COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD HX641 26480 RC148.M72 Rabies or hydrophobi RECAP ■X)HLEi\ RABIZ3 OR HYDTOPHOBIA Rc/Vg> rAiJi College of ^ijpsiicians anb ^urgeong Hitjrarp Digitized by the Internet Arciiive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/rabiesorhydrophoOOmohl Icsaed May 12, 1911- U. S. DEPARTMENT OF AGRICULTURE. FARMERS' BULLETIN 449. lABIES OR HYDROPHOBIA, JOHN R. MOHLER, V. M. D., Chief of the Pathological Division, Bureau of Animal Industry, WASHINGTON: GOVERNMENT PRINTING OFFICE. 1911. LETTER OF TRANSMITTAL U. S. Department of Agriculture, Bureau of Animal Industry, Washington^ D. C.^ March IJj,^ 1911, Sir : I have the honor to transmit herewith, and to recommend for )ublication as a Farmers' Bulletin, a paper on " Rabies, or Hydro- jhobia," by Dr. John R. Mohler, chief of the Pathological Division )f this bureau. This paper is based on an article which forms a part )f the Twenty-sixth Annual Report of this bureau. The disease known as rabies in animals and hydrophobia in man s one of the most terrible maladies known to medical science. Uthough some skepticism as to this disease persists and is industri- )usly fostered by the publication of erroneous views, the reality and he infectious nature of the malady have been abundantly established nd confirmed by the work of nmnerous competent scientific investi- gators, and there is no more reason for doubting the existence of abies than for questioning the actuality of other specific and well- ecognized contagious diseases. Rabies is prevalent among dogs in various parts of the United States, and the presence of infected animals is a constant menace to luman life. Under this condition the relative infrequency of deaths mong people who have been bitten by rabid dogs is due to the pro- ection afforded by the Pasteur treatment. Even with this treatment, towever, considerable anxiety, suffering, hardship, and expense are ntailed upon many people; and it must also be remembered that for number of reasons, not the least of which are the inconvenience and xpense involved, a large proportion of the persons and practically 11 the animals that have received the virus through bites do not ndergo this treatment. Theoretically, rabies is one of the most easily eradicated of conta- •ious diseases, but practically the undertaking is beset with difficulties, ill that is required is the muzzling of all dogs for a sufficient time, 'his has been amply proved by the experience of several European auntries where the disease has been stamped out in this manner. >ut the carrying out of such a measure in this country is not easy, iffective action can not be taken by the Federal Government alone ; ] is necessary to have the cooperation of the States and municipalities nd of the people at large. It seems desirable, therefore, that the iformation contained in the accompanying paper be given the widest ublicity. Respectfully, A. D. Melvin, Chief of Bureau. Hon. James Wilson, Secretary of Agriculture. I 449 3 CONTENTS, Nature and characteristics of the disease Cause of the disease Symptoms Furious rabies in the dog Dumb rabies in the dog Rabies in cattle Rabies in cats Post-mortem appearances Transmission of the disease by milk and meat. Differential diagnosis Distribution and prevalence In the United States In other countries Prevention and eradication Dog license Necessity for muzzling 449 4 RABIES OR HYDROPHOBIA. NATURE AND CHARACTEEISTICS OF THE DISEASE. Skepticism with reference to the existence and prevalence of rabies n animals, or hydrophobia in man, strange as it maj^ seem, is still mtertained by a few prominent professional men. Their contention shows an unwillingness to acce^Dt the work of rex^utable investigators (vith regard to this particular disease, although other results obtained :>y the same investigators upon allied subjects are accepted and advo- 'ated. There is no greater galaxy of names associated with the study )f any of the infectious diseases than is connected with the experi- nental investigation of rabies. The ablest scientists who have idorned the medical and veterinary professions, and to whom we )we the greatest deference for having advanced our knowledge of ,'ontagious diseases, have repeatedly shown hj their experiments that •abies is a specific, communicable disease, preeminently affecting the :anine race, although all warm-blooded animals, including man, are ;uscej)tible to it. Many years of patient scientific research have been required to lead hese investigators to a clear comprehension of the nature and char- icteristics of this disease. It was known and described several cen- uries prior to the beginning of the Christian era, and from the dawn if history the disease has been feared and dreaded. But it has been ►nly in comjoaratively recent j^ears that we have arrived at a tolerably lear understanding of the facts concerning this disease, which have jO a certain degree displaced many of the fallacies and superstitions hat have had a strong hold upon the public mind for many years. ndeed, it is still a widel}^ prevalent belief that if persons or animals re bitten by a dog they are liable to become rabid if the dog should ontract the disease at any future time. There is no foundation for his impression, and it would be a great comfort to many people who re now and then bitten by animals if the fallacy of this idea Avere ppreciated. All experience, both scientific and practical, goes to how that rabies is transmitted only bv animals that arc actuallv dis- 1 . . . , . " . ased at the time the bite is inflicted. Under natural conditions this 3 the sole method by which the disease is transmitted, and therefore 449 . 5 6 RABIES OR HYDROPHOBIA. the old idea of spontaneous generation of the malady is absolutely' fallacious. Artificiall}', it may be readily produced by inoculating susceptible animals with an emulsion of the brain or spinal cord or with the saliva, milk, and other secretions of the affected animal. The blood, on the other hand, seems to be free from the infectious principle. The saliva contains the virus which under natural con- ditions is introduced into or under the skin on the tooth of the rabid animal. Following the canine race, cattle seem to be the most frequently affected, probably because rabid dogs, next to their morbid desire to attack members of their own race, have a better opportunity to bite grazing cattle than any other species of animals. The relative fre- quency of rabies in these two species of animals is indicated by the carefully compiled statistics of the German Empire, which show that 560 dogs and 78 cows died of rabies in 1901, while in 1902 there were 516 cases in dogs and 77 in cattle. Every animal or jDerson bitten does not necessarily develop the disease and the percentage of fatalities has been variously estimated. According to Hogyes the proportion of persons who contract the disease after being bitten