much less affirmative than 
we are to-day. People have tried to put more precisi >n into 
this difficult question; and have clearly eliminated a large 
number of cases, more or less old women’s stories. 
The errors of diagnosis so frequent in matters concerning 
rabies; the notions recently acquired upon the subject of 
hydrophobia, viewed as a symptom of alcoholism, of mental 
alienation, of tetanus, of the grave fevers, of hysteria, of 
epilepsy, of certain kinds of pcisoning, etc , have finished 
by inspiring a scepticism nearly absolute upon all the past; 
so that it is to be feared we have erased cases which appear 
too exceptional, while we have fixed the extreme limits 
beyond which the rabid virus should be no more expect* d. 
It is generally admitted to day (report of M. Tardku to the 
consulting committee on hygiene, 1800; communication of 
M. Bouley, at the Academy of Sciences, April 4, 1S70), that 
rabies declares itself oftenest in the two months following 
the innoculation; three months passed, it is rare; it is ex- 
ceptional that six months elapse before it breaks out; after 
eight months, according to the opinions of those men who 
are occupied with the question, and who are the most com- 
petent, we lind no case which is not susceptible of the 
strongest objections. Nevertheless, Dr. Brouardtd, who, upon 
this point, agrees with the general opinion admits, excep- 
tionally. two cases in which the incubation had lasted much 
longer. In one of the cases it liste 1 ii teen months, (DL>*ez, 
viem. de vied, mil.it., second series T., XVII., ISoC) ; in the 
other, eighteen months, (Valentin, Union Med., IS70, p. 
432 ) These two observations appear to my colleague to pre- 
sent the characters of undoubted authenticity. 
I have made, in this regard, researches less extensive than I 32 
could have wished, and here are a few cases to add to the 
preceding ones : 
In the Annals med psych., 1843, M. Mesnet has had the 
kindness to indicate to me, on pp. 92 and 132, two 
observations (one by Aubanal, interne in Paris, 
now of the Asylum for Mental Alienation in Marseilles; the 
other, without the author’s name, read at the Soc. de Mid. of 
Paris , in which the incubation had lasted eleven and 
twelvemonths. These two observations appear to me still 
more indisputable than those of Dissez or of Valentin. I 
will say as much of the note of Corriere, interne with M. 
Huguier, at Beaujon (Gaz. des hap., 1864, No. 116), where the 
incubation had lasted eighteen months. The very curious 
circumstances of the observation and the reflections which 
accompanied them, are by M. Despres, who succeeded theny 
as Surgeon of the Central Bureau, M. Huguier, at the Beau- 
jon Hospital. 
M. Champagnat, in his thesis upon hydrophobia (Paris, 
1867), cites, under the authority of John'Hunter, an incuba- 
tion of seventeen months. 
M. Deluc (loc. cit.) said he had an authentic case of incu- 
bation of one year in a dog. 
1 am convinced that further researches would discover 
other analogous cases. 
We see, therefore, that, exceptional as they are, these cases 
are not absolutely rare. Nowt, 1 a;-k: Js not an incubation 
of eleven, twelve, fifteen, or eighteen months something for 
us almost inexplicable ? Frcm the m< ment we tee that a 
virus can sleep eighteen months in Ihe eystt m. without any 
sign of its presence, is it unlikely that the tame phenomena 
could be prolonged six months or one year longer? and 
where shall wre stop ? 
Nothing, then, in my opinion, demonstrates that labid 
virus may not hold itself in abeyance in a contaminated 
organism to a much more extended time than is admitted 33 
to-day; and there is nothing to prove that I have not the 
right to record my case with those I have cited. 
Without doubt, the best argument I could bring would be 
a positive innoculation of the saliva of the patient, in 
which I made default. I had hoped to make this experi- 
ment, but time and means both failed. Occasio praeceps. A 
few hours after the death of D., a distinguished 
veterinary surgeon, M. Weber, who heard of it by accident, 
came to offer his services, but it was too late. 
