Hydrophobia
HYDROPHOBIA (Gr. iiSup, water, and <6/3os, fear; so called from the symptom of dread of water), or RABIES (Lat.for" madness "), an acute disease, occurring chiefly in certain of the lower animals, particularly the canine species, and liable to be communicated by them to other animals and to man.
In Dogs, ffc. The occurrence of rabies in the fox, wolf, hyaena, jackal, raccoon, badger and skunk has been asserted; but there is every probability that it is originally a disease of the dog. It is communicated by inoculation to nearly all, if not all, warmblooded creatures. The transmission from one animal to another only certainly takes place through inoculation with viruliferous matters. The malady is generally characterized at a certain stage by an irrepressible desire in the animal to act offensively with its natural weapons dogs and other carnivora attacking with their teeth, herbivora with their hoofs or horns, and birds with their beaks, when excited ever so slightly. In the absence of excitement the malady may run its course without any fit of fury or madness.
Symptoms. The disease has been divided into three stages or periods, and has also been described as appearing in at least two forms, according to the peculiarities of the symptoms. But, as a rule, one period of the disease does not pass suddenly into another, the transition being almost imperceptible; and the forms do not differ essentially from each other, but appear merely to constitute varieties of the same disease, due to the natural disposition of the animal, or other modifying circumstances. These forms have been designated true or furious rabies (Fr. rage vrai ; Ger. rasende Wuth) and dumb rabies (Fr. rage mue; Ger. stille Wuth).
The malady does not commence with fury and madness, but in a strange and anomalous change in the habits of the dog: it becomes dull, gloomy, and taciturn, and seeks to isolate itself in out-of-the-way places, retiring beneath chairs and to odd corners. But in its retirement it cannot rest: it is uneasy and fidgety, and no sooner has it lain down than suddenly it jumps up in an agitated manner, walks backwards and forwards several times, again lies down and assumes a sleeping attitude, but has only maintained it for a few minutes when it is once more moving about. Again it retires to its corner, to the farthest recess it can find, and huddles itself up into a heap, with its head concealed beneath its chest and fore-paws. This state of continual agitation and inquietude is in striking contrast with its ordinary habits, and should therefore receive attention. Not unf requently there are a few moments when the creature appears more lively than usual, and displays an extraordinary amount of affection. Sometimes there is a disposition to gather up straw, thread, bits of wood, etc., which are industriously carried away; a tendency to lick anything cold, as iron, stones, etc., is also observed in many instances; and there is also a desire evinced to lick other animals. Sexual excitement is also frequently an early symptom. At this period no disposition to bite is observed; the animal is docile with its master and obeys his voice, though not so readily as before, nor with the same pleased countenance. There is something strange in the expression of its face, and the voice of its owner is scarcely able to make it change from a sudden gloominess to its usual animated aspect. These symptoms gradually become more marked; the restlessness and agitation increase. If on straw the dog scatters and pulls it about with its paws, and if in a room it scratches and tumbles the cushions or rugs on which it usually lies. It is incessantly on the move, rambling about, scratching the ground, sniffing in corners and at the doors, as if on the scent or seeking for something. It indulges in strange movements, as if affected by some mental influences or a prey to hallucinations. When not excited by any external influence it will remain for a brief period perfectly still and attentive, as if watching something, or following the movements of some creature on the wall; then it will suddenly dart forward and snap at the vacant air, as if pursuing an annoying object, or endeavouring to seize a fly. At another time it throws itself, yelling and furious, against the wall, as if it heard threatening voices on the other side, or was bent on attacking an enemy. Nevertheless, the animal is still docile and submissive, for its master's voice will bring it out of its frenzy. But the saliva is already virulent, and the excessive affection which it evinces at intervals, by licking the hands or face of those it loves, renders the danger very great should there be a wound or abrasion. Until a late period in the disease the master's voice has a powerful influence over the animal. When it has escaped from all control and wanders erratically abroad, ferocious and restless, and haunted by horrid phantoms, the familiar voice yet exerts its influence, and it is rare indeed that it attacks its master.
