Rabies in a Human

~From Facts and Problems of Rabies~
by Arthur Stimson, 1910

“The onset of rabies is usually rapid. The patient usually shows some psychical change very early, becoming anxious, melancholy, and oppressed with a strange pre-
sentiment of harm…”

“There are many cases recorded where the onset was apparently determined by some severe mental shock, and the initial symptoms may be apparently purely hysterical. In fact, hysterical manifestations are not unusual and may lead to a favor-
able diagnosis and prognosis. These symptoms are in some of the cases part of the psychological pathology of rabies, an aggravation of the usually less violent aberrations. The state of mind induced by the beginning disease often renders the patient susceptible to excitement on exposure to impressions which ordinarily would not
produce it. Fright and terror may, therefore, be regarded in many instances as a manifestation of the disease…”

“The symptoms usually progress without delay after the preliminary signs are observed… The “ grand symptom,” hydrophobia, is pi’esent in the majority of cases, although influenced by the patient’s disposition and surroundings to a considerable extent. It arises from the extremely painful spasms of the organs of deglutition and
respiration, which are induced by attempts to eat or especially to drink. These spasms are often of such an agonizing character that the thought of them causes a mental anguish not exceeded in the possibilities of human suffering of physical origin. Consequently the sight, smell, or sound of liquids suggests the act of swallowing
and is sufficient to bring on an attack in many cases…”

“As the disease progresses the symptoms become more severe. The mind is usually clear, questions being answered with understanding until the voice becomes indistinct and the words unintelligible…There are periods of excitement which may be truly maniacal, the
patient raging about the room, destroying furniture, and trying to escape…”

“The voice becomes hoarse with a peculiar quality. The strange sounds emitted during
expectoration or on the onset of the seizure have given rise to the popular statement that the patient ‘barks like a dog.’ The convulsive seizures become more frequent and severe and distributed over a larger area. Sometimes the muscular contractions are so severe as to cause rupture of the muscles. Small hemorrhages from mucous surfaces and elsewhere may occur. Vomiting is a rather frequent symptom, and the vomitus is often black. The color is said to be due to regurgitated bile, but blood also is sometimes found…”

Death may occur during the convulsive stage, but more frequently a condition of paralysis mercifully leads the patient on to death. The spasmodic seizures become less severe and frequent and less readily evoked. The muscles, racked to the limit of human endurance, become limp. The face, which had expressed terror and extreme suffering,
becomes smooth and expressionless. The jaw drops and the mouth hangs open. There is commonly an excessive secretion of saliva of a ropy character which the patient is unable to expel and which flows out of the corner of the mouth in large quantities; but where this is not abundant, the tongue becomes dry and hard. The breathing becomes irregular and feeble, and finally stops…”