After all, I do not know whether the experiment would 
have cut short the discussion. 
If the innoculation had succeeded, an objection would 
have remained, a little common-place, to be sure, but still 
difficult to answer. It might have been said that the rage of 
D., well and duly recognized as virulent, was due to an 
innoculation posterior to the bite of December, 1871, of 
which the patient was unaware, or that he had voluntarily 
disguised it. As this objection can always be offered, I shall 
be permitted to remark how little is here offered of proba- 
bility. 
In the long conversation I had with D., he entered 
into the smallest, details of his life, and himself recounted 
the incidents of the bite of 1871. How can we believe that 
he kept disguised another bite? 
As to an innoculation by licking or lapping, it is not very 
probable. We are bound to believe that D., who had 
been so much preoccupied with the events following the 
bite, would have had reason afterwards to keep all dogs at 
a respectable distance. All the evidence I have been able 
to gather convinces me that he had but the one innocula- 
tion—that of 1871. Then, in case the experimental innocu- 
lation had failed, what conclusion could we come to? Do 
we know at just what point the most virulent rabies is in- 
noculable from man to the dog ? Such trials have often 
failed. 34 
I will cite among others the note of M. Bergeron, (arch, de 
med., 1862), where trials were made, with all the care imagin- 
able, and under the best condition to obtain results. The 
number of positive innoculations was in the minimum. M. 
Bouley has written “that the saliva of man is virulent,but 
in a much lesser degree than that of the carnivora.” 
We see, then, that a negative result would not have been 
certain proof of non virulence of the rage of D. 
If this is so, in the actual state of science, seeing the com- 
plete ignorance we have of the possible duration of the in- 
cubation of rabid virus, and seeing the numerous examples 
of incubation prolonged from twelve to eighteen months, it 
appears to me impossible to call spontaneous, a hydrophobia 
completely identical in its form to the virulent rabies, and 
which declares itself two and one-half years after the bite of 
a dog clearly mad; and I conclude, definitely, for the 
reality of the incubation. 
Though this discussion may be much too prolonged, I will 
ask permission of the Academy to add a few words upon the 
symptoms and the pathological anatomy of rabies. 
Already, in a fiist memoir, which runs back to 1859, and 
which M. Brouardcl has done me the honor to quote, at the 
same time combatting it, I said that the bronchial froth 
(ecume) appeared to me to play an important part in the 
phenomenon of sputation. The fact had forced itself 
upon noe, as I was observing a hydrophobic pa- 
tient. I was ignorant at that time that it had been 
discussed and established in an excellent article by Trolliet 
and Villerine, (Diction, des Sciences Mcdicales). Finding 
it there excellently well described, I was astonished that, in 
1859, it had not become current coin in science; so much the 
more that Berard and Denonvilliers, in their Compendium de 
Chirurgie, have added the weight of their authority. Since 
that time, M. Gros has admitted it in his Thesis (1860). In 
1869, in the Societie Medicdle des Hopitaux, I reproduced my 35 
remark, pertinent to $,n interesting observation on rabies, 
communicated by M. Millard; and in the following meet- 
ing, M. Ernest Besnier brought to us an observation of M. 
Lagorce-Lavergne, of Lille, who also attributed to the bronchii 
the principal origin of the rabid froth. 
M. Boucher, of Ville-Jossy, also agreed in this opinion. 
M. Brouardel still refutes that, to-day, meanwhile relying 
upon an authority -which I highly respect, certainly, that of 
M. Bergeron. I maintain, nevertheless,, my statement; and 
in the recent cases, as in that of 1859, here is what I have 
observed, viz : The enraged patient does not secrete saliva, 
or, but very little, in the first hours; that is admitted by all 
parties. The mouth is dry; the tongue pasty; the buccal 
mucous membrane is pale, as far as, and including the soft 
palate, also the tongue. 