There is no dread of water in the rabid dog; the animal is generally thirsty, and if water be offered will lap it with avidity, and swallow it at the commencement of the disease. And when, at a later period, the constriction about the throat symptomatic of the disease renders swallowing difficult, the dog will none the less endeavour to drink, and the lappings are as frequent and prolonged when deglutition becomes impossible. So little dread has the rabid dog of water that it will ford streams and swim rivers; and when in the ferocious stage it will even do this in order to attack other creatures on the opposite side.
At the commencement of the disease the dog does not usually refuse to eat, and some animals are voracious to an unusual degree. But in a short time it becomes fastidious, only eating what it usually has a special predilection for. Soon, however, this gives place to a most characteristic symptom either the taste becomes extremely depraved or the dog has a fatal and imperious desire to bite and ingest everything. The litter of its kennel, wool from cushions, carpets, stockings, slippers, wood, grass, earth, stones, glass, horsedung, even its own faeces and urine, or whatever else may come in its way, are devoured. On examination of the body of a dog which has died of rabies it is so common to find in the stomach a quantity of dissimilar and strange matters on which the teeth have been exercised that, if there was nothing known of the animal's history, there would be strong evidence of its having been affected with the disease. When a dog, then, is observed to gnaw and eat suchlike matters, though it exhibits no tendency to bite, it should be suspected.
The mad dog does not usually foam at the mouth to any great extent at first. The mucus of the mouth is not much increased in quantity, but it soon becomes thicker, viscid, and glutinous, and adheres to the angles of the mouth, fauces and teeth. It is at this period that the thirst is most ardent, and the dog sometimes furiously attempts to detach the saliva with its paws; and if after a while it loses its balance in these attempts and tumbles over, there can no longer be any doubt as to the nature of the malady. There is another symptom connected with the mouth in that form of the disease named " dumb madness " which has frequently proved deceptive. The lower jaw drops in consequence of paralysis of its muscles, and the mouth remains open. The interior is dry from the air passing continually over it, and assumes a deep red tint, somewhat masked by patches of dust or earth, which more especially adhere to the upper surface of the tongue and to the lips. The strange alteration produced in the dog's physiognomy by its constantly open mouth and the dark colour of the interior is rendered still more characteristic by the dull, sad, or dead expression of the animal's eyes. In this condition the creature is not very dangerous, because generally it could not bite if it tried indeed there does not appear to be much desire to bite in dumb madness; but the saliva is none the less virulent, and accidental inoculations with it, through imprudent handling, will prove as fatal as in the furious form. The mouth should not be touched, numerous deaths having occurred through people thinking the dog had some foreign substance lodged in its throat, and thrusting their fingers down to remove it. The sensation of tightness which seems to exist at the throat causes the dog to act as if a bone were fixed between its teeth or towards the back of its mouth, and to employ its fore-paws as if to dislodge it. This is a very deceptive symptom, and may prove equally dangerous if caution be not observed. Vomiting of blood or a chocolate-coloured fluid is witnessed in some cases, and has been supposed to be due to the foreign substances in the stomach, which abrade the lining membrane; this, however, is not correct, as it has been observed in man.
The voice of the rabid dog is very peculiar, and so characteristic that to those acquainted with it nothing more is needed to prove the presence of the disease. Those who have heard it once or twice never forget its signification. Owing to the alterations taking place in the larynx the voice becomes hoarse, cracked and stridulous, like that of a child affected with croup the " voixducoq," as the French have it. A preliminary bark is made in a somewhat elevated tone and with open mouth; this is immediately succeeded by five, six or eight decreasing howls, emitted when the animal is sitting or standing, and always with the nose elevated, which seem to come from the depths of the throat, the jaws not coming together and closing the mouth during such emission, as in the healthy bark. This alteration in the voice is frequently the first observable indication of the malady, and should at once attract attention. In dumb madness the voice is frequently lost from the very commencement hence the designation.
