Rabies

“ In the early stage of rabies, the attachment of the dog towards his owner seems to be rapidly increased, and the expression of that feeling. He is employed, almost without ceasing, licking the hands, or face, or any part he can get at. Females, and men too, are occasionally apt to permit the dog, when in health, to indulge this filthy and very dangerous habit with regard to them. The virus, generated under the influence of rabies, is occasionally deposited on a wounded or abraded surface, and in process of time produces a similar disease in the person that has been so inoculated by it. ”

“ Here is his description of rabies as he knew it. The most important element is his recognition of the uncertainty of the length of the incubation period, but it contains two other ideas that are very interesting, because medicine in subsequent centuries has come back to them over and over again. One is that free bleeding may remove the virus, and the other that the cautery may help in preventing the infection.
“The biting of a wood-hound is deadly and venomous, and such venom is perilous. ”

“ Rabies is widely distributed, being most prevalent in the temperate zone, and where the population is most dense. It has been excluded from Australia, Tasmania and New Zealand by a rigid inspection and quarantine of all imported dogs.
The specific cause of rabies is probably a protozoan parasite (the Negri bodies present in nerve-cells, Fig. 105) . The germ spreads from the wounds through the nerves and central nervous system. The disease-producing organisms are present in great numbers in the nerve-tissue and saliva.
The period of incubation varies from a few days to several months. ”

“ The virus of rabies injected into the veins or beneath the skin produces paralytic rabies, while inoculations into the spinal cord or the brain produce the paroxysmal form. Inoculations with quantities of the virus too small to be effective, have no preservative influence against subsequent inoculations. Whether the virus is propagated by means of the nervous tissues or by absorption through the surfaces of the wound, has not been ascertained. Finally, the experiments have shown that the protective ‘attenuation’ of the virus is possible. ”

“ The teeth, in passing through the clothing, are wiped clean, so that the virus is not introduced into the blood; hence the comparatively few cases of rabies occurring in man. When, however, the wound is made upon an exposed surface, as the flesh of the hand, or of the face, this fatal disease is developed in spite of every precaution, unless such precautions are immediately taken. ”

“ Rabies prevailed among the deer of Richmond Park, London, and made necessary the destruction of many of the animals. The character of the disease was determined by inoculating rabbits with it, and these animals died exhibiting the characteristic symptoms of rabies. The infected animals are transformed to fierce and savage beasts, almost rivaling the rabid horse in their attempts to do mischief. The disease begins with signs of mental hallucination, and develops, through aggressive rage, into paralysis, ending with death by failure of the heart. ”

“ I can recollect, when I was a boy, to have been much surprised and horrified with the accounts that old people gave me, that it was the practice in decided cases of rabies canina to suffocate the unfortunate patient between feather beds. The disease being so suddenly and so invariably fatal, where it appeared unequivocally to attack the sufferer, might dispose the world to ascribe the death to what surely may be termed foul play ”

“ Rabies is the third assumed bacterial disease which is reacted upon by the administration of an antitoxin. When it occurs in man, it is generally known as hydrophobia, although it is the same disease as that known as rabies in dogs, skunks, wolves, and other animals. The virus of the disease is in the saliva of the animal, so that when a dog bites another animal or human beings, the poison is injected into the wound made with the teeth. ”

“ Rabies (called also hydrophobia in man) is a rare disease. It is communicable by inoculation, but it is very doubtful that the disease has been communicated from man to man. The saliva from a person suffering with rabies if injected into a warm-blooded animal will cause rabies, and on that account it is prudent to use care in touching such a patient in administering the last Sacraments. ”

“ When a patient has been bitten by a dog that has not died from rabies within three weeks after the bite, there is practical certainty that the animal did not have and could not communicate rabies. The cases of hydrophobia with long incubation periods are rather dubious, and the general impression now is that there has been subsequent infection. Patients who are in the midst of overwhelming dread of the development of rabies must be taken seriously and their cases treated by mental influence. ”

