UMASS/AMHERST

797
vM4

^»

**«

TftA ' • "J

s??

$#jj

L^BLaA&j

Ft:

5P|^

Mi

tf£

B*^bG>

St-

r!

LIBRARY

OF THE

MASSACHUSETTS

AGRICULTURAL

COLLEGE

NO.-. sr
SOUR 797

ATE.J0-1SU.
!§£

V-

RABIES-HYDROPHOBIA.

BY THEODORE R. MAC OLORE, LANSING, MICHIGAN.

[Reprinted from the Proceedings of the Sanitary Convention at Charlotte, Michigan, Nov. 22 and 23,

1894, published as a Supplement to the Annual Report of the Michigan

State Board of Health for the year 1895.]

[Rephint No. 433.1

U 19.3 1

H <rw

RABIES-HYDROPHOBIA.

By Theodoee R. MaoCluee, Lansing, Michigan.

INTRODUCTION.

Rabies is a disease common to both man and animals, and can be classed
with the diseases dangerous to the public health. Rabies in man may
be attended with one symptom which is spoken of as " fear of water" from
which the term hydrophobia originates, but really there is no great differ-
ence between the rabies of man and the rabies of animals. Water and
other liquids or even a draft of air from a window or from a fan may cause
the spasm or convulsion. The spasm caused by water has led to the term
hydrophobia. Many writers seem to favor using the term hydrophobia
when speaking of rabies in man, and rabies when speaking of the disease
in animals, although technically speaking there is no such disease as
hydrophobia. It seems, however, to be a convenient usage of terms; and
I may in the pages following use the term hydrophobia when speaking of
rabies in man and rabies when referring to the disease in animals.

Through my work in the office of the State Board of Health, in giving
attention to the reports of alleged outbreaks of rabies and cases of hydro-
phobia, I have become much interested in the subject. The disease does
not cause three thousand deaths in man in Michigan every year, as does
consumption, nor does it cause such great mortality in the human race
every year as does diphtheria, scarlet fever, typhoid fever or measles, but
I presume there is no disease to which the human race is heir that causes
more fear or consternation than does a case of hydrophobia or rabies.
Many people think that small-pox is a dreadful disease and causes many
deaths, but I presume that a yearly average for the last ten years will
show that there have been in Michigan not many more deaths from small-
pox than from hydrophobia. Neither small-pox nor hydrophobia is as
frequent as it was many years ago, when preventive medicine was not
known. In 1780 Jenner discovered preventive vaccination against small-
pox, and in 1885 Louis Pasteur discovered the preventive treatment
against hydrophobia and rabies, and to-day millions of people are being
vaccinated every year to protect themselves against an attack of small-pox,
and thousands of people having been bitten by dogs or other animals
known or supposed to have been mad, have received treatment which has
generally insured them against the development of that fearful disease —
hydrophobia.

* This paper was not read (except by titie) ; bat an outline of the paper was placed before the Execu-
tive Committee of the Conveatiou, and members of the State Board of Health and it was unanimously
voted that the paper should be printed in the pamphlet proceedings of the Convention.

Note.— In the preparation of this paper, especially that portion relating to Etiology, I am indebted to
the kind assistance of Dootoe Geobge H. Cattebmole, of Lansing.

RABIES— HYDROPHOBIA. 19

I am sorry that I am not in a position to give the results of some original
researches as are most of the persons who attempt to write on this subject;
but, as that is one of the impossibilities, I will endeavor to reiterate only
what has probably already been said. My object in writing this paper is
to place before the people some facts which may be of interest to them
and may directly or indirectly be the means of saving some human lives,
because it does not seem to me that there is any necessity for persons bit-
ten by rabid animals to suffer the agonies which are attended with death
from that terrible disease.

EARLY HISTORY.

Rabies has existed for many centuries; and, as the disease may occur in
almost any warm-blooded animal, it is not at all improbable that there may
have been cases of rabies soon after the creation of animals as mentioned
in the first book of the Bible. As the disease most frequently occurs in
dogs, I presume that history would record cases as early as 1,500 years
before Christ, for about that time dogs were mentioned by Moses, and
about 32, Anno Domini, dogs were spoken of as " eating the crumbs which
fall from their master's table."

The early history of canine rabies is somewhat obscure, but, whenever
spoken of by the early writers, it seems to be dreaded as much as at this
period. Plutarch says that hydrophobia was first observed in the days
of Asclepias, the God of Medicine. Aristotle spoke of canine rabies,
but thought the disease was never communicated to the human race.
Celsus gave the subject especial attention and believed that, on account of
a morbific virus, the bite of all animals was dangerous. Ovid states that
hydrophobia and gout were in his day reckoned among the incurable dis-
eases. During the first centuries of the Christian era considerable atten-
tion was given to the causation and treatment of hydrophobia. Many
different theories as to its causation were advanced, but Pedanius Diosco-
rides was probably about the first (in the fourth or fifth century, Anno
Domini) to give an exact description of the disease. In his work on
" Materia Medica " he mentioned its tranmissibility from animals to man-
kind, its certain fatalitv when once developed, and its prevention by cau-
terization. But up to the eighteenth century there was little progress
made in ascertaining the nature and causation of rabies or hydrophobia
and their restriction and prevention.

As early as 900, Anno Domini, outbreaks of rabies were recorded.
" One day a mad bear, following the course of the river Saone, at last
reached the quay at Lyons. Everybody fled at its approach, except some
boatmen who, armed with heavy sticks, attempted to kill it. The bear,
however, little intimidated by their number, rushed amongst them and bit
many — about twenty. Of this party six were smothered in about twenty-
seven days on account of fearful madness. The other fourteen, however,
had thrown themselves into the river to escape the animal's attacks, and
having to swim to the opposite bank, where thus preserved from the effects
of the poison; the water of the river had saved them, for in beating against
their wounds, it had washed away the venom." * In the sixteenth century,
according to Fleming, rabies was reported in Spain, Flanders, Turkey,
Hungary, Austria, et cetera, and in Hungary in 1 712 wild beasts of all
kinds went mad, as did also many persons, and in England many dogs went
mad and bit many people. " In 1768 rabies was alarmingly frequent in

* Fleming's " Animal Plagues," 1871, page 51.

20 CHARLOTTE SANITARY CONVENTION, NOVEMBER, 1894.

Boston and other towns of North America," and a few^years later in Boston
and vicinity rabies was present in dogs and foxes, and swine were the
principal victims of the animals' rage.

It is useless to cite further outbreaks of rabies and hydrophobia, for
during the fifteenth and sixteenth centuries and up to the present time
history is prolific with outbreaks of the disease in animals and in man.
One has but to read Fleming's work on " Rabies and Hydrophobia " to
become thoroughly convinced that these diseases were frequent and wide-
spread, causing great destruction of property and human lives.

ETIOLOGY.

Some observers have thought that rabies might occur spontaneously in
animals but I think there is not now much question but that most, if not
all, the rabies comes from a previous case and is due to a specific poison
which has been inoculated into the animal, generally by the bite of
another animal. It has been claimed that certain conditions either
directly or indirectly were the cause of the disease, but the recognized
authorities now believe that neither climate, season, sex, age, etc., cause
the disease, although they may have modifying influences.

We now know that the disease arises from the inoculation of the specific
virus which seems to be more abundant in the saliva than any other secre-
tion of the body. Boll, Fleming and others believe the poison is present
in the blood and consequently in all parts of the body, but other authori-
ties have failed to cause rabies by inoculation of the blood of rabic ani-
mals. M. Galtier has shown that the saliva of animals dead of rabies or
killed after having developed the disease does not lose its virulence for
some time after death. Animals inoculated with the fresh saliva, blood,
et cetera, do not always contract the disease, on account of some animals
being less susceptible than others. Fleming says that "dogs and cats hold
the first place in the scale of susceptibility; then man and pigs; next
ruminants, the sheep and the goat being more susceptible than the ox, and
lastly the horse." Renault inoculated ninety-nine animals (horses, dogs
and sheep) and only sixty-seven were affected with the disease. Roll says
that successful inoculations vary from twenty-four to seventy per cent.,
whilst from the bite of dogs it varies from twenty to seventy per cent.,
showing that the disease is less liable to be produced by the bite of a
rabid animal than from experimental inoculation, which can probably be
attributed to the fact that experimental inoculation occurs under different
conditions than does the bite, and that their hair, et cetera, protect the
animals somewhat from the introduction of the specific virus. Then,
again, it is not so sure that the poison is really inoculated by a bite as by
experimental inoculation.

The etiology of rabies is still questioned,* but many of those who at
first doubted its specific character, and its transmission by inoculation,
have, on continuing their experiments and improving their methods of
operation, come to conclusions almost identical with those of Pasteur and
his school, f Among the class of writers, who draw their conclusions from
experimentation, there is a consensus of opinion that the disease is due to
inoculation with virus containing the specific cause of the disease.

* Dulles: The Medical Record, 1877, page 672 ; The Medical News, 1894, pages 653—655. Stookwell
Brill, Spitzka, Johne; Jahresbericht, 1889. Von Friech, Vienna.

t Peofessob A. Hogyes: " Die Experimental Basis der Antirabischen Schutzimpfangen Pasteur's,"
Stuttgart, 1889.