The sensibility of the mad dog appears to be considerably diminished, and the animal appears to have lost the faculty of expressing the sensations it experiences: it is mute under the infliction of pain, though there can be no doubt that it still has peripheral sensation to some extent. Burning, beating and wounding produce much less effect than in health, and the animal will even mutilate itself with its teeth. Suspicion, therefore, should always strongly attach to a dog which does not manifest a certain susceptibility to painful impressions and receives punishment without any cry or complaint. There is also reason for apprehension when a dog bites itself persistently in any part of its body. A rabid dog is usually stirred to fury at the sight of one of its own species; this test has been resorted to by Henrie Marie Bouley (1814-1885) to dissipate doubts as to the existence of the disease when the diagnosis is otherwise uncertain. As soon as the suspected animal, if it is really rabid, finds itself in the presence of another of its species it at once assumes the aggressive, and, if allowed, will bite furiously. All rabid animals indeed become excited, exasperated, and furious at the sight of a dog, and attack it with their natural weapons, even the timid sheep when rabid butts furiously at the enemy before which in health it would have fled in terror. This inversion of sentiment is sometimes valuable in diagnosing the malady; it is so common that it may be said to be present in every case of rabies. When, therefore, a dog, contrary to its habits and natural inclination, becomes suddenly aggressive to other dogs, it is time to take precautions.
In the large majority of instances the dog is inoffensive in the early period of the disease to those to whom it is familiar. It then flies from its home and either dies, is killed as " mad," or returns in a miserable plight, and in an advanced stage of the malady, when the desire to bite is irresistible. It is in the early stage that sequestration and suppressive measures are most valuable. The dogs which propagate the disease are usually those that have escaped from their owners. After two or three days, frequently in about twelve hours, more serious and alarming symptoms appear, ferocious instincts are developed, and the desire to do injury is irrepressible. The animal has an indefinable expression of sombre melancholy and cruelty. The eyes have their pupils dilated, and emit flashes of light when they are not dull and heavy; they always appear so fierce as to produce terror in the beholder; they are red, and their sensibility to light is increased; and wrinkles, which sometimes appear on the forehead, add to the repulsive aspect of the animal. If caged it flies at the spectator, emitting its characteristic howl or bark, and seizing the iron bars with its teeth, and if a stick be thrust before it this is grasped and gnawed. This fury is soon succeeded by lassitude, when the animal remains insensible to every excitement. Then all at once it rouses up again, and another paroxysm of fury commences. The first paroxysm is usually the most intense, and the fits vary in duration from some hours to a day, and even longer; they are ordinarily briefer in trained and pet dogs than in those which are less domesticated, but in all the remission is so complete after the first paroxysm that the animals appear to be almost well, if not in perfect health. During the paroxysms respiration is hurried and laboured, but tranquil during the remissions. There is an increase of temperature, and the pulse is quick and hard. When the animal is kept in a dark place and not excited, the fits of fury are not observed. Sometimes it is agitated and restless in the manner already described. It never becomes really furious or aggressive unless excited by external objects the most potent of these, as has been said, being another dog, which, however, if it be admitted to its cage, it may not at once attack. The attacked animal rarely retaliates, but usually responds to the bites by acute yells, which contrast strangely with the silent anger of the aggressor, and tries to hide its head with its paws or beneath the straw. These repeated paroxysms hurry the course of the disease. The secretion and flowing of a large quantity of saliva from the mouth are usually only witnessed in cases in which swallowing has become impossible, the mouth being generally dry. At times the tongue, nose and whole head appear swollen. Other dogs frequently shun one which is rabid, as if aware of their danger.