by rabid dogs and not treated is conserva- tively estimated at 15 per cent. The percentage is considerably higher in man following bites by the wolf. From 35 to 45 per cent of the dogs, 40 per cent of the horses, 36 per cent of the hogs, and from 25 to 30 per cent of the cattle bitten by rabid animals contract the disease, making a general average of about 30 per cent. This, however, depends on the location and size of the wound, as well as the amount of hemorrhage produced, and various other conditions. In general, the nearer the bite is located to the central nervous system, and the deeper the wound is inflicted, the greater is the danger of a fatal result. In case^ where the hemorrhage resulting from the bite is profuse, there is a possibility that the virus will be washed out of the wound and thus obviate the danger of subsequent appearance of the disease. The virus after being deposited in the wound remains latent for an extremely variable period of time, which also depends on the size and depth of the wound as well as its location and the amount of virulent saliva introduced. Experiments have proved that the virus follows the course of the nerves to the spinal cord and along the lattei'j to the brain before the symptoms appear. Gerlach, having collected statistics from a large number of cases, has found the period between the bite and the appearance of the first symptom to vary from 14 to 285 days. The great majority of cases, however, contract the disease in from three weeks to three months after the bite has been inflicted.. It has been clearly demonstrated by the experiments of Roux and 449 BABIES OR HYDROPHOBIA. 7 Nocard that the bite of a dog is infectious at least three days before it manifests symptoms of rabies, while at the Athens (Greece) Pasteur Institute infection was noted in the saliva eight days before the dog showed signs of the disease. CAUSE OF THE DISEASE. Rabies is a specific infectious disease involving the nervous system and characterized by extreme excitability and other disorders, prac- tically alwaj^s terminating in death. The contagion of this disease has never been isolated, but the fact that the disease is caused by a specific organism principally found in the nervous system is indis- putable. For instance, if an emulsion of the brain of a rabid animal is rapidly filtered through a fine Pasteur-Chamberland filter, the filtrate will be harmless. On the other hand, if a similar emulsion is filtered through the more porous Berkefeld filter, the virus will be found in the filtrate. This fact indicates that the infectious principle is not in solution, but is an organism of such size as to be withheld from the filtrate by a very fine filter. Further proof of the organic nature of the virus is furnished by the fact that heating at 50° C. for one hour will render the vinilent emulsion inert, while similar re- sults follow its exposure to light for 14 hours, to the usual antiseptic solutions for a short period, or to the action of the gastric juice. This contagion can be propagated only in the body of an animal, and despite numerous attempts to cultivate it artificially upon various culture media only negative results have followed. There is no doubt that between rabies and other well-known in- fectious diseases there are analogies at many points, the most striking being the protective immunization which constitutes the great work 3f Pasteur. Moreover, the disease is transmitted from one animal to another through a long series, which indicates the presence of a living organism capable of multiplication, rather than a mere toxin which ?vould naturally become greatly diluted and innocuous by passage through such a series. In addition, the behavior of the disease makes as certain that it is caused by a specific micro-organism which, after ntroduction into the body, undergoes a period of incubation, during vvhich it multiplies and subsequently produces certain definite symp- ;ons and lesions which terminate in death. Innumerable attempts have been made to discover the causative igent, and investigators have announced the finding of many of the ower forms of animal and vegetable life as the pathogenic factor, "^mong the recently described causes certain protozoan-like bodies, found in 1903 by Negri in the ganglionic cells, and termed Negri )odics, are of a very suggestive nature. Negri claims that these )odies are not only specific for rabies but that they are protozoa and 449 8 RABIES OR HYDROPHOBIA. the cause of the disease. His work has been corroborated by investi- gators in all parts of the scientific %Yorld. An examination of the vitality of Negri bodies will show a striking resemblance to the vitality of an emulsion of the virulent tissue. Thus, Xegri bodies have been found to be quite resistant to external agencies, such as putrefaction, drying, etc.. and are about the last portion of the nerve cell to survive the advance of decomposition. Thej^ are also found in over 96 per cent of the cases of rabies examined, but have not been proved to exist in other diseases. Valenti states, as his strongest evidence of the protozoan nature of the bodies, that the virus of rabies is neutralized in test tubes by quinin, while no other alkaloid has this property. As a result of the work performed in the Xew York Cit}^ board of health laboratory'-, Park claims that Negri bodies are found in animals before the begin- ning of visible symptoms, and evidence is given that they may be found early enough to acount for the infectiousness of the central nervous system. These bodies are now almost universally consiclered as diagnostic of rabies, and in the pathological laboratory of the Bureau of Animal Industry their detection in the nerve cells of the brain suffices for a diagnosis of rabies without animal inoculations. In case these granular bodies are not found in a suspected animal, the plexiform ganglion is next examined, and should negative results still be obtained the inoculation of rabbits is then made as a last resort. It is indeed rare that positive results are obtained from the latter method after the first two methods have been negative, but it has occurred occasionally in cases where the animal had been killed in the early stages of the disease. SYMPTOMS. The symptoms of rabies are quite characteristic, and may be di- vided into two types — (1) the furious, violent, or irritable, and (2) the dumb or parah'tic. They vary somewhat in each species, but as the disease in the dog is the most important, it will receive principal attention at this time. FURIOUS RABIES IN THE DOG. Following the period of incubation of the disease, which is usually between three weeks and three months, there is first noticed in the furious form of rabies a marked change in the disposition of the animal, which should at once arouse suspicion. An affectionate dog may become morose and depressed, while a snapping, treacherous animal may become cowardly or affectionate. This is known as the stage of development, and in one or two days is followed by an' RABIES OE HYDEOPHOBIA. 