RABIES— HYDROPHOBIA. 21

Dana says: — " In order to prove that a certain disease is autonomous, dis-
tinct and special we must establish the fact that its etiology and its clinical
history are essentially uniform, or that the anatomical changes found after
death are the same, or that inoculations of animals with the secretions or
tissues of the victims of the disease reproduce the disease."

With regard to his first requirement — uniform etiology — there is not a
case on record where rabies appeared in an animal without its having been
inoculated with material from another animal which is suffering from the
same disease. Usually the infection in man can be traced directly to ani-
mals suspected from their actions, of having rabies, but in some cases the
injury is considered as a simple abrasion until the characteristic symptoms
appear.*

Doctor Paul Gibier states, in a letter to me, that — " The disease may be
communicated by a rabid dog licking the bare part of a person's skin on
which some slight abrasion exists."f

As to the second of Dana's requirements — a uniformity in the clinical
history — while the symptoms vary some in different animals, they are very
uniform for any certain species, as the extended irritative period (furious
rabies) in the dog, and the more marked stage of paralysis in the rabbit.

There are many good reasons for believing that rabies is due to micro-
organisms, whether a single species or not, we cannot say; different inves-
tigators find different microscopic forms present in the victims of the dis-
ease (as Fol's micrococcus, Babes' bacillus, et cetera, andGiBiER's micro-
coccus),! and the symptoms vary enough to make a mixed infection
possible.

There is strong evidence in favor of the belief that rabies is due to some
biological factor or living cause; this may be a bacterium, or one of the
lower animal forms, as protozoa, coccidia, or psorosperm. Considering the
period of incubation, the fact that minute quantities when inoculated »will
cause the disease, and the ease with which the virus is rendered inert,
by means which, while sufficient to destroy low forms of living organisms,
do not change the chemical products contained therein, we see at once the
resemblance between the properties and action of this virus and that of
other diseases which are known to be due to microorganisms, and it is evi-
dent from the following facts, that the causal agent is something capable
of reproduction and growth, and not a chemical poison contained in the
inoculating virus: (a) filtration removes the virulent matter from the
emulsion; (b) a longer or shorter period occurs, between the inoculation
and the onset of the disease, in which time (period of incubation) the
cause, if a biological one, has an opportunity of increasing; and (c) the
exposure of rabic virus for one hour to a temperature of 50° centigrade
(122° Fahrenheit), or to desiccation and direct sunlight for three hours
will destroy the virulence, and exposure to a one per cent, carbolic acid
solution, or to a one-tenth per cent, corrosive sublimate solution, for three
hours, renders the virus inert. §

Pasteur, Roux, Chambebland and others made careful search for micro-
organisms in the various tissues of animals affected with rabies; small

* "American Reference Hand-Book of Medical Science," Volume VI. Raffer: The British Medical
Journal, Volume II, 1889, page 687.

t Weloh on " Hydrophobia"—" Transactions of the Maryland Medical and Chirurgical Faculty," 1889.

In the Annals de V Institute Pasteur, 1889, was published an account of the cases of Pierre Butt and his
wife, who were licked on open wounds by a rabid dog. Butt was given antirabic treatment and did not
have rabies; his wife declined treatment and died of the disease.

% Sternberg's "Manual of Bacteriology," 1892, page 522.

§ Biggs: " Transactions of the New York Academy of Medicine," 1891. Welch: " Transactions of the
Maryland Medical and Chirurgical Faculty," 1889.

22 CHARLOTTE SANITARY CONVENTION, NOVEMBER, 1894.

bodies were seen in the medulla which were thought to be micrococci, but
later these were considered as having little or no relation to the disease.
In 1884 Gibier described his observations of supposed micrococci in the
medulla of animals dead of rabies.* In 1885 Fol was able to demonstrate
small granules resembling micrococci in the lymph spaces of the cord
taken from animals which had died of this disease; thin sections of the
cord were stained after Wiegert's method, with a solution of hematoxy-
line. Babes f describes his observations of organisms resembling micro-
cocci in the brain and cord of animals suffering from rabies, which are
stained a rose color by Loeffler's alkaline methylene blue solution. He
has succeeded in making cultures of this germ, which will cause symptoms
of rabiep when injected into animals, but not in all cases.

Curve-shaped bacilli and spindle-shaped bacilli are described as being
present in the brains of animals, and thick, curved motile bacilli are said
to be found in the blood of rabbits during the stage of fever. J

In the opinion of Sternberg death is caused in cases of rabies by the
action of a potent chemical poison of the class of toxalbumins, which is
possibly the same as the substance which Pasteur calls mati&re vaccinale
contained in the emulsion used in the antirabic treatment and supposed by
him to produce the immunity. He says it is contained in the inoculating
material, but is not identical with the microorganism causing rabies.

It has been found by experimentation that if large doses of the strong
virus are injected into the subcutaneous tissue the animal is less likely to
contract the disease than when a small amount of the strong virus is used.
Ferran requires that his patients agree to finish the treatment before he
gives them the first inoculation, because, he thinks that the immunity is in
proportion to the amount of virulent virus used. Bareggi lost five patients
by using the superintensive method, which misfortune Ferran attributes
to using too little of the virus. These results may be due to the large
amount of chemical product (toxalbumin) contained in the large dose
being sufficient to prevent the growth of the microorganisms, or the poison
may so stimulate the tissue cells that they are able to cope successfully
with the living matter contained in the emulsion.

Pasteur and others,§ I believe, have studied the action of these chem-
ical substances found in the emulsion, et cetera. It would seem possible
in reviewing the results obtained from the use of antitoxins in diphtheria,
malignant edema, anthrax, et cetera, that the use of the sterilized emul-
sion of rabic medulla, when used in the proper amount, might give immun-
ity from rabies.

The specific cause of the disease seems to select the central nervous sys-
tem as its most favorable habitat. It is usually present in the saliva and
salivary glands of dogs, as demonstrated by inoculation of other animals
with this material being followed by rabies, but whether the saliva of men
who have the disease is infectious is an open question. Lagorio writes
me that he has made a number of experiments with the saliva of three
rabid men, and in no instance did rabies develop in the inoculated rabbits.

In Bardach's experiments the juice from the salivary glandsof twenty-
two persons who died of rabies caused the disease when injected into
rabbits. Bordoni and Uffredduzzi made similar experiments in two

* Published at the School of Medicine, in Paris, 1884.
+ " Les Bacteries " (second edition).
i Woodhbad: " Bacteria and their Products," page 817.

sTizzoni and Centanni— " Chemical Vaccine Against Rabies:" The British Medical Journal, Vol-
ume 1, 1893.

RABIES— HYDROPHOBIA. 23

cases with negative results. The glands, in Bardach's experiments, were
not removed until twelve or twenty-four hours after death, while those used
by Uffredduzzi were removed in three to six hours after death; post-
mortem changes may have occurred in the former.

The statistics of the Pasteur Institute in Moscow,* for 1892, give two
instances where the disease was communicated from man to man. Doctor
Calmette reports one instance of the disease being contracted from the
bite of a man, as having occurred in the Cochin China Institute.*

PATHOLOGICAL ANATOMY.

There is " an acute hyperemia of the larynx, trachea, and bronchi"
(Osler), and Gowers says there is "perivascular exudation of leucocytes,
and minute hemorrhages, in the oblongata." This is found more marked
in the animals which survive for some time, and is known as miliary
abscess.f In man where the disease is so rapidly fatal this condition is not
so well marked, but in men who died of paralytic rabjes these changes
resemble those found in the medulla of the rabbit and may be widely
diffused.

Welch, in describing the lesions he had observed in the post-mortem
examination of three cases of rabies, says : " These lesions were microscopi-
cal, and their extent and distribution could be determined only by the
examination of a large number of sections of different parts. The lesions
were especially well marked in and near the nuclei of origin of the spinal
accessory, pneumo-gastric, and glosso-pharyngeal nerves, and in the motor
nucleus of the trigeminus."

That the pathological anatomy does not show the extent and presence of
the specific cause is obvious, as tissues or fluids from various parts of the
body of infected animals when inoculated into healthy animals will pro-
duce the disease, although nothing can be demonstrated in the tissues or
fluids to account for the disease.

SYMPTOMS IN ANIMALS.

There are two distinct varieties of the disease — the maniacal and the
paralytic. The disease has three well-marked stages — prodromal, irrita-
tive, and paralytic.

The prodromal stage in rabies is characterized by an alteration in the
manner and usul actions and habits of animals. If the disease occurs in a
domestic animal which is naturally friendly, it may suddenly change,
become cross and surly, and almost as suddenly again become natural and
affectionate. The animal is restless and not contented to remain in one
place. Many animals are dull, lazy and seek secluded places. There is
irritation at the seat of the wound demonstrated by a tendency to scratch,
rub or ruffle the cicatrix. Frequently the appetite is lost and. in others
there is a depraved ravenous appetite, evinced in dogs and pigs by
eating all sorts of strange things, such as pieces of wood, and iron.
Carnivorous animals " gulp " as if trying to free themselves from some-
thing, such as a bone in their throat, and vomiting frequently occurs. The
visible mucous membranes are red and saliva (except in horses) ^drivels

* Statistics from various Pasteub Institutes will be found on subsequent pages of this paper,
f Babstow and Hobsley: " Transactions of the Clinical Society of London, November, 1888."