The rabid dog, if lodged in a room or kept in a house, is continually endeavouring to escape; and when it makes its escape it goes freely forward, as if impelled by some irresistible force. It travels considerable distances in a short time, perhaps attacking every living creature it meets preferring dogs, however, to other animals, ana these to mankind; cats, sheep, cattle and horses are particularly liable to be injured. It attacks in silence, and never utters a snarl or a cry of anger; should it chance to be hurt in return it emits no cry or howl of pain. The degree of ferocity appears to be related to natural disposition and training. Some dogs, for instance, will only snap or give a slight bite in passing, wnile others will bite furiously, tearing the objects presented to them, or which they meet in their way, and sometimes with such violence as to injure their mouth and break their teeth, or even their jaws. If chained, they will in some cases gnaw the chain until their teeth are worn away and the bones laid bare. The rabid dog does not continue its progress very long. Exhausted by fatigue and the paroxysms of madness excited in it by the objects it meets, as well as by hunger, thirst, and also, no doubt, by the malady, its limbs soon become feeble; the rate of travelling is lessened and the walk is unsteady, while its drooping tail, head inclined towards the ground, open mouth, and protruded tongue (of a leaden colour or covered with dust) give the distressed creature a very striking and characteristic physiognomy. In this condition, however, it is much less to be dreaded than in its early fits of fury, since it is no longer capable or desirous of altering its course or going out of its way to attack an animal or a man not immediately in the path. It is very probable that its fast-failing vision, deadened scent, and generally diminished perception prevent its being so readily impressed or excited by surrounding objects as it previously was. To each paroxysm, which is always of short duration, there succeeds a degree of exhaustion as great as the fits have been violent and oft repeated. This compels the animal to stop; then it shelters itself in obscure places frequently in ditches by the roadside and lies there in a somnolescent state for perhaps hours. There is great danger, nevertheless, in disturbing the dog at this period; for when roused from its torpor it has sometimes sufficient strength to inflict a bite. This period, which may be termed the second stage, is as variable in its duration as the first, but it rarely exceeds three or four days. The above-described phenomena gradually merge into those of the third or last period, when symptoms of paralysis appear, which are speedily followed by death. During the remission in the paroxysms these paralytic symptoms are more particularly manifested in the hind limbs, which appear as if unable to support the animal's weight, and cause it to stagger about; or the lower jaw becomes more or less drooping, leaving the parched mouth partially open. Emaciation rapidly sets in, and the paroxysms diminish in intensity, while the remissions become less marked. The physiognomy assumes a still more sinister and repulsive aspect; the hair is dull and erect; the flanks are retracted; the eyes lose their lustre and are buried in the orbits, the pupil being dilated, and the cornea dull and semiopaque; very often, even at an early period, the eyes squint, and this adds still more to the terrifying appearance of the poor dog. The voice, if at all heard, is husky, tne breathing laborious, and the pulse hurried and irregular. Gradually the paralysis increases, and the posterior extremities are dragged as if the animal's back were broken, until at length it becomes general; it" is then the prelude to death. Or the dog remains lying in a state of stupor, and can only raise itself with difficulty on the fore-limbs when greatly excited. In this condition it may yet endeavour to bite at objects within its reach. At times convulsions of a tetanic character appear in certain muscles; at other times these are general. A comatose condition ensues, and the rabid dog, if permitted to die naturally, perishes, in the great majority of cases, from paralysis and asphyxia.
