Manual of Surgery Volume First: General Surgery. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume First: General Surgery. Sixth Edition.
Thomson, Alexis
Surgery
_Clinical Features._--There is almost always a history of the patient
having been bitten or licked by an animal supposed to suffer from
rabies. The incubation period averages about forty days, but varies from
a fortnight to seven or eight months, and is shorter in young than in
old persons. The original wound has long since healed, and beyond a
slight itchiness or pain shooting along the nerves of the part, shows no
sign of disturbance. A few days of general malaise, with chills and
giddiness precede the onset of the acute manifestations, which affect
chiefly the muscles of deglutition and respiration. One of the earliest
signs is that the patient has periodically a sudden catch in his
breathing "resembling what often occurs when a person goes into a cold
bath." This is due to spasm of the diaphragm, and is frequently
accompanied by a loud-sounding hiccough, likened by the laity to the
barking of a dog. Difficulty in swallowing fluids may be the first
symptom.
The spasms rapidly spread to all the muscles of deglutition and
respiration, so that the patient not only has the greatest difficulty in
swallowing, but has a constant sense of impending suffocation. To add to
his distress, a copious secretion of viscid saliva fills his mouth. Any
voluntary effort, as well as all forms of external stimuli, only serve
to aggravate the spasms which are always induced by the attempt to
swallow fluid, or even by the sound of running water.
The temperature is raised; the pulse is small, rapid, and intermittent;
and the urine may contain sugar and albumen.
The mind may remain clear to the end, or the patient may have delusions,
supposing himself to be surrounded by terrifying forms. There is always
extreme mental agitation and despair, and the sufferer is in constant
fear of his impending fate. Happily the inevitable issue is not long
delayed, death usually occurring in from two to four days from the
onset. The symptoms of the disease are so characteristic that there is
no difficulty in diagnosis. The only condition with which it is liable
to be confused is the variety of cephalic tetanus in which the muscles
of deglutition are specially involved--the so-called tetanus
hydrophobicus.
_Prophylaxis._--The bite of an animal suspected of being rabid should be
cauterised at once by means of the actual or Paquelin cautery, or by a
strong chemical escharotic such as pure carbolic acid, after which
antiseptic dressings are applied.
It is, however, to Pasteur's _preventive inoculation_ that we must look
for our best hope of averting the onset of symptoms. "It may now be
taken as established that a grave responsibility rests on those
concerned if a person bitten by a mad animal is not subjected to the
Pasteur treatment" (Muir and Ritchie).
This method is based on the fact that the long incubation period of the
disease admits of the patient being inoculated with a modified virus
producing a mild attack, which protects him from the natural disease.
Public-domain text, read in full here on John Shaqi.
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