24 CHARLOTTE SANITARY CONVENTION, NOVEMBER, 1894.

from the mouth. These symptoms generally last from twelve to forty-
eight hours, and then pass either to the irritative or paralytic stage.

During the irritative stage there is great propensity to injure other
animals, uneasiness, paroxysms of fury, with intervals of quietude, and
exhaustion. During the paroxysms dogs may tear their bedding, or what-
ever comes in their way, and snap at imaginary objects. The tongue is
swollen and frequently dipped in water to cool it, but the poor animal may
not be able to swallow and saliva hangs in strings from its mouth. How-
ever, in some animals this symptom is not so bad, and the animal wants
and takes a great amount of water. The gait or carriage of a dog is
unsteady and he soon begins to totter. The dog generally goes with an
unsteady gait, tail between his legs, bright and staring eyes that soon
become dull, head rolling from side to side, stomach tucked up, mouth
open and tongue protruding. It is said by those who have seen them that
it is quite easy to distinguish a mad dog by the actions above described.
In Fleming's work on " Hydrophobia and Rabies " can be seen a picture
of a rabid dog, and it is probable that a person would never forget it
should he once see one. A peculiar characteristic of a mad dog is that he
is devoid of sense of pain and will hold a red-hot iron in his mouth with-
out uttering a cry.

Cats are very savage and are very dangerous on account of their great
ferocity. Horses become violent, stamp their feet, kick, bite, et cetera,
and try to get loose. Cattle rarely use their teeth but paw and bellow, and
use their horns and frequently break them. Pigs slaver at the mouth, bite
at their fellows and become very wild. The voice of all animals is altered
and strange. In dogs the voice is one of the best diagnostic symptoms. It
has a peculiar high-toned, croupy, ringing sound, as if the bark and the
howl were blended together. At first the paroxysms are prolonged and
violent, and finally become weak and short, and it may then be said that
the paralytic stage has set in.

In the paralytic stage there is paralysis of the lower jaw, which renders
the animal unable to bite. The dog generally stays at home. If he does
go away he quickly returns, and seeks some secluded spot, in which he may
die. The tongue is swollen, livid and hangs out of the mouth; the saliva
is tenacious and abundant, paralysis of the posterior extremities sets in
and death soon follows.

Babies generally makes quick work of the animal, and may take a rapid
course and kill within forty-eight hours. It rarely lasts more than ten
days, although there have been cases of canine rabies lasting twenty days.
The duration depends largely upon the constitutional vigor of the animal.

Hydrophobia is an affection of the nervous system, and the stimulus
which excites the paroxysm is conducted often from the ganglia of special
sense, or even from the brain, so that the sight or sound of fluids, or even
the idea of them, occasions equally with their contact, or with that of a
current of air, most distressing convulsions (Caepenter).

SYMPTOMS IN MAN.

There are many points of similarity between the symptoms of hydropho-
bia and those of rabies. There is some sense of pain in or near the seat of
the wound, extending toward the body, if the injury had occured on the
limbs. There may be considerable irritation or very acute pain in the
cicatrix. The old wound may swell and open, or, if yet unhealed, assume

RABIES— HYDROPHOBIA. 25

an unhealthy appearance, discharging a thin, ichorous fluid instead of pus.
Usually there is a general nervous disturbance; the patient becomes
dejected, irritable and restless, but does not appear to have any idea of
what may be the cause of his peculiar feeling, or, if he does, he is careful
not to mention it; he seeks solitude or amusement away from home; his
sleep is troubled; he often starts up from a sound sleep; pains are often
experienced in different parts of the body; and frequently there is disorder
with the digestive apparatus. After these premonitory symptoms, which
vary from a few hours to a few days, the patient becomes sensible of a stiff-
ness or tightness about the throat and he experiences some difficulty in
swallowing, especially fluids, which may be considered as the commence-
ment of the attack in man.

The difficulty in connection with swallowing rapidly increases and soon
becomes quite impossible, unless it is attempted with determination, which
generally throws the patient into convulsions; there is a sensation of tight-
ness in the chest, as well as throat; difficulty in breathing and necessity
for fresh air. The most marked symptoms are the spasms or convulsions
which are brought on by an attempt to swallow, or may even be brought
on by the mere mention of liquids or knowledge that they are near, or by
a draft from the window or fan. The sound of a liquid being poured from
one vessel to another, or the application of any cold or damp substance
to the body may bring on the paroxysms. The patient's face wears an
expression of terror, anxiety or despair. During one of these convulsions
the patient suffers great agony and it is quite impossible to stand by and
witness the suffering. The spasms generally last but a few seconds and
the patient then becomes tranquil, but the least disturbance may bring on
a fresh attack. During the intervals between the spasms, the patient
is calm, rational and may feel thirsty, but on trying to drink is uniformly
thrown into another convulsion. The patient is frequently aware of the
approach of these attacks, and, fearful of doing injury, begs to be restrained.
The patient may be troubled with hallucinations of both sight and hearing.
Sometimes the patient gives away to wild fury, may roar, howl, curse,
strike, may try to bite others or himself, and finally, through exhaustion,
will sink into a gloomy and sleepy state, until attacked by another parox-
ysm. The tongue is swollen and red, there is often a sense of burning in
the throat, with thirst which cannot be satisfied. There is generally a
secretion of a viscid tenacious mucus in the fauces (called the " hydrophobic
slaver"), of which the patient makes every effort to free himself and spits
it out to drop wherever it may. This mucus is generally abundant as the
disease advances and the lower jaw is frequently paralyzed, and the mucus
flows from the corners of the mouth. Paralysis may become quite general
before death. There may occur times during the disease that the patient
may take both food and water without the convulsions, but it is always
with much difficulty. The temperature gradually rises from the commence-
ment of the disease, and frequently as high as 105° Fahrenheit and 106°
Fahrenheit. Death generally follows after a hard convulsion. The desire
to bite is rare in man, but cases are recorded where the bite of a man
has caused the disease.

The duration of the disease is somewhat varied, lasting from two to ten
days. In 324 cases death occurred in the majority of cases between the
second and fourth days, in a few death occurred the first day, and in a few
cases life was prolonged even to fifteen days.
4

26 CHARLOTTE SANITARY CONVENTION, NOVEMBER, 1894.

PERIOD OF INCUBATION IN MAN.

The period of incubation is that time between the bite and the appear-
ance of the characteristic symptoms of the disease. During this period
the patient often experiences unnatural conditions. These conditions
have been described on preceding pages of this paper under the head
of prodromal or premonitory symptoms.

Much attention has been given to the subject of the period of 'incubation;
and, although there has been found no fixed number of days in which the
disease will surely appear, if at all, in most cases the disease shows itself
between forty and sixty days. The period has frequently been much less,
and even as short as one day in some cases, and in other cases as long as
two and one-half or three years. Rouche has observed that in Algiers the
average period is fifty-one days, the ordinary minimum thirty days and the
maximum ninety days. Doctor Fleming records 224 cases in which the
latency was less than a month in 40, from one to three months in 143,
from three to six months in 30, and from six to twelve months in 11 cases.
Trousseau says the incubation period may vary from a few days to a year.
Haguenot cites a case where a peasant was suffering from hydrophobia on
the third day after receiving his wound from a mad wolf. Finco, of Padua,
cites a case where a young woman developed the disease 14 years after
being bitten by a mad dog. Instances of extremely short or extremely
long periods of incubation are recorded but it is possible that there are
mistakes made as regards the date of receiving the bite which causes the
disease.

Doctor Bauer recorded his observations on 510 cases and found that
the average period was 72 days. In the male the average period was 80
days, and in the female it was 65 days. He thought that age had consider-
able influence and that the period was shortened 20 days in patients under
fourteen years of age. He found that in
49 cases where a wolf caused the bite, the av. incubation period was 39 days.
293 " " " dog " " " " " " " " 73 "

0 u a a £QX a u te a a a <c i( gg (f

31 " " " cat " " " " " " " " 80 "

1 " " " cow " " " " " " " " 30 "

Doctor Kraiouchkine, director of the Saint Petersburg Institute,
informs me that his experience, during the years 1886 to 1892, leads him
to announce that the period of incubation varies from 16 to 494 days; the
average period being about 60 days.

Doctor Augusto F. des Santos, director of the Pasteur Institute at
Rio Janerio, writes me that his experience indicates that the period of
incubation is from 30 to 90 days.

Doctor Padilla, of the National Department of Hygiene of the Argen-
tine Republic, states that in cases he has observed the average period was
40 days.

Doctor A. N. Blodgett, of Boston, says that in seventeen per cent, of
ail cases of rabies in man the period is three months or over.