9 irresistible tehdency to roam. If prevented the dog will fight or bite at the restraint or at anything that interferes with his freedom. This roving may occur for one to three days, during which he travels aimlessly in a nervous and irritable condition. His instinctive methods of defense are nearly alwa5^s highly developed or exag- gerated, but he seldom willfully attacks persons or other animals without provocation. When he returns, if not destroyed in the meanwhile, he shows from his exhausted, dirty, sheepish, or de- pressed appearance evidences of wandering. Having returned home, he frequently seeks secluded places such as are found under the jhouse or porch. During this period of roving he exhibits a disposition to eat or chew indigestible objects, as rags, leather, straw, feathers, sticks, and even pieces of coal, which are often swallowed. The secretion of saliva in some cases appears to be excessive, owing to the inability to swallow, and it sometimes becomes frothy from the champing of the jaws. However, foaming at the mouth is not a constant symp- tom of rabies, as is commonly believed by the layman; and further- more, it is frequently misleading owing to the fact that it may be Dbserved in other diseases. The erroneous opinion among the laity that dogs suffering with this disease are afraid of water is also misleading, since such dogs have been known to swim streams in iheir roamings. On the other hand, they appear to be afraid of lothing, as is evidenced by attacking all animals regardless of size. A change in the voice of the animal is peculiar to this affection, md is due to the beginning paralysis of the throat, which usually ;ets in early. Instead of the normal bark the affected dog makes a ong, resonant, peculiarly drawn-out bark which has been likened to he yelp of a coyote. Later, as the paralysis gradually extends, )arking and swallowing become impossible, although attempts may )e made to swallow. At this stage the muscles of the jaw become )araiyzed, causing the lower jaw to drop and the tongue to hang )ut, which makes it collect dirt and appear dry and darker in olor. Owing to this latter symptom the disease has been termed black tongue " in certain sections. Upon closer observation the )upil of the eye is frequently found to be dilated. The paralysis ontinues to extend, the hind legs become involved, and the dumb orm of the disease results. Finally death follows in from four to ight days after the development of the first symptoms. DUMB RABIES IN THE DOG. The dumb or paralytic form of rabies is much more infrequent han the furious type, and is characterized by the early appearance f paralysis without symptoms of frenzy or irritabilit}' which are 88301°— Bull. 449—11 1 10 RABIES OR HYDROPHOBIA. observed in the early stages of the furious form. Therefore the,^ animal affected with this type of the disease is not capable of doing ^ much damage. Indeed the dog is much depressed from the begin- ning and seeks quiet spots or hides in some secluded place. Probably the first symptom noted by the owner is the paralysis of the lower jaw, as a result of which the animal is often suspected of having a " bone in its throat." The paralysis quickly progresses until it involves the legs and trunk and results in death in from one to three days. RABIES IlSr CATTLE. In cattle both furious and dumb rabies are met with as in dogs, the former being the more common. However, a sharp line of dis- tinction can not always be drawn between these two forms of the disease, as the furious type usually merges into the dumb, due to the paralysis which always appears prior to death. The typical cases of dumb rabies are those where the paralysis occurs at the beginning of the attack and remains until the death of the animal. The disease first manifests itself by loss of appetite, stopping of the secretion of milk, great restlessness, anxiety, manifestation of fear, and change in the disposition of the animal. This preliminary stage is followed in a day or two by the stage of excitation or madness, which is indi- cated by increasing restlessness, loud bellowing with a peculiar change in the sound of the voice, violent butting with the horns and pawing the ground with the feet, with an insane tendency to attack other animals, although the desire to bite is not so marked in cattle as in the canine race. About the fourth day the animal usually becomes quieter and the walk is stiff, unsteady, and swaying, showing that the final paralysis is coming on. Loss of flesh is extremely rapid, and even during the short course of the disease the animal becomes exceedingly emaciated. The temperature is never elevated, but usually remains about normal or even subnormal. Finally there is complete paralysis of the hind quarters, the animal being unable to rise, and, but for irregular convulsive movements, lies in a comatose condition and dies usually in from four to six days after the apjoear ance of the first symptoms. RABIES IN CATS. "When the disease attacks cats, these animals generally hide them- selves under the furniture or in some dark hidden corner, and there they may die unobserved in the course of a day or two. As a rule, however, the disease implies danger for human beings. The rabid cat becomes very bellicose; from the dark corner where it has hidden itself it will suddenl}' attack animals or persons, and especiall}- when 449 EABIES OE HYDEOPHOBIA. 11 children are involved it will jump up to the face and inflict severe wounds with its teeth and claws. In the violence of this attack it frequently bites itself. The rabid cat loses its voice, being able only to mew hoarsely. Later it loses its appetite, has difficulty in swal- lowing, becomes emaciated, and succumbs within several days with symptoms of paralj'sis. Horses, sheep, goats, hogs, chickens, and animals of prey such as wolves, foxes, badgers, and martens also contract rabies when bitten b}" rabid animals, and behave quite similarly to rabid dogs, cattle, and cats. POST-MORTEM APPEAEANCES. In rabies there are no constant or definite lesions observed on post- mortem examination of the carcass. In fact, the alterations are slight, variable, and almost absent at times, so that unless there is a good historj^ or characteristic symptoms a positive diagnosis can not be made without recourse to microscopic examination or animal inoculations of the brain of the suspected animal. The most sug- gestive indication of rabies is the presence in the stomach of unusual bodies such as stones, wood, earth, cloth, iron, feathers, etc. Fre- jquently the stomach is empty of food, but distended with material of this character. Its mucous membrane is frequently injected, and at times a marked reddening of the folds of the stomach, with or without erosions, is noticed. There may also be