“ There seems no doubt that in a certain number of cases pseudo-rabies occurs; that is, persons are bitten by a dog, become seriously disturbed over the possibility of rabies developing, and after brooding over this for a time their mind gives way and there is either a neurosis simulating many symptoms of true rabies, or a state of collapse from fright in which even death may take place. ”

“ The potency of rabies-virus increases in passing from one rabbit to another, or from one Guinea-pig to another. When it has been brought to a maximum in rabbits, it exhibits its full strength on being transferred to the dog, and is then more potent than virus from a mad dog. Such virus inoculated into the circulatory system of a dog invariably causes madness which results in death. ”

“ The early diagnosis of rabies in the dog is of supreme importance as enabling the owner to destroy or seclude the dangerous animal before he has developed the disposition to bite and to propagate the disease. If the dog himself is known to have been bitten, every premonitory symptom should be carefully looked for and critically studied. ”

“ As the investigations by which we have come to a tolerably clear understanding of the facts concerning rabies have been comparatively recent, and for the most part, have appeared in scientific periodicals, fallacies in regard to the disease continue to have a strong hold upon the public mind. For instance, it is still a widely prevalent belief that if persons or animals are bitten by a dog they are liable to become rabid if the dog should contract the disease at any future time. ”

“ And, as with fowl-cholera and anthrax, so with rabies; a virus which has been attenuated till it has been rendered innocuous, can yet confer immunity against its more virulent forms: just as vaccination can protect against smallpox. A man, bitten by a rabid animal, has at least some weeks of respite before the disease can break out ”

“ Already, in the midst of his work on anthrax, he was thinking of rabies; and in 1881 he proved that it was conveyed through the saliva of the mad dog, and that it could be communicated to rabbits. Saliva, however, was not in every case to be depended on. In some cases it failed to convey the disease. Experiment showed that the poison was concentrated in the brain. To this day no one has succeeded in finding the organism—if it be an organism—which causes rabies. ”

“ Furious rabies is more common in the horse. The animal is very nervous, restless and alert. It may attack other animals in a vicious manner, kicking and biting them. The animal does not seem to care to eat or drink, and usually shows violent nervous symptoms, such as biting the manger, rearing and kicking when confined in the stable.
Cattle butt with the horns and show a tendency to lick other animals. They bellow more than common and the sexual desire is increased. Paralytic symptoms are manifested early in the disease, and the animal may fall when moving about. ”

“ C . — Infective Diseases in which an Organism has been found, but has not finally been connected with the Disease.
Hydrophobia is usually contracted by man through inoculation of an abraded surface with the saliva of an animal affected with rabies — through the bite of a dog, the animal in which the so-called rabies of the streets occurs. The puppy is specially dangerous, as, although it may be suffering from rabies when the saliva contains an extremely exalted virus, the animal may exhibit no signs of the disease almost up to the time of its death. ”

“ It will perhaps be remembered that Pasteur, when working at hydrophobia, experienced the greatest difficulty in exciting rabies in animals with certainty, and that it was only when the fact of its being a disease which essentially affects the nervous system of the animal was taken into account that it occurred to him to cultivate the virus in the medium for which it had seemingly the greatest affinity, viz. the nervous tissue of an animal ”

“ It is weakened by the fact that bites of dogs in the stage of incubation sometimes produce rabies, but it must be borne in mind that there is still a period between the passage of the living germ to the salivary glands and brain and the growth of the germ in the nerve-centres, so as to produce pathognomonic symptoms, during which both blood and saliva must be virulent. ”

“ The irritation and reopening of the original wound or point of inoculation is a valuable factor in diagnosis. Diagnosis after death may be made by microscopic examination for Negri bodies or by the inoculation of rabbits, as already mentioned.
Recovery from rabies may be considered as a question of the correctness of the original diagnosis. Rabies is always fatal.
Treatment.—No remedial treatment has ever been successful. All the anodynes and anesthetics, opium, belladonna, bromid of potash, ether, chloroform, etc., have been used without avail. ”