Pasteur says that the disease shows itself in a majority of cases in 40
to 60 days after receiving the bite, which is probably the period which
will most commonly be observed. However, the location of the bite has

KABIES— HYDEOPHOBIA. 27

much to do in influencing the time of the appearance of the disease. It
has been found that where the wound was located on the head or neck the
incubation period was 35 days, on the upper extremities 81 days, and on
the lower extremities 74 days.

In India, in 1893, it has been observed that in the cases of hydrophobia,
the period of incubation was uniformly about 90 days.

INCUBATORY PERIOD IN ANIMALS.

In regard to the period of incubation in animals, Doctor Fleming, in
his exhaustive work, " Hydrophobia and Rabies," gives detailed and elab-
orate results of different observers. Lafoss states that the shortest
authenticated period in the dog that occurred in his experience was 7 days
and the longest was 155. Blaine asserts that the majority of cases occur-
red between the third and seventh week. Haubner's experience in 200
cases showed that in 83 per cent, the period was within two months; the
average being three months.

With the cat the incubatory period is said to be from two to four
weeks.

According to Roll the period in the horse varies from 15 days to two
months.

Haubner found that in the ox that it varied from nine days to several
months. In 234 cases 10 per cent, developed the disease in about three
months.

In sheep two weeks seem to be the minimum and four weeks the
maximum.

Pigs occasionally develop rabies in nine days, but it does not usually
appear until the fourth week after infection.

THE PASTEUR TREATMENT.

Prior to October 26, 1885, when M. Pasteur announced to the Academie
des Sciences de Paris that he had discovered a treatment which would
prevent the development of hydrophobia in man, it was conceded generally
that hydrophobia was always fatal. Imagine the great surprise and wonder
which followed the announcement of this great discovery, second only
perhaps in importance in preventive medicine to that of Jenner.* It is
not, however, to be wondered at that the suspicious and incredulous were
ready to question the efficacy of the treatment, but it is now gratifying to
say that the method has been thoroughly tested by scientific men all over
the world and there is probably now no doubt in any informed mind but
that Louis Pasteur is a great benefactor and has done much to relieve
suffering humanity.

The careful and unbiased experiments of Doctor Ernst, of Boston,
Doctors Welch and Kierle, of Baltimore, Doctor Shakespeare, of
Philadelphia, and others in this country have fully confirmed the state-
ments and methods of M. Pasteur and his illustrious co-workers in
Europe.

Before Pasteur announced his discovery, he and other experimenters
spent much valuable time in trying to bring about the same results, but

* Up to this time the antitoxin treatment of diphtheria has not been universally adopted.

28 CHARLOTTE SANITARY CONVENTION, NOVEMBER, 1894.

Pasteue was first to make his method public, and has since treated many
persons proved to be or supposed to have been innoculated with hydro-
phobic virus. At first his inoculations were made at his laboratory in the
Rue d'Ulm; but since the method came to be recognized by nearly all the
world, a grant of several million francs, from the Imperial Treasury, for
a new laboratory and its equipment, and a donation of a whole block of
ground in the heart of that great city, Pasteue has built and is now
occupying a magnificent institute, standing back from the street, occupy-
ing the block donated by the city and surrounded by a beautiful grass-plot.
In front on the lawn will be found a bronze statue representing a boy strug-
gling with a mad. dog which indicates at least one branch of work carried
on inside the building. This well-equipped laboratory is occupied by
Pasteue and his corps of untiring searchers for knowledge, ever trying to
discover some new vaccine or other preventive of disease. The laboratory
is for practical work in different branches of micro-biology, and associated
with Pasteue are some fifteen directors and assistants. Among these
valuable assistants may be mentioned such notables as Roux, Yebsin,
Metsohnikoef, Stbaus, Duclaux, Chantemesse, Gbancheb, and others,
each working in his special line.

In way of digression, and as an instance of some of the recent valuable
work coming from this institute, I might mention that it was Doctob
Roux, of the Paris Pasteue Institute, who, at the meeting of the Interna-
tional Congress of Hygiene and Demography, at Budapest!)., September 1
to 9, 1894, gave to the congress and to the public the results of his experi-
ments in connection with the treatment of diphtheria by the immunizing
blood serum of the horse. While Doctob Behbing practically left his method
a secret, Doctob Roux revealed every detail of his method, and offered to
supply the serum, and made known his intention to give his time to the
prevention of diphtheria.

One can well see how a man of Pasteue's temperament should have
such a deep interest in a disease attended by such fearful suffering
for both patient and friends. It was in 1880 that he began his study
of the etiology of hydrophobia. He obtained from a child suffering
with the disease a small quantity of the saliva and injected it under
the skin of a rabbit; the animal died in two days. Taking some of
the saliva of this rabbit, he treated another rabbit, and in that the
disease was produced in a most virulent form. Continuing his experi-
ments he found that by trephining a healthy rabbit and taking a few drops
of the cerebro-spinal fluid and injecting it under the dura mater of the
healthy rabbit the disease rapidly developed and with more certainty than
by the use of the saliva, but was not of so virulent a type. Fragments of
the brain and spinal cord also produced the disease, and he then abandoned
the use of the saliva. Knowing by previous experiments with anthrax
virus that the virulence of the virus might be increased or decreased by
inoculation into animals of another species he followed out the same lines
of work with hydrophobic virus and obtained similar results. Inoculation
from dog to dog killed at the same period of incubation and in practically
the same time; but inoculation from dogs to monkeys gave a weaker or
more attenuated virus, the virus becoming more attenuated by successive
inoculations from monkey to monkey, until there came a time when the
virus was so weak that it would fail to cause the disease. If this weakened
virus were then inoculated into a rabbit or dog it remained inactive for a

RABIES— HYDROPHOBIA. 29

time, but by successive inoculations the virus regained its original viru-
lency. However, if these series of inoculations be made into a rabbit
with the primary virus from a dog the virus gradually grows stronger
instead of weaker until it is even more malignant than the fresh virus
from a dog suffering from street rabies. For instance, if a rabbit be inocu-
lated with the virus of a rabid dog the rabbit will show symptoms in about
fifteen days, never shorter than nine days; if, however, the virus of this first
rabbit be used on a second rabbit the period of incubation is shorter ; if
a third rabbit be likewise treated with the virus of the second, the period
is still shorter, and so on until it is reduced to six or seven days, at which
time the period of incubation becomes stationary or what Pasteur calls a
" fixed " virus ; that is, the period of incubation is always six or seven days,
and the animal certainly dies on the tenth day after inoculation. This
discovery was of great importance to Pasteur, as he was able to deter-
mine exactly when the animal would die, and was able to obtain a fixed and
regular supply of virus for his every-day inoculations.

Pasteur had observed that the spinal cord of rabbits dead from rabies
gradually lost its virulence in direct ratio to the time intervening after the
death of the rabbit. This and other facts lead him to believe he could
obtain an inoculation material of different degrees of virulence, which
could be relied upon for the treatment of human beings. Accordingly he
injected a rabbit with the " fixed " virus, and when the rabbit died the
spinal cord was hung in a dry, sterilized bottle and kept at a temperature
of 17° centigrade to 18° centigrade (63° Fahrenheit to 65° Fahrenheit) .

The cord of " one day " drying was found to be slightly weaker and
when injected into another rabbit still produced the disease, but the death
of the rabbit was prolonged just one day more than it would have been
had the rabbit been inoculated with the fresh virus. Inoculation with the
spinal cord of two days' drying prolonged life in the rabbit one day longer.
He found that the virulence decreased in direct proportion to the tempera-
ture and the length of time it had been dried, the weaker the injecting
emulsion, the longer the period of incubation and the longer death was
delayed; the cord that had been dried fifteen days nearly uniformly failed
to produce the disease; and the cord that had been dried only one day was
nearly as strong as the first virus.

Doctor Uffredbuzze* found that if the cord was dried —
2 days it produced death in 11 to 17 davs, but postponing it
" " " 14 to 16 " "

" " 12 to 15 " "

" " 17 to 20 " "

" " 12 to 22 " "

" " 23 to 29 " "
" " " 24 to 27 " "

" " 27 to 40 " "

" " 32 to 36 '•' "

" " 30 to 35 " "

* From a paper by Dootob Ruffek, read before the Section on Medicine of the British Medical Asso-
ciation, at Leeds, August, 1889.

3

a a

4

it u

5

(t (c

6

tt a

7

a a

8

it it

9

a i.

10

it tt

11

u a

t

1 to 2 days

(>

4 to 6

a

tt

2 to 5

a

a

7 to 10

it

ii

2 to 12

a

ii

13 to 19

a

ii

14 to 17

a

tt

17 to 30

a

a

22 to 26

a

a

20 to 25

tt

30 CHARLOTTE SANITARY CONVENTION, NOVEMBER, 1894.

It had been known for some time that every microorganism during its
growth excreted substances, just as higher animals excrete certain sub-
stances every day, and that some microorganisms, such as those of anthrax,
malignant edema, et cetera, excrete a chemical substance (ptomain, toxin,
et cetera), which when injected into an animal will render that animal
immune against an invasion of the specific organisms of that disease.
Pasteur was the first to point out that vaccination could probably be
accomplished by use of these chemical substances, and thus opened a new
field for original research .