an inflammation of ;the covering of the brain and cord as well as of the mucous lining of the mouth, throat, and respiratory tract. The feet of rabid dogs may present sores and bruises, denoting extensive travel which had been accomplished during the period of roving. The heart and peri- cardium are often inflamed, but these and similar lesions are more frequently due to the condition of the animal before dying than to any specific alteration. The carcass rapidly undergoes decomposition. TRANSMISSION OF THE DISEASE BY MILK AND MEAT. While the virus of rabies is most frequently found in the central nervous system and the salivary glands, it may also be found in other glands and secretions, including the mammary glands and the milk. That rabies may at times be excreted with the milk has been proved by IN'ocard, Perroncito, Bardach, and the writer. In these latter experiments the milk of a rabid bitch having a litter of puppies was inoculated intramuscularly into rabbits and guinea pigs, and produced typical rabies; but the puppies, removed from the mother when the first symptoms developed, were kept under observa- tion for 18 months without developing the disease. The reason for these negative results in the puppies may be explained (1) by not 449 12 EABIES OR HYDROPHOBIA. having been bitten bv the mother before she was removed, and (2) the absence of any abrasion in the alimentary tract through which the virus could have entered the circulation. It is a generally accejoted fact that rabies can not be transmitted to normal animals through food containing the virus of the disease unless lesions are present in the alimentary canal; but the conclusion that there is no danger to the consumer from the meat or milk of animals that are rabid is not tenable, since abrasions of the lips, mouth, and pharj'nx are all too frequent to permit of such risks. These products must therefore be considered as dangerous to health. One case is on record where a bab}' in Cuba developed rabies from nursing its mother while the latter was in the early stages of hydro- phobia. In this case, however, the virus in the milk raaj have entered the circulation through abrasions of the gums during teeth- ing. Similar cases have been reported in veterinar3^ practice where the virus of rabies was observed to have been passed to the offspring through the mother's milk, but in these cases it is impossible to elimmate an obscure bite from the bitch or lesions of the gums dur- ing this early age. TSTiile it is not probable that cattle would be milked after the symptoms of rabi&s developed, it is nevertheless important to realize the danger of using such milk and the necessity for presenting calves from sucking such diseased cows. All attempts to convey the disease to healthy dogs by feeding them upon meat from infected animals have given negative results.^ Xevertheless the meat of rabid animals must l^e considered as unfit for food, and the meat-inspection regulations enforced by the various countries having such inspection provide for the total condemnation of the carcasses of these animals. Infection has occurred in man from making autopsies on rabid dogs, and it is likewise possible to result if inoculation occurs while handling the meat of rabid cattle, hogs, or sheep. Ostertag reports the case of a veterinarj^ student at Copenhagen who infected a wound on his finger while making an autoj^s}^ on a dog dead of rabies and died of the disease. Another somewhat similar case occurred in a veterinary student at Dresden in consequence of an injury received while holding a post-mortem on a rabid dog. Wyrsykowski. in an attempt to discover the reason for the fact that no illness followed the eating of the meat and even the brain of rabid animals, tested the action of the gastric juice upon infectious material in vitro. Twenty-one rabbits were inoculated with this artificially dig-ested virus, but not one animal contracted the disease, while all the * Claudio Fermi' has recently produced rabies in rats and mice by feedinj:? them rabietic, material with their food. About 60 per cent of the 70 animals so fed died of paralyti rabies. 440 1 EABIES OR HYDROPHOBIA. 13 17 check rabbits which were inoculated with undigested rabies virus developed the disease and died. It is evident, therefore, that the gastric juice has a pronounced deleterious effect ujDon the virus of rabies. DIFFERENTIAL DIAGNOSIS. The present advocates of the assumption that, rabies is a disease of phe imagination should be better fortified in both their facts and their heory. Little children certainly do not die after a dog bite from the effects on the imagination, nor do horses, cattle, sheep, hogs, dogs, 'abbits, and monkeys die from an imaginary disease. It must be nore than a mere coincidence that ever since the recognition of this lisease in the days of Aristotle this peculiar mode of death has occurred only after infection by a rabid animal. The daily news- )apers may add to the sensational details of these occurrences, but here is no doubt of the real danger involved. Anyone who has seen the suffering of one human being affected v'ith this fatal disease will readily concede that no amount of incon- enience caused animals by muzzling or other protective arrange- iient can ever be considered too much to prevent such suffering, nor hould it prove difficult to differentiate between hydrophobia and he pseudo form, which has been termed lyssophobia, if all the cases 'f these diseases were as typical as the two which were brought to lie writer's attention. Through the courtesy of Dr. "William C. Woodward, health officer f the District of Columbia, I Avas invited to visit Freedmen's Hos- dtal for the purpose of seeing a patient whose case had been diag- osed b}^ the resident surgeon as suspected hydrophobia. The woman, 8 years of age, had been fiercely attacked and severely bitten on the ight forearm and about the face by a stray collie dog. Eighteen ays later she complained of a general malaise and pains in the cica- pized wounds of the head, which rapidly grew more severe, necessi- iting the services of a physician, upon whose advice the patient was 3moved to the hospital on the following day. My visit occurred on le afternoon of the succeeding day, at which time the patient was Dund in an extremely nervous condition, having an excessive feel- ig of fear and uneasiness. The eyes were staring and a general s:pression of anxiety pervaded her countenance. Her mind was ^ear, and no efforts at violence were made. A'^Tien interviewed as to le scars on her head and forearm she lightly replied. " Oh, a dog it me there some weeks ago, but they are all right now." From time to time reflex spasms involving the muscles of deglu- tion were noticed, causing a clutching at the throat and difficult reathing during the attack. These rapidly became more general- ;ed and soon involved the respiratory muscles, causing dyspnea. 