Already, at this time we can perceive, at ltast in certain 
cases, a redness pretty lively and shining, at the extremity 
of the pharynx, compared with the paleness of the rest of 
the mucous membrane. 
The conditions remain thus for some time. It is only a 
few hours before death that sputation appears, and sud- 
denly, the violent attacks of furor break out. So far, he has 
had nothing but agitation, and that we could control more 
or less easily by reasoning. From this moment the straight- 
jacket becomes indispensable. When the patient is about 
to expectorate, we are notified by a sort of vomative effort, 
which is limited to the pharynx, the diapraghm taking no 
part. It is a kind of regurgitation. Then the patient says 
he is strangling; that bile suffocates him; that he must vomit; 
if he is lying on his back, he begs to be turned on to his 
side, so that the ubile will run out ” the more easily. That 
which we have taken for an effort of deglutition of saliva, is 
an effort of regurgitation—of expulsion—and it seems to me 
to be determined by the entrance of the bronchial froth 
upon the isthmu s of the fauces. When the patient feels 36 
that froth is in his mouth, he is taken with spasms, and 
with chills, and he recoils with horror. The water which 
he tried to swallow, produced the same effect. I think that 
this froth ascends slowly, but incessantly, driven, perhaps, 
by the ciliary epithelium, or, perhaps, by some special 
spasm of the respiratory passages. While the quantity of 
it is elsewhere, it is most singular that a few moments be- 
fore -trying to expectorate, the patient’s mouth is dry, and 
he complains that he has not saliva. 
I do net pretend to deny that at this very moment the 
salivary glands may begin to secrete. About this I know 
nothing. 
I have not said that the rabid virus is exclusively contained 
in the bronchial froth, nor do I now know more about it. 
I am equally in the dark as to what takes place in the dog. 
I am content to acknowledge in the human subject, following 
Trolliet and Villerm6, the large part which the bronchial 
froth takes in the phenomenon of sputation. And I believe 
I am the first to describe the movement of regurgitation, 
which signalizes the arrival of this froth in the mouth. I 
believe every body would verify the exactitude of my descrip- 
tion, if they could once see this when opportunity afforded. 
In accordance with this explanation, in the two autopsies 
I have made, I found the large bronchi and their divisions 
filled with a quantity of rose colored froth (ecume). In the 
same points the mucous membrane was of a lively red, with 
little sanguineous effusions; and on the contrary, the buccal 
mucus membrane is pale and seems normal. 
It is very remarkable that in nearly all the autopsies made, 
we find the apparent integrity of the salivary glands. We 
find neither redness nor hypersecretion, whilst the bronchial 
froth, and the redness of the pharynx and of all the air 
passages are very often noted. 
Trolliet and Villerm6 have set out the absolute impossi- 
bility of supposing that this bronchial froth proceeds from 37 
saliva, which goes the wrong way during deglutition. “ It 
is not the saliva which constitutes the frothy slaver; this on 
the contrary seems to ascend from the chest.” 
It is truly surprising that, with such a quantity of bron- 
chial froth, and such acknowledged signs of irritation of 
the mucous membrane, the patients do not cough. There is 
probably present a special kind of bronchial anesthesia, and 
it is without doubt the absence of the cough which has pre- 
vented most authors from attributing to these lesions the 
importance which they seem to me to merit. 
Still the cough does sometimes exist, (obs. de Michel et de 
F4r6ol actes de la Soc. Med. d’obs., 1859,) and in these cases 
we found signs of bronchitis on auscultation. But we can 
conceive that it is often difficult to auscultate at the moment 
when sputation is produced; the patient being too much 
agitated, and often is in the straight-jacket. But nearly al- 
ways at the beginning he complains of oppression ; a feeling 
of constriction at the throat, and of weight on the sternum, 
whilst he never complains of puffiness or swelling, nor of 
pain either in the parotid or sub-maxillary glands. 
It would not be exact, for the rest, to say that the patients 
succomb to asphyxia, if we take the word in the sense of a 
mechanical obstruction to respiration. 
