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THE CURIOUS CASE OF THE BOY WHO WAS BITTEN BY A DOG AND THEN STARTED TO ACT LIKE A DOG


On October 23, 1902, a twelve-year-old boy was bitten by a dog. Two weeks later, he was having convulsions, making peculiar noises, growing thicker hair, and running around on his hands and feet. His mother feared the worst—her son was becoming an animal.

A description of this unusual case appeared in The Journal of Abnormal Psychology in August 1910. Henry W. Miller, the author of the article, was one of the many doctors to examine the patient. It was a puzzling case with a most unexpected solution.

THE DOG BITE
The patient, referred to as R.M.W., was born May 29, 1890. A “typical boy,” according to his mother, he liked to play and got along with other kids his age. He was healthy and bright. He showed no symptoms of neuroses before the incident.


The dog, described as a small terrier, had bitten R.M.W. on the calf of his right leg. His mother immediately began to worry. She knew that some dogs carried rabies, and there was a possibility her son was now infected.

R.M.W. was afraid, too. He heard stories from his mother about dogs going mad in the fall months, and feared the same might happen to him. The boys at school learned of the dog bite and teased him. “Look out,” they said. “He is going to bite you, he is going to go mad.”

SYMPTOMS EMERGE
About two weeks after the incident, R.M.W. was not feeling himself. At school, he made multiple errors in a spelling exercise, which was unusual for him. The teacher reported he did not seem well. When going up the steps at school “he seemed dazed, did not apparently know what he was doing or where he was going.”

That night, he awoke from sleep making a strange noise. This was followed by full-body convulsions and foaming at the mouth—classic symptoms of rabies. The following day, his mother tested the rabies theory by approaching him several times with water. Every time she did this, R.M.W. would “become rigid, draw back, and have a look of horror on his face.” The fear of water, or “hydrophobia,” is another defining symptom of rabies.

A physician was called to the house. He made the diagnosis official: R.M.W. had rabies. But further developments in the case would call this diagnosis into question.

DOG BEHAVIOR, HAIR, AND HYSTERIA
Two days after his first seizure, R.M.W. began to exhibit disturbing behavior. According to his mom, he would, at times, act like a dog. He was “wild, running about on his hands and feet, crawling under the bed, and looking at her in a peculiar dog-like fashion.” She noticed physical changes too, that the hair on his legs grew longer and thicker. She was convinced, not only did her son have rabies, he had taken on an animal nature.

His symptoms, including episodes of dog-like behavior, continued on and off for six years. The symptoms would disappear and then resurface about every six months as a sudden attack. These attacks typically occurred in January and, coincidentally, during the “dog days” of summer.

Government Hospital for the Insane, ca. 1900.

In February 1909, R.M.W. had a nervous breakdown that eventually landed him in the Government Hospital for the Insane in Washington D.C. He had been working at a newspaper office, when he began to feel numb, like an attack was coming on, and could not work. That night, he had convulsions and the following three days remained “in a stupor… he breathed heavily, had profuse perspiration… did not eat, did not speak.”

By the time he was admitted to the Government Hospital for the Insane, R.M.W. had gone a week without food. He was “laughing and crying alternately, shouting that he was going to die, that he was the Lord Jesus Christ, and that he was the devil.” This was when Dr. Miller met the patient.

At the time, Dr. Miller was the clinical director at the hospital. He interviewed the patient and his mother and developed a chronology of the patient’s symptoms over the past six years. Dr. Miller also performed a battery of tests and hypnotherapy. Soon enough, he came up with his own bizarre explanation for the patient’s unusual symptoms.
NOT RABIES
Dr. Miller didn’t believe the patient had rabies. In his published report, he never explained how he ruled out the disease. But several features of the case seemed to contraindicate a rabies diagnosis.

Rabies is a viral disease that causes severe inflammation of the brain. It is commonly transmitted to humans by contact with feral animals carrying the rabies virus, Rabies lyssavirus. Symptoms can include convulsions, foaming at the mouth, fear of water, hysteria, and paranoid delusions (so far, similar to the case of R.M.W.).

However, after the emergence of symptoms, an infected person has about a week to live. A scenario where R.M.W. contracted rabies and experienced symptoms for six years would be unprecedented. A rabies diagnosis would also fail to explain important features of the case. For instance, rabies does not go into remission for months at a time or resurface at regular intervals. And what about the dog-like behavior? And the hair?

Not to mention the small terrier that attacked R.M.W. displayed no signs of rabies before or after the bite, casting further doubt on the rabies theory.

Dr. Miller concluded that the patient must have had something else—something that caused rabies symptoms without actually being rabies. And, according to Dr. Miller, what the patient had was a neurotic mother.

A MOTHER'S INFLUENCE AND LYSSOPHOBIA
Dr. Miller believed that the mother’s insistence that her son had rabies was the major impetus for his symptoms.