By inoculating under the skin of a dog an emulsion of the spinal cord
of a rabbit recently dead of rabies the microorganism of rabies and the
chemical excrement of the microorganism are at the same time introduced.
This chemical substance at once proceeds to destroy the microorganism
and by the time the microorganism would naturally produce the disease
the chemical substance has performed its work and has produced the
immunity. If a small quantity of the rabic virus (emulsion) be introduced
into an animal only a small quantity of organism and a small quantity of
the vaccinating substance are introduced and the animal dies from rabies;
but if 10 to 20 or 30 cubic centimetres of the emulsion be injected a large
quantity of the organisms and at the same time a large quantity of the
chemical vaccinating substance is introduced which overpowers the micro-
organism and prevents the disease from developing.

Pasteur took fifty dogs and inoculated them in ten successive days,
commencing with the weakest virus and each day using one of more strength
until at the end of the treatment he could inoculate them with the strong-
est virus, even with the virus of a dog suffering with street rabies (rage de
la rue). In this way he produced an immunity which lasted apparently
for at least two years, and probably for a considerably longer time.

Thus Pasteur had been able to protect animals from rabies, but he
found his method for animals was not entirely applicable to man. How-
ever, Pasteur was equal to the difficulty. It will be remembered the
longer the cord was dried the fewer the microorganisms, but there was
left a goodly quantity of their chemical excrement or vaccinating sub-
stance for his treatment of man. He made two injections each day, com-
mencing with the cord of fourteen and thirteen days, on the second day
with the emulsion of the cord of twelve and eleven days, the third day
with the cord of ten and nine days, the fourth day the cord of eight and
seven days drying, the fifth day only the cord of six days, and so on. This
process finally came to be known as the " simple method."

The simple method has been found sufficient in most cases; but, where
the patient has been bitten badly on the face or head, a more intensive
method has been found necessary, because in such cases the period of
incubation is generally shorter and there is need for more active and vigor-
ous measures, and thus the " intensive method " came to be used. Each
injection consists of one-half cubic centimeter of the crushed cord in two
cubic centimeters of sterilized beef tea. The patient is inoculated on the

RABIES— HYDROPHOBIA.

31

1st day with the cord of 14, 13, 12, 11 days drying.

2d

3d

4th

5th

6th

7th

8th

9th

10th

11th

12th

13th

14th

15th

10, 9, 8,
6
5
5
4
3
4
3
5
5
4
4
3
3

(Two inoculations)

On the sixteenth and seventeenth days there is a rest, and on the eigh-
teenth, nineteenth and twentieth days there is one inoculation each day
with the cord of five, four and three days drying, respectively, which ends
the treatment.

The following diagram will show at a glance the " simple " and " inten-
sive " methods of treatment employed at the Pasteur Institute:

PASTEUR'S

ANTIRABIC

INOCULATIONS

- "simple" and"intensive"methods. .

SPIJML

cep.a,

OAYS
DRIED.

DAYS OF INOCULATIONS .

/

2

3

f

5

6

7

g

7

10

//

12

13

/¥

15

lb

17

it

17

20

14

• •

7 3

3

^

11

•

•
1

//

•

1

10

•
<

>

9

•
•

1

?

■

•

1

«

7

•
— \-

1
\

6

<

*\

>

**-

>

«fr

*•..

••. ;

-v

5ij

•—
J?"

— •

>,

4-

%

V

^
,•><

/

'»

, « —

-•

*

*

3

'*•*'

V

V

\

,'**

1

1

. ;

Jfote — ^acA Dot represents one injection. <Sach injection consists cf about one-half of a
cubic centimeter of spinal coed emitted in tuio cubic centimeters of sterilized beef tea, .

32 CHARLOTTE SANITARY CONVENTION, NOVEMBER, 1894.

By means of the hypodermic needle subcutaneous injections are made
into either side of the abdomen just above the crest of the ilium. Every
precaution is taken that other complications — as abscess, syphilis, erysipe-
las, et cetera — are not spread from one patient to another. The injecting
fluid is perfectly free from all pus-forming microorganisms, the needle is
sterilized after each injection and in other ways asepsis is provided.
Doctor Buffer says he has seen many thousands of inoculations made
and has yet to observe one instance of abscess resuting therefrom.

The personal inconveniences experienced during the antihydrophobic
treatment are very slight. Following the example of a number of other
directors and assistants connected with other Pasteur institutes and for
protection against a possible accidental inoculation while performing their
every-day duties, Doctor Paul Gibier, director of the New York Institute,
innoculated himself and two of his assistants. In a paper read before the
New York County Medical Association, May, 1890, he gives in detail
these interesting experiments. A brief mention of their experience may
be of interest to the readers of this paper.

The treatment was according to the simple method. The injections of
the first four days were followed by a slight irritation and redness at the
site of the injection, and sleep was somewhat disturbed at night by a sensi-
tiveness at the spot of inoculation. There was also a slight rise of
temperature. These symptoms remained during the first ten days of the
treatment; then the tissues seemed to have accustomed themselves to the
injections and the above-mentioned symptoms decreased in severity and
three days after the last inoculation there remained hardly a trace of the
injections. Gibier said there was unusual activity of his salivary glands,
and several times each day he was obliged to eject ; that during the last
week of the treatment and the week following he had a certain heavi-
ness of his head and felt unable to work. The same symptoms, with the
following additional ones, were experienced by his assistants: after inocu-
lation with marrow of the sixth day, one assistant complained of sudden
pain in his right side lasting about one hour, and at times during the last
week of the treatment suffered neuralgic pains in different parts of his
body, and dizziness which rendered walking difficult; during most of the
treatment the other assistant suffered more or less severe local and general
pains. These symptoms continued for about fifteen days after the treat-
ment, accompanied by unusual sexual excitement, sadness, undefined
preoccupation and neuralgic pains. About fifteen days after the last
inoculation each assistant experienced pain in the spots where the injec-
tions were made.

Doctor Kraiouchkine, of the Saint Petersburg Institute, says he has
noticed during the treatment almost no general reaction on the organism,
but, with the exception of very rare cases, he has observed lassitude, or
fatigue, accompanied with headache and sleepiness but without elevation of
temperature. Very often there is a local reaction of the pricked spot,
redness, swelling, edema and hardening, but a little cold cream and rice
powder makes it disappear rapidly. This local reaction produces princi-
pally on the individual a very thick cutaneous tissue, but abscesses have
never formed.

Doctor Ullmann and his four assistants also took the treatment to
insure against accidental inoculations.

RABIES— HYDROPHOBIA.

33

PASTEUEISM, AND ITS EESULTS.

Since the establishment of the Paris Pasteur Institute for the preven-
tive treatment of hydrophobia, many institutes and laboratories have made
preparations to give the treatment, until to-day such institutions are so
numerous, and conveniently located as to be accessible to all. To my
knowledge they are now located in Paris, Saint Petersburg, Odessa, Vienna,
Moscow, Constantinople, Milan, Naples, Lisbon, Barcelona, Bucharest,
Cochin China (at Sagon), Mexico, Havana, Tunis, Padua, Kharkof, Bud-
apesth, Stamboul (Turkey), Buenos Ayres, Rio de Janerio, Turin, Cal-
cutta and, last but not least, in New York and Chicago.

Early in the year effort was made toward the establishment of a Pasteur
Institute at Simla, India, not only for antihydrophobia inoculations but
for the systematic and specialized investigations into the causation and
prevention of various diseases. The movement has been received with
much favor . Donation s, government grants and subscriptions from individ-
uals and municipalities have been made, and the government has promised
the services of a capable medical official. It is probable that the institute
is now in working order.

In April of this year the British Institute for Preventive Medicine made
application to erect a Pasteur Institute at Chelsea, England. There was
some objection by the residents of Chelsea, claiming that it would not
only depreciate the adjoining property, but would be a possible source of
infection. The institute has been commenced and although the building
proper is not yet completed work is being pursued.

It is announced that antihydrophobia stations are soon to be established
in various cities of Turkey, among which are especially mentioned Yemen,
Bagdad, Damascus, Erzeroum, and Monastir.

In Paris — M. Pasteur, Director.

Since Joseph Meister was treated antihydrophobically many thousands
of people have undergone the inoculations at the Paris Pasteur Institute.
The following table will give you the results during the years 1886 — 1893 :

Years.

Persons
treated.

Deaths,

Death-rate
per cent.

1886

2,571
1,770
1,622
1,830
1,540
1,559
1,790
1,648

25

14
9
7
5
4
4
4

0.94
0.79
0.55
0.38
0.32
0.25
0.22
0.24

1887. ..._

1888 __

1889.

1890 •_.

1891

1892

1893 ._ .__

Total ._

14,330

72

0.50

34

CHARLOTTE SANITARY CONVENTION, NOVEMBER, 1894.

Pasteur has established a custom of dividing the cases into three classes,
namely:

(A) Those bitten by animals proved to be rabid, by laboratory experi-
ments, or by the death of other persons or animals bitten by the same
animal.