In dumb madness there is paralysis of the lower jaw, which imparts a curious and very characteristic physiognomy to the dog; the voice is also lost, and the animal can neither eat nor drink. In this condition the creature remains with its jaw pendent and the mouth consequently wide open, showing the flaccid or swollen tongue covered with brownish matter, and a stringy gelatinouslooking saliva lying between it and the lower lip and coating the fauces, which sometimes appear to be inflamed. Though the animal is unable to swallow fluids, the desire to drink is nevertheless intense; for the creature will thrust its face into the vessel of water in futile attempts to obtain relief, even until the approach of death. Water may be poured down its throat without inducing a paroxysm. The general physiognomy and demeanour of the poor creature inspire the beholder with pity rather than fear. The symptoms due to cerebral excitement are less marked than in the furious form of the disease; the agitation is not so considerable, and the restlessness, tendency to run away, and desire to bite are nearly absent; generally the animal is quite passive. Not unfrequently one or both eyes squint, and it is only when very much excitea that the dog may contrive to close its mouth. Sometimes there is swelling about the pharynx and the neck ; when the tongue shares in this complication it hangs out of the mouth. In certain cases there is a catarrhal condition of the membrane lining the nasal cavities, larynx, and bronchi; sometimes the animal testifies to the existence of abdominal pain, and the faeces are then soft or fluid. The other symptoms such as the rapid exhaustion and emaciation, paralysis of the posterior limbs towards the termination of the disease, as well as the rapidity with which it runs its course are the same as in the furious form.
The simultaneous occurrence of furious and dumb madness has frequently been observed in packs of fox-hounds. Dumb madness differs, then, from the furious type in the paralysis of the lower jaw, which hinders the dog from biting, save in very exceptional circumstances; the ferocious instincts are also in abeyance; and there is no tendency to aggression. It has been calculated that from 15 to 20% of rabid dogs have this particular form of the disease. Puppies and young dogs chiefly have furious rabies.
These are the symptoms of rabies in the dog; but it is not likely, nor is it necessary, that they will all be present in every case. In other species the symptoms differ more or less from those manifested by the dog, but they are generally marked by a change in the manner and habits of the creatures affected, with strong indications of nervous disturbance, in the majority of species amounting to ferociousness and a desire to injure, timid creatures becoming bold and aggressive.
In Human Beings. The disease of hydrophobia has been known from early times, and is alluded to in the works of Aristotle, Xenophon, Plutarch, Virgil, Horace, Ovid and many others, as well as in those of the early writers on medicine. Celsus gives detailed instructions respecting the treatment of men who have been bitten by rabid dogs, and dwells on the dangers attending such wounds. After recommending suction of the bitten part by means of a dry cupping glass, and thereafter the application of the actual cautery or of strong caustics, and the employment of baths and various internal remedies, he says: " Idque cum ita per triduum factum est, tutus esse homo a periculo videtur. Solet autem ex eo vulnere, ubi parum occursum est, aquae timor nasci, v5po<j>ofila.v Graeci appellant. Miserrimum genus morbi; in quo simul aeger et siti et aquae metu cruciatur; quo oppressis in angusto spes est." Subsequently Galen described minutely the phenomena of hydrophobia, and recommended the excision of the wounded part as a protection against the disease. Throughout many succeeding centuries little or nothing was added to the facts which the early physicians had made known upon the subject. The malady was regarded with universal horror and dread, and the unfortunate sufferers were generally abandoned by all around them and left to their terrible fate. In later times the investigations of Boerhaave, Gerard van Swieten (1700-1772), John Hunter, Francois Magendie (1783-1855), Gilbert Breschet (1784-1845), Virchow, Albert Reder, as also of William Youatt (1776-1847), George Fleming, Meynell, Karl Hertwig (1798-1881), and others, have furnished important information; but all these were put into the shade by the researches of Pasteur.
The disease is communicated by the secretions of the mouth of the affected animal entering a wound or abrasion of the human skin or mucous membrane. In the great majority of cases (90%) this is due to the bite of a rabid dog, but bites of rabid cats, wolves, foxes, jackals, etc., are occasionally the means of conveying the disease. Numerous popular fallacies still prevail on the subject of hydrophobia. 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.
The period of incubation of the disease, or that time which elapses between the introduction of the virus and the development of the symptoms, appears to vary in a remarkable degree, being in some cases as short as a fortnight, and in others as long as several months or even years. On an average it seems to be from about six weeks to three months, but it mainly depends on the part bitten; bites on the head are the most dangerous. The incubation period is also said to be shorter in children. The rare instances of the appearance of hydrophobia many years after the introduction of the poison are always more or less open to question as to subsequent inoculation.