449 14 EABIES OR HYDROrHOBIA. Attempts at vomiting ttouIcI then occur, but no evacuations followed Contrary' to the views of our skeptical friends, the patient accredited these symptoms to indigestion, and had not the slightest suspicion of the true nature of her condition, thus disproving the idea that the nervousness and fear usually seen in the early stages of rabies in the human subject are due to the natural dread of the disease and apprehension of the* consequences rather than to organic changes in the central nervous system. During the night these s3anptoms be- came more aggravated and spasms followed one another more rapidlj'^, causing grave delirium. The patient finally became violent, requir- ing the adoption of forcible measures to keep her under control. Death occurred on the following morning, 21 days after the bites had been inflicted. On post-mortem examination no pathological lesions were found which could be held accountable for the symptoms which resulted in death, but histological examinations of the plexiform ganglia and the medulla, as well as the inoculation of rabbits, both subdurally and intramuscularly, with an emulsion of the brain, re suited in the confirmation of the diagnosis of hydrophobia. That the appearance of a disease like rabies in a community seemsj peculiarly and in an extraordinary degree to be associated with an' atmosphere of hysterical simulation and to inspire states of auto- suggestion must be admitted. One case of this character recently came to my attention through the kindness of a local phj^sician which is in direct contrast to the instance cited above. A young man, 24 years of age, employed as a clerk in a drj goods store, was bitten on a Saturday morning by a watchdog belonging to the proprietor. The bite, which was slight, had been immediately cauterized, and no further attention was given to the incident until Wednesday morning, when the young man fainted at the counter. Upon reviving he stated that he had been reading about rabies and the symptoins which would develop in man from the bite of a rabid dog, and insisted that he was developing hydrox^hobia as a result of having been bitten by the watchdog. He was immediately sent to; his home and the dog brought to the bureau to be kept under obser- vation. Two days later the young man was in a very hysterical state and kept insisting that the dog that bit him was rabid. During this time the patient had been in bed, and seemed to have had marked IDaroxysms. He would roll himself over and over in bed, snarling, growling, and snapping at the bed clothes. He would catch the pil- low or sheet with his teeth and shake it like a terrier shaking a rat, and in numerous other ways would show more imitative accuracy than in the genuine disease. At first it was impossible to attract his atteji- tion, although he would mutter and talk to himself, "\^^len he was informed that the dog that bit him did not have rabies, that it was 44ft BABIES OR HYDROPHOBIA. 15 ilive and well, and tliat even if it did develop rabies several weeks ater it would have no bearing on his case, as the saliva would not be 7-irulent such a long period before the development of the symptoms n the dog, and furthermore that he had developed symptoms entirely ,00 soon after the bite had been inflicted, as a longer period of incuba- ion had to intervene for the virus to multiply and produce its effects, 16 commenced to realize that he had been making himself a victim of autosuggestion, and rapid recovery followed. Here was a typical case of lyssophobia or pseudo-rabies, a figment if an overworked imagination, and, as in all cases of this class, re- overy took place instead of death, which is always the termination f the true disease. It has been stated b}^ certain physicians that tetanus (lockjaw) is mdoubtedl}^ the true cause of death in the majority of instances where abies has been diagnosed. It is not my purpose to give a differential iagnosis between these two diseases in man, but there is such a larked difference between a horse affected with tetanus and one with abies, or a cow affected with tetanus and one with rabies, or a dog ffected with tetanus and one with rabies, that a few brief words on ifferential characteristics will be given. Tetanus may be readily differentiated from rabies by the per- istence of muscular cramps, especially of the neck and abdomen, hich cause these muscles to become set and hard as wood. In itanus there is also an absence of a depraved appetite or of a will- ul propensity to hurt other animals or damage the surroundings, 'he general muscular contraction gives the animal a rigid appear- nce, and there is an absence of paralysis which marks the advanced 'age of rabies. The dumb form of rabies in dogs is characterized y a paralysis and pendency of the lower jaw, while in tetanus the iws are locked. This locking of the jaws in horses is very charac- iristic, and in cattle or dogs it renders the animals incapable of bel- )wing or barking as in rabies. Finally, tetanus may be distinguished fom rabies by the fact that the central nervous system does not con- lin the infectious principle, while in rabies the inoculation of test aimals with the brain or cord of a rabid animal will produce the isease with characteristic symptoms after an interval of 15 to 20 ays. This period of incubation is much longer than in tetanus, nee the inoculation of rabbits with tetanus bacilli invariably results I death aft-er a short period, usually within 3 or 4 days. DISTRIBUTION AND PREVALENCE. There is no intention of assuming the part of an alarmist with iference to the increasing prevalence of rabies. It can not be denied, Dwever, that there is at present unusual occasion for alarm in certain 440 16 BABIES OE. HYDEOPHOBIA. parts of this country. It may be true that many newspaper stories have been exaggerated or are entirel}^ false, but it is not true thai all are fabrications. This is shown by a number of cases traced bj the writer where the diagnosis had been made m reputable labora tories by recognized scientists. Kerr and Stimson in their invest! gation of the prevalence of rabies used a number of press clippings and in no instance did a press report lack official confirmation, which is quite contrary to the general opinion on this subject. IN THE UNITED STATES. In looking over the proceedings of the American Veterinary Medical Association for the past 12 years, it was observed that rabies is reported as existing in a number of States each year, although there has been no special endeavor on the part of the resident State secretaries to ascertain the extent of this particular disease in their sections. Tn 1897 the disease was reported in 4 States, in 1898 in 5 States, while in 1899 the statement of Huidekoper was cited by Parker to the effect that the disease was not west of the Rockies aiid was rare in the United States except in Pennsylvania and Massa chusetts. However, in the 