The lesions which we observe upon the dead body, are much 
less those of asphyxia than of congestion. The little ecchy- 
moses about the umbilicus of the lung are often absent, and 
are always very slightly marked. 
The patients are not asphyxiated, properly speaking; they 
fall into a kind of comatose torpor, which we have called the 
paralytic period, or else they die suddenly. And in either 
case it seems that it may be by an exhaustion of the nervous 
influx. 
It would not be just any longer to attribute to cutaneous 
hyperesthesia, the symptom signalized under the name of 
aerophobia, a symptom to which Dr. Barth attaches consid. 38 
erable value, since he says that he has never seen it estab- 
lished in the imaginary hydrophobias. 
Cutaneous hyperesthesia, it is true, has been noted in a 
large number of cases, among others by M. Bergeron (arch, 
de med., 1862). 
On the other hand I have established in my patient a very 
marked anesthesia. The same fact is described in an inter- 
esting observation of M. Delpech (Gaz. des hop., 1869). The 
patient had cruelly wolinded himself on the head wishing 
to kill himself, and said he did not suffer from it, and that it 
did him no harm. 
We know that analgesia is the rule in rabies in brute 
animals. In this last we often see animals tear and wound 
themselves without showing any sign of pain. They feel, 
however; they recoil when we touch them with red-hot 
iron, but do not cry, not even when they are rolled or pushed 
about, at the same time biting sharply. The spasm pro- 
duced by the agitation of the air seams not to depend so 
much upon the'cutaneous hyperesthesia, which is not estab- 
lished, as upon a special excitation of the respiratory nerve 8 
The rabid spasm, itself, has in its form something of re- 
spiratory complication, which has not escaped any observer, 
and which distinguishes it absolutely from the hydrophobic 
spasms due to other causes than the virus of rabies. 
The principal symptoms, and the principal lesions o 
rabies seem, therefore, to cluster round the res ] .. 
tions. 
Everything is consistent with this view; and there is in 
this concordance a powerful argument in favor of the 
important part which it is necessary to attribute to the 
bronchial froth, in the pathological history of rabies in 
man. 
Having arrived at the end of this discussion, I will, if the 
Academy permit, sum up, under the form of propositions: 
1. The incubation of rabies is most often limited to the 39 
two first months of innoculation, but can, exceptionally, 
extend itself much longer, viz: as much as eighteen months, 
as much as two and a half years. 
2. The symptoms of rabies, habitually very uniform, 
may assume very different aspects under the influence of a 
number of elements, (mental alienation, alcoholism, hyste- 
ria, etc.); but there are certain signs, such as the respira- 
tory spasm, the special mode of sputation, the symptom 
described under the name of aerophobia, which belong only 
to rabies and which ought, very often, to permit of a diag- 
nosis under these complications. 
3. If imaginary hydrophobia, which is generally cured, 
can terminate in death, we ought to find in the symptoms 
sufficient reasons to affirm that it is not veritable rabies. 
4. The bronchial ecume (froth) plays an important part 
in the phenomenon of sputation in hydrophobic patients; and 
the principal symptoms, as well as the principal lesions in 
rabies in man, are grouped around the respiratory func- 
tions. 
It is the respiratory character which distinguishes rabid 
hydrophobia from all other hydrophobias of a non-virulent 
kind. 
Note by the Translator.—To avoid repetition, the word rabies, 
wherever used without qualification, represents the condition of innocu- 
lation by the virus of “ rabies canina.” 
The translator desires, also, to add a case from his friend and confrere, 
Dr. Maci, as lollows : Two brotheis in Bordeaux were bitten by a dog 
supposed to be mad. One brother went to America. After eighteen 
months, hearing nothing fiom the brother who remained at Bordeaux, he 
returned, and found tbat, his brother had died ot hydrophobia. He was 
taken sick at once, and died ot hydrophobia. Details not known.