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 the patient barks like a dog. In many instances there is great mental disturbance, with fits of maniacal excitement, in which he strikes at every one about him, and accuses them of being the cause of his sufferings these attacks being succeeded by calm intervals in which he expresses great regret for his violent behaviour. During all this stage of the disease the patient is tormented with a viscid secretion accumulating in his mouth, which from dread of swallowing he is constantly spitting about him. There may also be noticed snapping movements of the jaws as if he were attempting to bite, but these are in reality a manifestation of the spasmodic action which affects the muscles generally. There is no great amount of fever, but there is constipation, diminished flow of urine, and often sexual excitement.
After two or three days of suffering of the most terrible description the patient succumbs, death taking place either in a paroxysm of choking, or on the other hand in a tranquil manner from exhaustion, all the symptoms having abated, and the power of swallowing returned before the end. The duration of the disease from the first declaration of the symptoms is generally from three to five days.
Apart from the inoculation method (see below) , the treatment of most avail is that which is directed towards preventing the absorption of the poison into the system. This may be accomplished by excision of the part involved in the bite of the rabid animal, or, where this from its locality is impracticable, in the application to the wound of some chemical agent which will destroy the activity of the virus, such as potassa fusa, lunar caustic (nitrate of silver), or the actual cautery in the form of a red-hot wire. The part should be thoroughly acted on by these agents, no matter what amount of temporary suffering this may occasion. Such applications should be resorted to immediately after the bite has been inflicted, or as soon thereafter as possible. Further, even though many hours or days should elapse, these local remedies should still be applied ; for if, as appears probable, some at least of the virus remains for long at the injured part, the removal or effectual destruction of this may prevent the dread consequences of its absorption. Every effort should be made to tranquillize and reassure the patient.
Two special points of interest have arisen in recent years in connexion with this disease. One is the Pasteur treatment by inoculation with rabic virus (see also PARASITIC DISEASES), and the other was the attempt of the government to exterminate rabies in the British Isles by muzzling dogs.
The Pasteur treatment was first applied to human beings in 1885 after prolonged investigation and experimental trial on animals. It is based on the fact that a virus, capable of giving rabies by inoculation, can be extracted from the tissues of a rabid animal and then intensified or attenuated at pleasure. It appears that the strength oi the rabic virus, as determined by inoculation, is constant in the same species of animal, but is modified by passing through another species. For instance, the natural virus of dogs is always of the same strength, but when inoculated.into monkeys it becomes weakened, and the process of attenuation can be carried on by passing the virus through a succession of monkeys, until it loses the power of causing death. If this weakened virus is then passed back through guinea-pigs, dogs or rabbits, it regains xiv. 6 a its former strength. Again, if it be passed through a succession of dogs it becomes intensified up to a maximum of strength which is called the virus fixe. Pasteur further discovered that the strength can be modified by temperature and by keeping the dried tissues of a rabid animal containing the virus. Thus, if the spinal cord of a rabid dog be preserved in a dry state, the virus loses strength day by day. The system of treatment consists in making an emulsion of the cord and graduating the strength of the dose by using a succession of cords, which have been kept for a progressively diminishing length of time. Those which have been kept for fourteen days are used as a startingpoint, yielding virus.of a minimum strength. They are followed by preparations of diminishing age and increasing strength, day by day, up to the maximum, which is three days old. These are successively injected into the circulatory system. The principle is the artificial acquisition by the patient of resistance to the rabic virus, which is presumed to be already in the system but has not yet become active, by accustoming him gradually to its toxic effect, beginning with a weak form and progressively increasing the dose. It is not exactly treatment of the disease, because it is useless or nearly so when the disease has commenced, nor is it exactly preventive, for the patient has already been bitten. It must be regarded as a kind of anticipatory cure. The cords are cut into sections and preserved dry in sterilized flasks plugged with cotton-wool. Another method of preparing the inoculatory virus, which has been devised by Guido Tizzoni and Eugenic Centanni, consists in subjecting the virus fixe to peptic digestion by diluted gastric juice for varying periods of time.