(B) Those bitten by animals recognized by clinical or veterinary
examination to be rabid; and

(C) Those bitten by animals supposed to have been rabid.

These rules have been generally followed out in the statistical results of
Pasteur Institutes.

Years.

A

B

C

,0 CO

Dg
S5-3

13

s

CO u
0 o

Ms
ag

55 ♦*

T3
CD

s

.2 a

-i cb

a o

o co

ag

a t-

T3
CD

s

.2 CI
>-< CO

SI

1886...
1887. _.
1888...
1889.. _
1890...
1891...
1892...
1893—

223
357
403
348
385
313
139
HI

5

2
7
4
0
0
1
0

2.15

0.56

1.74

1.15

0

0

0.72

0

1,931
1,161

974
1,188

960

967
1,052

937

24
15
4
9
3
7
3
7

1.24
1.29
0.41
0.25
0.95
0.72
0.29
0.75

518
260
248
298
223
313
609
497

7
4
1
3
0
2
2
2

1.35
1.54
0.40
1.00
0
0.64
0.33
0.40

2,279

19

9,170

72

2,966

21

Of the 1,648 treated during 1893, 178 came from places outside of France;
43 from Spain; 35 from Greece; 23 from England; 22 from Belgium; 18
from Egypt; 14 from British India; 9 from Switzerland; 9 from Holland;
6 from Portugal; Germany and Turkey, 2 each; and Austria, United
States, Brazil, Russia and Morocco, one each.

Since the foundation of the institute, no fewer than 14,380 have been
treated by the Pasteur method in Paris. Of these 1,213 (16 fatal cases)
were bitten on the head, 8,032 (45 fatal cases) on the hands, and 5,185
(11 fatal cases) on the limbs.

In August, 1884, in the absence of M. Pasteur, Doctor Eoux replying
to an inquiry, stated that nothing had yet been done in preventing the
development of hydrophobia in human beings infected with the disease.
Contrast this statement of Doctor Roux with a statement that he would
have been able to make at the close of the year 1893, when 14,330 persons
have been treated with a mortality of* only 0.50 per cent.

The statistics of the Paris Institute show that the majority of cases of
hydrophobia occur between the months of February and May.

At Turin, Italy.

During the period from September 30, 1886, to September 30, 1893,
there have been treated a total of 1,738 persons, with 8 deaths, or a mor-
tality of .46 per cent.

BABIES— HYDROPHOBIA. 35

At New York — Doctor Paul Gibier, Director.

Statistics of the Preventive Treatment against Hydrophobia since its
opening — from February 18, 1890, to January 1, 1895 (nearly four years):

Bites inflicted on the ^ simple
head and on the face ( multiple
,-».... ( efficacious.-

A*

B*

c*

5

ill

18

11

9

-----

17)
16$

33

Cauterization j ^-efficacious .
No cauterization

7
11

~~2~
49
61

9

24

1

47
65

"§"

30

36

5

6

9

1
40
59

"T

15

23

14

9

Bites inflicted on the ( simple
hands /multiple

No cauterization

64)
49 \

113

58)
42 )

100

63)
50$

113

-fiY

23)

44

Bites inflicted on the ( simple

limbs and on the ■]

body .(multiple

~ .... {efficacious

23}

15)

38

50 ~)
19)

69

Cauterization ] "J° „Jr™„-"~
( non-efficacious -

No cauterization

28

16

11

3

Clothes torn

Bites inflicted on bare parts

Bites inflicted on different parts
or the body

1

1
12

5

5

11

10

Cauterization \ efflcacwus......

( non-efficacious -
No cauterization

1
4
' 8
1
9

1
8

7
4
9

4
6
1
4

Bites inflicted on bare parts

231

188

157

• 576

* The column A refers to persons bitten by animals in which hydrophobia has been evidenced by exper-
imentation or by the death of some other persons or animals bitten by them; column B to persons who
have been wounded by animals having been recognized rabid by the clinical or veterinary examination;
and column C to cases in which hydrophobia could only be suspected, as the animals had disappeared or
were killed instantly and their bodies thrown away,

Of the 576 persons treated during the period from February 18, 1890, to
January 1, 1895, there were only four deaths, or a mortality of 0.67 per
cent. In The New York Therapeutic Gazette, for September, 1894,
Doctor Gibier exhibits some very interesting tables. One table shows
that 40 persons who were bitten by dogs which bit and caused the death
of other animals, were treated successfully. Another table shows where
24 persons who were bitten by dogs whose bite caused the death by hydro-
phobia of some other persons, were treated successfully. In one of these
cases four men, in another three men and a child, in a third a woman and
a child and in the rest of these cases one person, all subsequently died of
hydrophobia.

Of the 85 persons treated in 1893, 26 were bitten by animals proved to
be rabid, 11 by animals recognized by clinical or veterinary examination
to be rabid, the remaining 48 were bitten by animals suspected of rage.

36

CHARLOTTE SANITARY CONVENTION, NOVEMBER, 1894.

At Odessa, Russia — Doctor Buivid, Director.

During the year 1890 there were treated at Odessa 727 persons (443
males and 284 females). Among this number 257 were children of 10
years or under.

In 649 cases the animal causing the bite was a dog, in 43 a cat, in 6 a
horse, in 4 a wolf, in 3 an ox, and in 3 a pig.

In 201 cases the animal causing the bite was proved experimentally to
be rabid, in 10 by death of other animals bitten at the same time, in 261
by post mortem examination, in 251 by symptons evinced by the animal,
and in 4 it was uncertain.

In 120 cases the wounds were severe and on uncovered parts of the body,
in 485 moderately severe, in 103 slight (having been inflicted on the limbs
through thick clothing).

In 524 cases the persons presented themselves for treatment within a
week after the bite, in 122 cases within two weeks, in 44 within three weeks,
in 14 within four weeks, and in 4 a month or more after the bite.

Classified by months of the year, they were as follows:

Months.

January..
February
March ...

April

May

June

Persons
bitten.

34

40
59

84
76
82

Months.

July

August

September
October ...
November .
December .

Persons
bitten.

117
91
40
43
35
31

Total.

732

The duration of treatment was in the majority of the cases three weeks.
The total number of persons who underwent the complete treatment was
704, with 9 deaths, or a mortality of 0.71 per cent. ; of these 4 died during
the treatment, and 5 after its completion.

At the Odessa Bacteriological Station, during the year 1893, there were
treated 793 persons. Of those who had passed through the treatment, and
could be said to have died in spite of the preventive inoculations, there
were two deaths or a mortality of only 0.26 per cent. However, 4 of the 793
delayed in commencing the inoculations, and died during the treatment
and should not be included in the deaths. If these four were included the
number of deaths would have been 6, and the mortality would have been
0.76 per cent. Of the 793 persons admitted for treatment, 83 were batten
by animals proved experimentally to be rabid; 253 by animals pronounced
rabid after veterinary or post-mortem examination; 439 were bitten by ani-
mals suspected of rage; and 18 were persons who had been subject to the
danger of contagion while attending sick persons or animals.

Classifying these persons according to age, 96 were under five years of
age, 161 from 5 to 10, 211 from 10 to 20, 231 from 20 to 40, 74 from 40 to
60, and 20 were over 60 years of age.

RABIES— HYDROPHOBIA. 37

In 5 cases the animal causing the bite was a wolf.

In 710 "

a

a

a

a a

" " dog.

In 56 "

a

a

a

a u

" " cat.

In 2 "

ic

a

a

K 11

" " calf.

In 1 "

a

a

a

u a

" "pig-

In 1 "

a

a

«

« u

" " horse.

In 18 cases

there

was

possibility

of infection while tending

sick persons or

animals.

At Budapesth, Hungary — Professor Hogyes, Director.

From April 15, 189.0, to April 14, 1891, the number of persons subjected
to the protective inoculations was 701, of whom 8 died of hydrophobia,
giving a mortality rate of 1.14 per cent.

From April 15, 1891, to April 14, 1892, there were treated 540, of whom
3 died, giving a mortality of 0.58 per cent. The average mortality for the
first two years (April 15, 1890, to April 14, 1892) was 0.88 per cent. Of
the 1,241 persons treated 130 had been bitten on the head, face or neck, of
these 3, or 2.30 per cent, died; of 486 bitten on the hands 7, or 1.64 per
cent, died, and of 625 bitten on the foot or on the trunk, only 1, or 0.16 per
cent. died.

Official statistics of the Hungarian Government show that of those who
were bitten during these two years, who either did not apply for treatment,
or applied too late for successful treatment, the mortality was 26.8 per cent.
When this mortality rate is compared with the rate among those treated in
time, the difference bears striking testimony to the efficacy of the protect-
ive inoculations.

During the year ending April 14, 1893, there were 641 persons treated,
with six deaths or a mortality of 0.93 per cent, during the third year of the
Institute. In the second year the mortality was 1.16, and in the first it
was 0.56. During the three years ending April 14, 1893, there were 1,350
persons treated with 13 deaths, or a mortality of 0.91 per cent. Experience
showed that the largest number of cases occurred in June, July, and August,
and the least in November. The total number of persons who died of
hydrophobia in all Hungary during the same period was 103.