Dr. Miller described the patient’s mother as having a “neurotic temperament” and penchant for “spectacular religious emotionalism.” In the months prior to the dog bite, there had been many reports of rabid dogs in Washington D.C. This likely put the mother on high alert after the incident with her son.


Team of doctors and nurses treating a single patient (foreground) at St. Elizabeth's Hospital (formerly Government Hospital for the Insane), Washington D.C., 1957.

In addition to knowing about rabies symptoms, the mother held popular, but erroneous beliefs about the disease. For instance, she believed that rabies symptoms occurred regularly at specific times of year (especially during the dog days), and that rabies made people act like animals.

According to Dr. Miller, R.M.W. was an impressionable young man. When his mother suspected he had rabies and looked for signs, R.M.W. acted in a manner that confirmed his mother’s view of the disease. He did this unconsciously and because he was anxious about having a fatal disease.

This hypothesis can explain many strange features of the disorder, such as the dog-like behavior and seasonal schedule of attacks. The mother constantly looking for signs of R.M.W.’s animal nature may have tricked her into seeing longer and thicker hair on his legs. Or, the hair could have resulted from rising hormone levels. R.M.W. was at a prime age for puberty, after all.

The mother read many books about rabies and did all she could to further confirm the diagnosis and find a cure. In addition to a procession of doctors, she consulted Christian Scientists and faith healers and admitted her son to various general hospitals around Washington D.C. She pricked her son with needles, tested him frequently with water, and even had medical students come to her house to examine his saliva.

Elaine Benes with Lyssophobia

Dr. Miller suggested that the mother’s behavior caused her son to develop lyssophobia—the fear of rabies. Other factors, like reports of rabid dogs in the area and the taunting from schoolmates, likely contributed. There have been several published accounts of lyssophobia, and all seem to involve some display of rabies symptoms, most commonly the fear of water.

Although lyssophobia can explain many of R.M.W.’s symptoms, it cannot explain all of them. A contemporary review of the case forces us to re-examine some of Dr. Miller’s conclusions and the limits of his diagnosis.

A CONTEMPORARY PERSPECTIVE
Dr. Miller had an overly critical view of the mother. It would seem that sexist attitudes of the era (which shaped much of psychology in the early days of the field) led Dr. Miller to emphasize the highly emotional nature of the mother. He was critical too of her “impolitic” efforts to get a firm diagnosis and cure for her son—things most parents would do if they believed their child was very sick. She was also a single mother and had to shoulder much of the burden herself. 

Granted, the mother’s behavior likely contributed to R.M.W.’s condition. However, it was highly probable that the patient had another disease (or diseases), unrelated to the mother, that Dr. Miller failed to recognize.

R.M.W. had many convulsive attacks, or “seizures,” over the course of six years. These attacks were followed by temporary paralysis (hemiplegia and paraplegia), tactile anesthesia, mutism, and blindness in one eye. It's difficult to imagine that fear of rabies caused these particular defects.

Instead, R.M.W. may have suffered from epilepsy, a neurological disorder characterized by recurring seizures. There is some evidence that epileptics have seizures more often at specific times of year, which could explain the seasonal regularity of R.M.W.’s attacks. Of note, epilepsy is sometimes followed by temporary paralysis and loss of sensation, known as Todd’s paralysis, similar again to R.M.W.’s case.

In the end, R.M.W. may have had several problems: anxiety, lyssophobia, epilepsy, and possibly others. The mother could have only been responsible for a fraction of these, and I'm glad a modern review of the case has allowed us to relieve her of some blame.

FURTHER READING
Miller, H. W. (1910). Report of a case of hysteria: Lyssophobia. First crisis following a dog bite. The Journal of Abnormal Psychology, 5(3), 100-108.
This is the original article describing the case of R.M.W. The article contains additional information not mentioned above, such as a strange dream the patient had about a pirate giving him drugs and a father wanting to kill his mother. Dr. Miller also suggests that his therapy, a “readjustment of the patient and his mother's viewpoint,” prevented further attacks for one year. We don’t know whether R.M.W. experienced any attacks beyond the one-year mark.

Williams, T. A. (1910). A Propos of Dr. Miller's case of lyssophobia. The Journal of Abnormal Psychology, 5(3), 109-113.
In a response to the original article, Tom A. Williams agreed with much of Dr. Miller’s conclusions and also blamed the mother for her son’s condition. We also learn that R.M.W. was presented before the Washington Society of Mental and Nervous Disease, and that Dr. Williams had a chance to examine the patient first hand. Dr. Williams also argues that R.M.W.’s case supports Babinski’s view of hysteria, i.e. "a hysterical symptom is one capable of production by suggestion, and susceptible of removal by suggestion-persuasion."

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