The first patient was treated by Pasteur's system in July 1885. He was successively inoculated with emulsions made from cords that had been kept fourteen and ten days, then eleven and eight days, then eight, seven, six days, and so on. Two forms of treatment are now used (i) the "simple," in which the course from weak to strong virus is extended over nine days; (2) the " intensive," in which the maximum is reached in seven days. The latter is used in cases of very bad bites and those of some standing, in which it is desirable to lose no time. Two days are compressed into one at the commencement by making injections morning and evening instead of once a day, so that the fifth-day cord is reached in four days instead of six, as in the " simple " treatment. When the maximum the third-day cord is reached the injections are continued with fifth-, fourth-, and third-day cords. The whole course is fifteen days in the simple treatment and twenty-one in the intensive. The doses injected range from i to 3 cubic centimetres. Injections are made alternately into the right and left flanks. The following table shows the number treated from 1886 to 1905, with the mortality.
Year.
Patients Treated.
Deaths.
Mortality per cent.
1886 2671 1887 1770 1888 1622 1889 1830 1890 1540 1891 1559 1892 1790 1893 1648 1894 1387 1895 1520 1896 1308 1897 1521 1898 1465 1899 1614 1900 1419 1901 1318 1902 1105 1903 1904 1905 These figures do not include cases which develop hydrophobia during treatment or within fifteen days after treatment is com- pleted, for it is held that persons who die within that period have their nervous centres invaded by virus before the cure has time to act. The true mortality should therefore be considerably higher. For instance, in 1898 three deaths came within this category, which just doubles the mortality; and in 1899 the additional deaths were six, bringing the mortality up to two- anda-half times that indicated in the table. When, however, the additional deaths are included the results remain sufficiently striking, if two assumptions are granted (i) that all the persons treated have been bitten by rabid animals; (2) that a large proportion of persons so bitten usually have hydrophobia. Unfortunately, both these assumptions lack proof, and therefore the evidence of the efficacy of the treatment cannot be said to satisfy a strictly scientific standard. With regard to the first point, the patients are divided into three categories (i) those bitten by an animal the rabidity of which is proved by the development of rabies in other animals bitten by it or inoculated from its spinal cord; (2) those bitten by an animal pronounced rabid on a veterinary examination; (3) those bitten by an animal suspected of being rabid. The number of patients in each category in 1898 was (i) 141, (2) 855, (3) 469; and in 1899 it was (i) 152, (2) 1099, (3) 363. As might be expected, the vast majority came under the second and third heads, in which the evidence of rabidity is doubtful or altogether lacking. With regard to the second point, the proportion of persons bitten by rabid animals who ordinarily develop hydrophobia has only been " estimated " from very inadequate data. Otto Bollinger from a series of collected statistics states that before the introduction of the Pasteur treatment, of patients bitten by dogs undoubtedly rabid 47% died, the rate being 33% in those whose wounds had been cauterized and 83% when there had been no local treatment. If the number of rabid dogs be compared with the deaths from hydrophobia in any year or series of years, it can hardly be very high. For instance, in 1893, 668 dogs, besides other animals, were killed and certified to be rabid in England, and the deaths from hydrophobia were twenty. Of course this proves nothing, as the number of persons bitten is not known, but the difference between the amount of rabies and of hydrophobia is suggestively great in view of the marked propensity of rabid dogs to bite, nor is it accounted for by the fact that some of the persons bitten were treated at the Institut Pasteur. A comparison of the annual mortality from hydrophobia in France before and after the introduction of the treatment would afford decisive evidence as to its efficacy; but unfortunately no such comparison can be made for lack of vital statistics in that country. The experience of the Paris hospitals, however, points to a decided diminution of mortality. On the whole it must be said, in the absence of further data, that the Pasteur treatment certainly diminishes the danger of hydrophobia from the bites of rabid animals.