At Moscow, Russia — Doctor Gotdenbach, Director.

The statistics for the year 1892 show that 907 persons were treated, of
whom 613 were males, and 294 females. Of the 907 treated, 178 were
bitten by animals proved to be rabid, 439 by animals pronounced rabid
after veterinary or post-mortem examination, 290 by animals probably
rabid.

In 769 cases the animal causing the bite was a dog.

" " "wolf.

" " cat.
" " " horse.
" " " cow.
" " " pig.
2 cases the bite was caused by a human being.

In

45 '

In

70 '

In

11 '

In

8 '

In

2 '

In

2 ca

38 CHARLOTTE SANITARY CONVENTION, NOVEMBER, 1894.

Of the 907 treated, 6 died notwithstanding the treatment, giving a
mortality of 0.66 per cent.

From June 25, 1886, to June 25, 1892, there have been inoculated a total
of 3,961 persons.

At Rio De Janerio, Brazil — Doctor Agusto Dos Santos, Director.

From the opening of the institute (February 9, 1888) to June 30, 1892,
1,149 persons presented themselves for treatment, but of this number 473
persons were for various reasons rejected. Of the remaining 676 there
were 511 males and 165 females; 105 were treated in 1888, 90 in 1889,
158 in 1890, 212 in 1891, and 81 in 1892.

In 505 cases the bites were inflicted on uncovered parts of the body, and
in 171 on covered parts of the body, but the animal's teeth had penetrated
the clothing.

Cauterization was performed effectually in 34 cases, ineffectually in 392,
and there was no cauterization in 250 cases.

The animal causing the bite in 613 cases was a dog, in 52 a cat, in 2 a
mule, and in 1 a horse. In the remaining number the treatment was
applied because of probable accidental infection while attending the sick
persons or animals.

In six cases the bite was on the head, in 236 on the hands, in 131 on the
arms, in 201 on the legs, and in 29 on the trunk. In ten cases the patient had
been bitten on different parts of the body.

In 80 cases the animal causing the bite was proved experimentally to be
rabid, in 287 the animal was recognized rabid because of its symptoms, and
in 300 cases the symptoms of the animal were so suspicious as to make it
probable that the animal was rabid.

Of the total (676) commencing the inoculations, 15 for various reasons
discontinued the treatment, leaving 661 who completed it. Of these 661
only 7 died, giving a mortality of 1.05 per cent.

During the period between February 9, 1888, and August 14, 1889, there
were 150 persons treated. Of this number 141 were bitten by dogs and
15 by cats. In 19 cases the animal causing the bite was found to be mad,
in 67 cases the animal was recognized by clinical or veterinary examination
to be mad and in 70 cases the animal was supposed to be mad.

From February 9, 1888, to May 19, 1894, there were treated 1,147 per-
sons, with only 9 deaths, or a mortality of 0,78 per cent.

At Saigon, Cochin China — Doctor Calmette, Director.

From April 15, 1891, to May 1,1892 (first year of the institute), 48
persons were treated. In 16 of these cases the animal was proved to be
rabid, and in all other cases confirmation of the virulence of the bite was
received before treatment was commenced. Of the number treated during
this period, 16 presented themselves on the fifth day after being bitten, 4
from the tenth to the twentieth, 6 from the twentieth to the thirtieth, and
1 on the fortieth day. In spite of the long delay before commencing
treatment, only one patient died. In all cases the " intensive method "
was used.

Between May 1, 1893, and May 1, 1894, there were 49 treated, with two
deaths, one of these deaths occurred immediately after the completion of
the treatment.

RABIES— HYDROPHOBIA.

39

At this institute the natives are treated at the public expense, and every
native bitten by an animal known to be rabid or strongly suspected of
rabies, is immediately sent for treatment.

During the twelve months ending May 1, 1893 (second year), there
were 62 persons treated, with 1 death, or, a mortality of 1.61 per cent. In
12 cases the animal causing the bite was proved, experimentally, to be
rabid, and in the other 50 cases the diagnosis was made clinically on the
statements of veterinarians, and, in some cases, on the statement of civil
or military officials. The dog was the cause of the bite in all instances
except one, when the biter was a man suffering from hydrophobia.

Since the establishment of the institute (April 15, 1891) to May 1, 1893,
there were 110 persons treated, with two deaths, or a mortality of 1.81 per
cent.

At Padua, Italy — Doctor Giovanni, Director.

During the last seven months of 1890, Doctor Giovanni had treated 49
persons with no deaths. Twenty-three of these were bitten by animals
proved experimentally to be rabid, 18 by animals recognized by clinical or
veterinary examination to be rabid, and in the remaining 8 by animals in
which rage was only suspected. In all the patients the bite had drawn
blood, and in nearly all the wound was on an exposed part of the body, in
30 cases the bite was on the upper limbs, and in 2 the bite was on the
head. Three months after the last treatment in 1890 all patients were
reported healthy.

In the year 1891 there were 57 persons treated, and in 1892 there were
48. No death occurred in either year.

At Buenos Aires, Argentine Republic — Doctor D. J. Davel, Director.

The institute at Buenos Ayres was the first of its kind in North or South
America, and the fifth in the entire world. The first inoculations were
made September 4, 1886, in the presence of a distinguished assembly, com-
posed mostly of medical men and students. From September 4, 1886, to
September 6, 1894, there were 1,981 cases treated, with 14 deaths, or a
mortality of 0.70 per cent. The following are the facts for the several
years:

Years.

Nnmber
treated.

Deaths.

Death-rate
per cent.

1886

19*

77
236
259
254
285
313
327
211f

0
1
1
5
3
1
0
2

1

.00

1.29

.42

1.93

1.18

1.35

.00

.61

.47

1887

1888

1889. _.

1890

1891

1892

1893

1894

Total _.

1,981

11

0.70

* From September 4 to December 31. 1886.
t From January 1 to September 6, 1894.

40 CHARLOTTE SANITARY CONVENTION, NOVEMBER, 1894.

Of the 14 fatal cases one person sought treatment 36 days after receiv-
ing the bite, several delayed 26 days, one 12 days; and, considering these
long delays, the great fatality cannot be attributed to the inefficiency of
the method of treatment. Again, in some of the 14 cases death was not
produced exclusively by rabies, but other serious complications, and the
gravity of the bite, were causative factors.

In 683 cases the animal causing the bite was proved, experimentally, to
be rabid; and of these only 4 died. It is estimated that thirty per cent, of
these 683, or 204 persons, would have died had they not presented them-
selves for the treatment. Of the total number treated (1^981) there would
have resulted, at the same ratio, 594 deaths.

Of the 825 persons treated during the period between September, 1886,
to December 31, 1890, the mortality among those bitten by animals proved,
experimentally, to be rabid was 2.74 per cent., among those in which the
animals were recognized by veterinarians to be rabid 0.S5 per cent., and
among those bitten by animals suspected of rage it was 0.59 per cent.

At Bucharest — Professor Babes, Director.

At the meeting of the International Medical Congress in Berlin (1890)
Babes reported that in the Pasteur Institute at Bucharest about three
hundred persons are inoculated yearly, with a mortality of about 0.40 per
cent, in cases bitten by dogs, most of which were demonstrated to be rabid
by inoculation experiments made at the institute.

At Naples — Doctor Calabrese, Director.

From August, 1886, to April, 1894, there were inoculated 1,000 persons.
Of this number 291 were bitten by animals proved to be rabid, 486 by
animals recognized by clinical or veterinary examination to have been
rabid, the remaining 223 were bitten by animals only suspected of rage.
The number of deaths was 8, or a mortality of 0.80 per cent.

At Havana, Cuba (Bacteriological Laboratory) — Doctor Acosta, Director.

This is reported to have been the first place in the tropics where the
Pasteur method was tried. From April 15, 1887, to December 31, 1889,
there were 306 persons treated, with two deaths, or a mortality of 0.65 per
cent. In the first 105 persons treated no deaths resulted, although they
had been bitten by dogs proved experimentally or clinically to have been
mad. Notwithstanding some 700 persons applied for treatment during
this period, only the 306 were accepted.

At Saint Petersburg — Doctor M. W. Kraiouchkine, Director.

This antirabic station was established July 13, 1886, and was a gift of
his Highness, Prince Alexandre Petrovitch d'Oldenbourg, and was
first installed at the Veterinary Infirmary of the Regiment of Horse
Guards, but was in 1892 transferred to the Imperial Institute of Experi-
mental Medicine, which institute was also founded by his Highness.

During the five years ending July 13, 1891, 1,256 persons presented
themselves for treatment. Of this number 394 were rejected for various
reasons and 23 discontinued the treatment, leaving 839 who completed the
treatment.

RABIES— HYDROPHOBIA.

41

The following table shows, by years, the number treated during the five
years ending July 13, 1891 :

Years.

1886 (last six months).

1887.

1888

1889

1890

1891 (first six months).

Total

Persons treated.
137
200
184
106
142
70

839

Of the 839 persons treated there were 391 men, 192 women, and 256
children (under fifteen years of age).