“ I shall prove that the increase in the length of the periods of incubation of the rabies, communicated day after day to rabbits, as I have just said, to test the condition of virulence of our marrows, dried in contact with the air, is an effect of impoverishment in the quantity of the virus contained in the marrows, and not an effect of its impoverishment in virulence. ”

“ A rabid dog generally knows his master until overcome by the fury of the disease.
Most dogs succumb within a week after the advent of the first signs of the complaint. From a week to three months may be set down as the minimum and maximum periods for the development (incubation) of rabies, after the dog [381] has been bitten by a rabid animal, or received the virus of the malady into its system, such as might occur through rubbing, licking, etc., upon a mucous surface. ”

“ Thus it is supposed that the bite of an angry dog may produce the disease, and all the more if the animal should subsequently develop symptoms of rabies. The ground for this erroneous notion is the fact, which is unquestionable, that animals in whom rabies is in the stage of incubation, during which there are few if any symptoms, may by their bites convey the disease, though fortunately during this early stage they are little disposed to bite. The bite of a non-rabid animal, however enraged, cannot give rise to hydrophobia. ”

“ Cipriano Fisher told me that he had cured a valuable bulldog of rabies by this same method, using the bitter juice of the pitahaya, a species of cactus, for medicine. This crude means of alleged cure is unique, and seems based on the theory that the antipathy of rabid animals to water, implied in the name hydrophobia, is the cause of their death, and partial drowning, therefore, a cure.
Rabies is extremely prevalent at times in certain districts of the Cape region. ”

“ In the above epitome of alleged causes we find nothing proving the spontaneous evolution of rabies. The prevalence of the affection in wolves, foxes, jackals, cats, skunks, etc. proves nothing for spontaneity, more than its existence in the dog. In all these species of animals the malady develops the dread propensity to bite, and thus in all alike provision is made for the perpetuation and propagation of the malady. ”

“ The virus appears to be communicated through the saliva of the animal, and to show a marked affinity for nerve tissues; and the disease is most likely to develop when the patient is infected on the face or other uncovered part, or in a part richly endowed with nerves.
A dog which has bitten a person should on no account be killed until its condition has been proved one way or the other. Should rabies develop and its destruction become necessary, the head and spinal cord should be retained and forwarded, packed in ice, to a competent observer. ”

“ But it is not yet proved that the disease is produced by privation of the generative act, while if it were it is still certain that cases of spontaneous rabies are extremely rare; that the rabid dog bites the castrated one as readily as the perfect male; that the emasculated one contracts rabies as readily as others when bitten, and that he communicates it no less persistently. Galtier's method of intravenous injection of the rabic saliva, which seems to have proved effectual in sheep and rabbits, utterly failed in the hands of Lussana and [p. 905] Pasteur in dogs. ”

“ This treatment involves the inoculation of the rabies virus which has first been passed through a series of rabbits, in the course of which the virus has become exceedingly strong. The treatment of the [Pg 408] human being consists in successive inoculations with virus of various strengths, beginning with the weakest and ending with the most powerful rabbit virus. After this has been done, the effect of the bite of the mad dog has been neutralized, so that in most cases the disease has been robbed of its power. ”

“ As rabies is usually transmitted by the bite, it is well to note that not all the bites of rabid animals are effective. Of 183 dogs confined with and bitten by a rabid dog 91 contracted rabies; of 73 cattle bitten 45 became rabid; out of 121 sheep bitten 51 succumbed and of 890 persons bitten, 428 took hydrophobia. Of 440 persons bitten by rabid wolves 291 contracted the disease. The escape of such a large proportion is variously accounted for. Wolves naturally attack the face, throat or hands where there is no protection by clothing, and inoculation is therefore much more certain. ”