1900 report we find that the disease had appeared in Montana, Wyoming, and Colorado, in addition to cer- tain Eastern and Central Western States. It is evident from the succeeding reports that the disease was becoming more widespread and at the meeting of the American Veterinary Medical Association in Philadelphia in 1908, of the 20 resident State secretaries who reported, 13 incidentally mentioned the existence of rabies in their States, and in Alabama, Connecticut, the District of Columbia^ Minnesota, Mississippi, and Ohio the disease seemed to be on tha increase. As there was no apparent reason for mentioning the pres- ence or absence of this disease, the failure of the reports from the remaining 7 States to refer to rabies should not be considered as indicative of its absence. In fact, the writer has corresponded witb officials in these 7 States, and replies have been received from 5 oi them to the effect that rabies had prevailed in their localities during 1908, thus showing that the disease existed in 18 of the 20 States mentioned in the 1908 report. We have gone even further in oufl correspondence and have endeavored to find out if there is any State or Territory in the United States where rabies is unknown.! From the information at the writer's disposal it would appear that the disease occurs in almost every State in the Union, and the onlyj places where it has been impossible to obtain positive information) are Idaho, Utah, Nevada, and Oregon,^ while in the State of Wash-i I Rabies has been reported in Oregon by Pcrnot since this paper was written. 449 I KABIES OR HYDROPHOBIA. 17 ngton there has been but one outbreak, which was quickly sup- )ressed 7 years ago. It would be entirely impracticable without egistration laws to ascertain the extent of the disease among ani- aals in the various infected sections, but the disease appears at imes in certain centers with all the vigor of an enzootic, and such utbreaks have occurred recently in Jacksonville, Fla. ; El Paso, Tex. ; Norfolk, Va.; Kansas City, Mo.; Boston, Mass.; Chicago, 111.; Bal- imore, Md. ; Washington, D. C. ; Cleveland, Ohio ; Pasadena and jOS Angeles, Cal. ; and certain sections of New York, Pennsylvania, linnesota, Ohio, Missouri, and Michigan. Not only is there a radual increase in the number of outbreaks of rabies, but many new ienters which appear to be more or less permanent are being estab- shed from year to year. The fiscal year 1909 is the first year when ver 100 cases of rabies have been diagnosed in the Pathological Hvision of the Bureau of Animal Industry, and of the positive ases, 79 came from the District of Columbia and 33 were divided mong Virginia, Maryland, West Virginia, and South Carolina. The following table, prepared by Kerr and Stimson, of the United tates Public Health and Marine-Hospital Service, gives a partial st of the number of laboratory diagnoses of rabies found in 1908 t the various institutions interested in the investigation of this dis- ise. They call attention to the fact that these figures represent in lany instances only a small proportion of the actual number of cases f rabies occurring in the various States. For example, while only 7 cases of rabies have been actually demonstrated in Wisconsin, the tate veterinarian estimates that 584 animals died of this disease iiring 1908. Positive findings of rahies in animals, 190S. Diagnosis made by— li ;laware State Board of Health laboratory. . . nnecticut State Board of Health laboratory. orida State Board of Health laboratory liana University, Bloomington, Ind liana State Board of Health lalwratory Itimore (Md.) Pasteur Institute •ssachusetts cattle bureau liversity of Michigan Pasteur Institute w Harripshire State Board of Health w Jersey State Board of Health w York Pasteur lastitute •rth Carolina State laboratory of hygiene rmont State Board of Health iscoDsin state hygienic laboratory " w YorkState Veterinary College anesota State li ve-stoclv board '.reau of Animal Industry, Pathological Division, Washington, D. C . iveland health department, east side nnsyl vania State live-stock sanitary board io State Board of Health laboratories ■ginia Pasteur Institute, Richmond ^logical laboratories, Brown University, Providence, R.I Total 449 Number. 7 14 20 12 75 74 135 101 7 13 60 21 2 47 188 15 121 49 103 32 39 32 1,167 18 EABIES OR HYDROPHOBIA. In a letter from former State Veterinarian Langley he states tlia Texas j^robably has more rabies than any other State in the Union Se^^eral j^ears ago President Frank Wells, of the Michigan Stat( Board of Health, made rabies largely the subject of his annual ad dress and declared it was epidemic in Michigan. Vaughan, who re ported as a special committee on rabies, intimated that it had gradj ually spread from New York, where it had prevailed for a number o: years previously, into Ohio and thence to Michigan, having been dif fused throughout the Lower Peninsula of Michigan, In fact, th(' disease became so widespread and so many people were bitten that th( State appropriated funds for the establishment of a Pasteur institut< in connection with the medical department of the University of Michi gan. A Pasteur institute was likewise established in April, 1908, ir Washington, D. C., in connection with the Hj^gienic Laboratory of th(' '' United States Public Health and Marine-Hospital Service, owing t( the continued outbreak of rabies in that vicinit}'' and the large numbeif of people bitten hj rabid animals, 139 persons having been treated since its establishment. In addition, there are 18 other Pasteur insti- tutes in the United States, located at Atlanta, Ga. ; Austin, Tex. Baltimore, Mel. ; Chicago, 111. ; Iowa City, Iowa ; Jacksonville, Fla. Minneapolis, Minn.; Montgomery, Ala.; Newark, Del.; New Or leans, La. ; Pittsburg, Pa. ; Ealeigh, N. C. ; Richmond, Va. ; St. Louis, Mo. ; two in Indianapolis, Ind. ; and two in New York City. As an indication of both the distribution and the prevalence oi *' rabies among animals may be considered the number of persons whc 'i have been treated at these institutes. The directors of these Pasteui"' institutes have been requested to furnish this information, and the' Si majority have responded. From these reports it is evident thaff several thousand people have been subjected to the Pasteur treatmeni ^ recently, and hundreds (nearly 1,500 persons in 1908) receive the treatment every year as a result of bites inflicted by rabid animals, At the Pittsburg institute 1,022 persons from Canada, Ohio, Pennsyl vania, New York, West Virginia, and Colorado have received treat- ment, as follows : 3i From December, 1900, to September, 1902, 76 cases. * From October, 1902, to October, 1904, 143 cases. From October, 1904, to October, 1906, 185 cases. From October, 1906, to October, 1908, 368 cases. From October, 1908, to June, 1909, 250 cases. The Texas institute, under State control, has been established less than 5 years, but the number of persons who have applied for treatment has gi-adually increased from 81 in 1905 to 254 in 1906, SlOf in 1907, and 353 in 1908, these patients coming from 7 Southwestern States and old Mexico. 