More recently treatment with an anti-rabic serum has been suggested (see PARASITIC DISEASES). Victor Babes and Lepp and later Guido Tizzoni and Eugenio Centanni have worked out a method of serum treatment curative and protective. In this method not the rabic poison itself, as in the Pasteur treatment, but the protective substance formed is injected into the tissues. The serum of a vaccinated animal is capable of neutralizing the power of the virus of rabies not only when mixed with the virus before injection but even when injected simultaneously or within twenty-four hours after the introduction of the virus. These authors showed that the serum of a rabbit protects a rabbit better than does the serum of a dog, and vice versa. At the end of twenty days' injections they found they could obtain such a large quantity of anti-rabic substance in the serum of an animal, that even i part of serum to 25,000 of the body weight would protect an animal. This process differs from that of Pasteur in so far as that in place of promoting the formation of the antidote within the body of the patient, by a process of vaccination with progressively stronger and stronger virus, this part of the process is carried on in an animal, Babes using the dog and Centanni the sheep, the blood serum of which is injected. This method of vaccination is useful as a protective to those in charge of kennels.
The attempt to stamp out rabies in Great Britain was an experiment undertaken by the government in the public interest. The principal means adopted were the muzzling of Muzzling (jogg m m f ec ted areas, and prolonged quarantine for imported animals. The efficacy of dog-muzzling in checking the spread of rabies and diminishing its prevalence has been repeatedly proved in various countries. Liable as other animals may be to the disease, in England at least the dog is pre-eminently the vehicle of contagion and the great source of danger to human beings. There is a difference of opinion on the way in which muzzling acts, though there can be none as to the effect it produces in reducing rabies. Probably it acts rather by securing the destruction of ownerless and stray which generally includes rabid dogs than by preventing biting; for though it may prevent snapping, even the wire-cage muzzle does not prevent furious dogs from biting, and it is healthy, not rabid, dogs that wear the muzzle. It has therefore been suggested that a collar would have the same effect, if all collarless dogs were seized; but the evidence goes to show that it has not, perhaps because rabid dogs are more likely to stray from home with their collars, which are constantly worn, than with muzzles which are not, and so escape seizure. Moreover, it is much easier for the police to see whether a dog is wearing a muzzle or not than it is to make sure about the collar. However this may be, the muzzle has proved more efficacious, but it was not applied systematically in England until a late date. Sometimes the regulations were in the hands of the government, and sometimes they were left to local authorities; in either case they were allowed to lapse as soon as rabies had died down. In April 1897 the Board of Agriculture entered on a systematic attempt to exterminate rabies by the means indicated. The plan was to enforce muzzling over large areas in which the disease existed, and to maintain it for six months after the occurrence of the last case. In spite of much opposition and criticism, this was resolutely carried out under Mr Walter Long, the responsible minister, and met with great success. By the spring of 1899 that is, in two years the disease had disappeared in Great Britain, except for one area in Wales; and, with this exception, muzzling was everywhere relaxed in October 1899. It was taken off in Wales also in the following May, no case having occurred since November 1899. Rabies was then pronounced extinct. During the summer of 1900, however, it reappeared in Wales, and several counties were again placed under the order. The year 1901 was the third in succession in which no death from hydrophobia was registered in the United Kingdom. In the ten years preceding 1899, 104 deaths were registered, the death-rate reaching 30 in 1889 and averaging 29 annually. In 1902 two deaths from hydrophobia were registered. From that date to June 1909 (the latest available for the purpose of this article) no death from hydrophobia was notified in the United Kingdom.
See Annales de llnstitut Pasteur, from 1886; Journal of the Board of Agriculture, 1899; Makins, " Hydrophobia," in Treves's System of Surgery; Woodhead, " Rabies, ' in Allbutt's System of Medicine.
Note - this article incorporates content from Encyclopaedia Britannica, Eleventh Edition, (1910-1911)
