When the disease is about to declare itself it not unfrequently happens
that the wound, which had quickly and entirely healed after the bite,
begins to exhibit evidence of irritation or inflammatory action, or at
least to be the seat of morbid sensations such as numbness, tingling or
itching. The symptoms characterizing the premonitory stage are great
mental depression and disquietude, together with restlessness and a kind
of indefinite fear. There is an unusual tendency to talk, and the
articulation is abrupt and rapid. Although in some instances the
patients will not acknowledge that they have been previously bitten, and
deny it with great obstinacy, yet generally they are well aware of the
nature of their malady, and speak despairingly of its consequences.
There is in this early stage a certain amount of constitutional
disturbance showing itself by feverishness, loss of appetite,
sleeplessness, headache, great nervous excitability, respiration of a
peculiar sighing or sobbing character, and even occasionally a
noticeable aversion to liquids. These symptoms--constituting what is
termed the melancholic stage--continue in general for one or two days,
when they are succeeded by the stage of excitement in which all the
characteristic phenomena of the malady are fully developed. Sometimes
the disease first shows itself in this stage, without antecedent
symptoms.
The agitation of the sufferer now becomes greatly increased, and the
countenance exhibits anxiety and terror. There is noticed a marked
embarrassment of the breathing, but the most striking and terrible
features of this stage are the effects produced by attempts to swallow
fluids. The patient suffers from thirst and desires eagerly to drink,
but on making the effort is seized with a most violent suffocative
paroxysm produced by spasm of the muscles of swallowing and breathing,
which continues for several seconds, and is succeeded by a feeling of
intense alarm and distress. With great caution and determination the
attempt is renewed, but only to be followed with a repetition of the
seizure, until the unhappy sufferer ceases from sheer dread to try to
quench the thirst which torments him. Indeed the very thought of doing
so suffices to bring on a choking paroxysm, as does also the sound of
the running of water. The patient is extremely sensitive to any kind of
external impression; a bright light, a loud noise, a breath of cool air,
contact with any one, are all apt to bring on one of these seizures. But
besides these suffocative attacks there also occur general convulsions
affecting the whole muscular system of the body, and occasionally a
condition of tetanic spasm. These various paroxysms increase in
frequency and severity with the advance of the disease, but alternate
with intervals of comparative quiet, in which, however, there is intense
anxiety and more or less constant difficulty of breathing, accompanied
with a peculiar sonorous expiration, which has suggested the notion that
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