449 E ti Ji BABIES OR HYDROPHOBIA. 19 At the St. Louis institute 381 persons have been treated, coming icrom 11 Southern and Central Western States and from Mexico. j Since 1890 the Chicago institute has treated 3,016 people, coming :rom 30 different States of the Union. At the New York institute (Rambaud's) 1,367 cases were treated between 1880 and 1900, 237 cases in 1900 and 1901, and 486 cases Tom October, 1904, to October, 1906. Brawner, of the Georgia institute, has treated 670 patients since ■900, with only 2 deaths. During this time all the people in Georgia )itten hj rabid animals so far as could be learned, and who did not ake the treatment, were recorded, and of the 120 bitten without sub- equent treatment 29 have died. Rabies is said to be very much on he increase in that section, and it is not uncommon for farmers to ose many horses, cows, and hogs from the disease. At the Baltimore institute 1,092 cases have been treated, 334 of ?^hich came from Maryland, 117 from North Carolina, 102 from Penn- ylvania, 104 from Virginia, 112 from West Virginia, 57 from the district of Columbia, and the remainder from 13 other States. Since 1901 the Richmond institute has treated 208 cases, coming rom Virginia, North and South Carolina, and West Virginia. As a further indication of the number of persons bitten but who lid not take the Pasteur treatment are the census reports showing he mortality statistics from rabies. In the census of 1900, when only bout 40 per cent of the population resided in districts where registra- ion was observed, 123 deaths from rabies distributed in 20 States (^ere reported. That this number was entirely too low was shown by Jalmon in 1900, who corresponded with a number of health officers rithin and without the registration districts and collected 230 authen- Lc cases of hydrophobia in man during this same interval in 73 cities. That the increase of rabies in animals which has been demonstrated bove bears a direct relation to the increase in the disease in man is hown by the vital statistics of the Census Bureau, as follows : In 1903, 43 people died of rabies ; in 1904, 38 ; in 1905, 44 ; in 1906, 5 ; in 1907, 75 ; in 1908, 82. These deaths occurred only in the regis- ration area of the United States, which now includes about 51 per ent of the total population. IN OTHER COITNTIIIES. While the disease in certain foreign countries has at times appeared 1 the form if severe enzootics extending over considerable territory, 1 the course of the last decade the affection has decreased on the hole, and in some places has even disappeared entirely, owing to the Igid enforcement of muzzling and quarantine regulations. Accor^l- ig to Tlutyra and Marek the disease in France is widely distributed 449 20 BABIES OR HYDEOPHOBIA. all over the country. Since 1899 more than 2,000 cases of rabies in | animals have been reported each year, and in 1903 there were 2,391 rabid animals. In Germany during the years 1895 to 1898 the num- ber of cases of rabies increased rapidly from 489 to 1,202. The number then decreased to 612 in 1902. These cases occurred mainly in the eastern and southern provinces bordering on the badly infected districts in Russia and Austria, while in the other parts of Germany only a few isolated outbreaks of the disease appeared. In Austria the disease has been on the increase since 1891, and in 1900 there vvere 1.187 cases reported. During this interval — from 1891 to 1900 — 4,974 people were bitten by rabid animals, 123 or 2.4 per cent of whom died of hydrophobia. In 1903 the number of people bitten by mad dogs varied from 11 to 42 weekly. In Hungar}^ there was a momen- tous decrease in rabies following the passage of the veterinar}' sani- tary law of 1888, but since 1893, when there were 883 cases, outbreaks have been gradually increasing, and in 1903, 2,040 rabid animals were reported. The disease is most common in Russia, and it also appears very frequently in Roumania, Servia, and Bulgaria. In Turkey, despite the large number of dogs, the disease does not increase much, which is explained by Remlinger by the fact that the af!ection gen- erally appears in the form of dumb rabies. In 1903 only 35 rabid animals were reported in Belgium, 25 in Holland, 18 in Switzerland, and 376 in Italy. Spain has had more frequent outbreaks of the disease, while Denmark, Sweden, and especially Norway and Great Britain, have beer, free from the contagion for several 3'ears owing to the wise provision that all dogs running at large shall be muzzled. The islands of Australia, Tasmania, New Zealand, St. Helena, and the Azores have never become infected with rabies, and the first three prevent its introduction by rigid inspection and quarantine. In 1905 Rutherford reported the disease to be spreading in Canada, and in 1908 Dudley made a similar statement for the Philippine Islands, where the malady had been found to exist in 39 jjrovinces. The latter recommends the establishment of a Pasteur institute in the islands. That rabies is increasing in Mexico is shown by the report of the Pasteur institute in the City of Mexico. For the 20 years since this institute was established 8,680 patients from all the Federal States of Mexico have taken treatment, 4,579 of these people receiving the treat- ment during the last six years. The disease is also known to occur at infrequent intervals in certain sections of South America, Africa, and Asia. PREVENTION AND ERADICATION. Sanitary regulations which seek to control the disease effectively by exterminating it among dogs are most likely to prove successful. There is no communicable disease which is more easily prevented or 440 BABIES OR HYDROPHOBIA. 21 jradicated than rabies. Since the infection is practically alwaj-s trans- mitted by a bite, and since the animal which does the biting is almost ahva^^s a dog, all sanitary- measures must be directed to the control of the;Ee animals for a snfficient time to cover the incubation period of the disease. It seems inexcusable, therefore, to allow this contagion to be propagated indefinitely, causing untold suffering to the affected animals and menacing the lives of persons, particularly children, who go upon the streets. The only measures necessary to obtain the desired result are (1) a tax or license for all dogs, with a fee of $2 for males and $5 for females, and the destruction of homeless or vagrant dogs; (2) restraint of all dogs which appear in public places, either by the use of a leash or an efficient muzzle. DOG LICENSE. , There is no doubt that neglect has allowed the accumulation of Dwnerless dogs in this countr}' to an extent that renders our large cities frequently liable to incursions of rabid animals. To even mention muzzling, however, is sufficient to bring tirades of abuse upon the tiead of the sanitarian, and dog sentimentalists are immediately up in arms, using time, influence, and money to prevent such an ordinance. In spite of the obloquy with which it is received by a certain mistaken lass of the community, the results of muzzling amply justify its recommendation, and its rigid enforcement without any additional requirement will exterminate rabies in a district in a shorter time than any other known method. Even Dulles, the great controversialist on rabies, admits that he considers muzzling to be the most important measure for limiting the ravages of this disorder, no matter on what theory it may be accounted for. Excellent examples of its efficiency are shown by the well-known results obtained in eradicating the disease from England, Sweden, Denmark, Berlin, and in other ommunities. NECESSITY FOR MUZZLING. The striking results obtained by England have caused many persons to propose and advocate a national dog muzzling law for the United States, enforced by the Department of Agriculture. These sugges- dons, however, do not take into consideration the discrimination bc- ■ween the functions of the Federal and State Governments and the differences between the laws of the United States and those of Eng- land. The power conferred is not in all cases sufficient to effect the radication of a disease, for the reason that the Federal Government 3an not enforce measures within a State without the legislative consent of the State unless the animals affected are subjects of or 449 22 BABIES OR HYDROPHOBIA. endanger interstate commerce. Its work, therefore, without the co operation of the States affected, is limited to interstate traffic, and quarantine lines are thus made to follow State lines. The department is always willing to cooperate, so far as possible, with any State which requests assistance in eradicating an infectious disease. But such a State must necessarily have the proper laws by which the con- trol of the disease is made possible. "Wlien a disease such as rabies is confined within a State it does not come under the jurisdiction of the Federal Government and can not be treated as the infectious diseases pleuro-pneumonia and foot-and-mouth disease, which spread from State to State and become a serious menace to interstate traffic. The Department of Agriculture could quarantine against States where the rabies exists, but it can readily be seen that owing to the great freedom of movement which dogs enjoy it would be impracti- cable to enforce such a quarantine further than to require all dogs to be muzzled which are being transported interstate by common car- riers. Such a requirement would give an infinitesimal amount of protection, as these dogs would be beyond the Federal jurisdiction after reaching the State for which they were destined. If all States should enact muzzling laws, or if the State boards of health. State sanitary boards, and municipal authorities in the in- fected States should be empowered to issue and enforce regulations compelling the muzzling of all dogs in the infected area and the im- pounding or humane destruction of all dogs found running at large, ' t]ie disease would soon be stamped out. The necessity for a muzzling order having arisen in the District of Columbia, the Secretary of Agriculture notified the District Com- missioners of the presence of this disease in an alarming degree among the canines of Washington, and requested the enactment of a muzzling order. Such an order was deemed advisable because the disease had suddenly jumped from 12 cases during the fiscal year of 1906-7 to 61 cases in 1907-8. The Commissioners, however, believing that the most effective manner of dealing with the matter was to impound and destroy stray dogs, started to increase the dog-catching service on February 1, 1908, and from this time to June 15, 1908, there were 2,702 dogs impounded as compared with 1,185 dogs impounded during the corresponding period for 1907. The Presi- dent of the United States became interested in the subject, and the Commissioners issued a muzzling order to be effective for a period of six months. With ■ the extra wagons and force employed, the number of dogs captured during the period of the muzzling order was 4,355, as compared with 2,794 captured during the corresponding period of the preceding year. The cost of the service for the period of the muzzling order was $6,125, as compared with $2,243 for the 449 RABIES OR HYDROPHOBIA. 23 corresponding period in the jDrevioiis year. To further the execu- tion of this order, 146 arrests were made and 134 convictions secured, besides what was accomplished by giving notice of a penalty for violation. In 1908, during the last six months of which the muzzling order was enforced, 8,225 dogs were impounded, while after the expiration of the muzzling order only 2,243 dogs were impounded during the first half of 1909. During the last six months of 1908, the period when muzzling was required, there were 46 cases of rabies, while in the first six months of 1909 there were only 28 cases. The results from the muzzling order were therefore becoming apparent, and an additional six months' quarantine was requested b}^ the Secre- tary of Agriculture, but this request was not complied with b};^ the District Commissioners. In the last half of 1909 there were only 24 cases, but in the first half of 1910 the number rose to 34. During this time new Com- missioners came into office, and as the disease persisted and showed a tendency to increase, they issued another muzzling order, taking effect August 11, 1910. Since that time the number of cases has gradually decreased, notwithstanding the fact that owing to the insufficiency of the appropriation the authorities have been unable to enforce the order adequatel}^ In order to secure State and municipal legislation for the control of rabies it wall require concerted action on the part of all interested parties, whether professional men or laymen, to prove to the public the need, value, and benefits of such a procedure. With such legis- lation properly enforced no dog would be seen running at large with- out a muzzle. Those contracting the disease would be unable to transfer the virus to other animals. Monetary loss, untold suffering, and death among both human beings and animals caused by the disease would rapidly decrease, and in a relatively short period rabies would be eradicated from our country. After reaching this desired goal the reappearance of the disease could be readily prevented by a six months' quarantine of all dogs imported into the United States from countries where rabies is prevalent. O COLUMBIA UNIVERSITY LIBRARIES This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the rules of the Library or by special arrange- ment with the Librarian in charge. DATE BORROWED , DATE DUE DATE BORROWED DATE DUE C2e(ll4l)M100 RC148 M72 Mohler