The largest number of persons were bitteu during the months of June,
July and August. This may, however, be due to the fact that the peasants
were the class of people most commonly bitten and the summer months
is the season of the year when they pass most of their time in the fields.
The following table will classify the bites, by months of the year:

Months.

January ..
February
March ...

April

May

June

Persons
bitten.

66
74
62
68*
45
92

Months.

July

August

September
October ...
November.
December .

Persons
bitten.

116
88
73
63
56
36

Total.

839

The majority of persons bitten presented themselves within one week
after being bitten; and, as this is an important factor in the success of the
inoculations, the following table is presented:

Those presenting themselves within 3 days after the bite, 213

" 1 week " " " 281

" 2 weeks " " " 213

" " " 8 " " " " 80

ct t< u u A a « u u on

" later than 1 month " " " 15

Total, ------- 839'

In 735 cases the animal causing the bite was a dog.

"cat.
" wolf.
" horse.
" cow.
" fox.

839

In

75

a a

In

16

cc a

In

4

(< it

In

3

a a

In

6

it a

42

CHARLOTTE SANITARY CONVENTION, NOVEMBER, 1894.

Of the 839 treated, 222 were bitten on covered parts, and the remaining
617 are divided as follows:

Those bitten on the head 54

" " " " superior members 487

" " " inferior " 33

" " " different parts of the body 43

617

In 422 cases the animal causing the bite was proved to be rabid, and the
mortality was 3.08 per cent. ; in 240 cases the animal was recognized by
clinical or veterinary examination to be rabid, and the mortality was 1.25
per cent.; and in 177 cases where the animal could only be suspected of
rage, the mortality was 3.38 per cent. The general mortality was 2.62 per
cent.

The largest number of deaths occurred among those patients presenting
multiple bites on the head or other parts of the body. No deaths
occurred in the 222 cases where the bite was on covered parts; but, in the
617 cases where the bite was on uncovered parts, there were 22 deaths or a
mortality of 3.56 per cent.

In the year 1892 there were 288 persons presented for treatment. Of
this number 66. were rejected for various reasons, and 11 discontinued the
treatment, thus leaving 211 persons who completed the inoculations. Of
this number 109 were men, 43 women, and 59 children (under 15 years of
age).

The following table classifies the bites by months of the year:

Months.

January ..
February
March ...

April

May

June

Persons
bitten.

18
9
13
28
19
22

Months.

July

August

September
October ___
November.
December..

Persons
bitten.

15

22

21

15

7

6

Total.

195

Those presenting themselves within 3 days after the bite, 25

it

it

CI

a

1 week " "

it

71

(i

it

it

ci

2 weeks " "

a

63

(S

li

((

it

3 " " "

a

29

it

tt

11

(i

4 it n it

(C

14

it

it

Total

it

later than 1 month " "

((

9

211

In 181

cases

the

animal causing

the bite

was a dog.

In 17

u

u

(<

(i <<

" " cat.

In 8

((

<(

. a

a tt

" "wolf.

In 3

ft

tl

it

a it

" " horse.

In 1

(1

b(

u

<< <(

" " guinea pig

experimental

In 1

l<

((

it

«< tt

" " mouse

animals.

RABIES— HYDROPHOBIA. 43

Of the 211 persons treated, 68 were bitten on covered parts, no death
occurring. The remaining 143 were bitten as follows:

Those bitten on the head 16

" " " superior members - 108

" " inferior " _• 11

" " " different parts of the body 8

143

Of the 211 persons treated during the year 1892, three died, giving a
mortality of 1.42 per cent. »

At Vienna — Professor Paltauf, Director.

Antihydrophobia inoculations are being given at the Rudolph Stiftung
Hospital at Vienna. The inoculations are performed daily between 10
and 11 a. m. At present there is no charge for the treatment, but it is
understood that the charge for such treatment is now under consideration.

Preventive inoculations have been given by Doctor Ullmann. In one
year 122 persons were treated, within 10 days after the bite, and only 3
died, or a mortality of 2.46 per cent. During the same period several
others were bitten by the same dog causing the bite of some of the 122
treated. These persons did not undergo the treatment and have since
died.

At Chicago — Doctor A. Lagorio, Director.

During the period between July 2, 1890, and February 9, 1894, 366
persons were treated, and are classified as follows:

Of the total number treated 104 were bitten by animals recognized to be
rabid by experimental proof, or by death of other persons or animals bit-
ten by the same animal; 126 were bitten by animals recognized to be rabid
by the symptoms of the disease; and 72 were bitten by animals strongly
suspected of rabies.

Dogs caused the bite in 341 cases, horses in 9, cats in 7, skunks in 5,
wolves in 2, a mule in 1 case, and a pig in 1 case.

Two deaths were reported among the above mentioned patients, giving
a mortality of only 0.54 per cent.

In 123 of the cases the animal causing the bite was proved to be rabid,,
in 160 the animal was recognized to be rabid by the symptoms of the
disease shown during life, and in 83 cases the animal causing the bite was.
strongly suspected of rabies.

Besides the 366 persons who were treated, 372 others were rejected for
various reasons.

[Doctor Lagorio records the case of a five-year-old boy, subject to
epilepsy, who, on account of the bite of a dog, was treated at the labora-
tory in August, 1890, and who has not only never suffered bad consequence
from the bite, but recovered from the epilepsy as well. Similar cases and
results have been noticed at other institutes, although I believe that
Doctor Lagorio claims priority].

At Calcutta, Bengal — A. Renter, Director.

A Pasteur Institute was successfully inaugurated on January 30, 1894,
in the presence of a large company. After the ceremony subscriptions to
a considerable amount were promised.

44 CHARLOTTE SANITARY CONVENTION, NOVEMBER, 1894.

At Milan, Italy — Doctor Remo Segre, Director.

This institute was established in 1890, by subscription from local busi-
ness houses. During the years 1890 and 1891, 238 cases were treated.
Of these 108 were bitten by animals proved experimentally to be rabid
(two deaths), 121 by animals recognized by medical men or veterinary
surgeons to have been rabid (two deaths), and 9 were bitten by animals
suspected of rage (no death). Thus out of 238 treated there occurred 4
deaths, or a mortality of 1.68 per cent.

At Constantinople, Turkey — Doctor Zoeros, Director.

Between May 1, 1887, and March 1, 1889, 41 persons were treated, with
no death resulting. Of these 12 had been bitten by animals proved
experimentally to be rabid, 26 by animals recognized rabid by medical men,
veterinary surgeons, or other competent persons, and 3 by animals in
which rabies was only suspected.

Value of the Dog.

That there is about one dog to every fourth family, and many more dogs
than is absolutely necessary, is a fact recognized by nearly every citizen in
the United States and probably by the great majority of people in the
world; however, that species of animal is still being propagated, until
to-day an important question is " What is to be done with the dog?"

Recognizing the fact that probably nine-tenths of all the cases of hydro-
phobia are due to the bite of the dog, many ways to prevent the occurrence
of rabies have been suggested. One will advocate the muzzling of all dogs,
and another will recommend the extermination of that animal. Preven-
tive inoculation of every dog has been suggested; but, as this has not been
generally tried, it does not at present seem entirely practicable.

Muzzling is effective when fully enforced, but experience has shown
that it is difficult to keep muzzled every dog. It is stated, however, that
in Germany where muzzling is generally enforced there are very few cases
of hydrophobia.

In cities the system of " catching and killing " stray dogs has proved
efficacious indeed and every year there are thousands of stray dogs caught
and, if not claimed within a certain period, they are killed by various
methods, such as drowning, smothering in a vacuum chamber, killing by
poisonous gasses, et cetera. This seems cruel, but something must be
done to rid the country of the over-numerous dogs.

While the protection of human beings is of primary importance, there
is still another consideration of no slight importance, namely, the destruc-
tion of property. It is not uncommon to have it reported that a mad dog
has killed or given rabies to such valuable property as horses, cows, sheep,
chickens, et cetera, which usually means death to the animals infected.
While there are many instances of destruction of stock, the most notable
I now have in mind is the outbreak of rabies near Fowler ville, Michigan,
in March, 1888. It is reported that one dog caused the death of some six
cows, nine horses, and about seventy-five chickens. The dog also attacked
two children; but, as the bite was on parts thoroughly covered and there
was no abrasion of the skin, the children did not have hydrophobia.
Nearly all of the mentioned animals died of rabies. It is of common

RABIES— HYDROPHOBIA.

45

occurrence to Hear of outbreaks of rabies of more or less magnitude occur-
ring in different parts of the world. In fact they are so frequent that it
would be useless to try to enumerate them; medical journals and statistics
abound with them.

The following table will give a vivid idea of the enormous money-loss
by dogs in the state of Ohio for the years 1880-1893. Through the kind-
ness of the Secretary of State's office at Columbus, I have been able to
secure, and have tabulated the following facts:

NUMBER AND VALUE OF SHEEP KILLED AND INJURED BY DOGS, IN OHIO. FOUR-
TEEN YEARS, 1880-93; AND NUMBER OF MILCH COWS COMPARED WITH NUMBER
OF DOGS, IN OHIO, FOURTEEN YEARS, 1880-93.

Year.

Sheep killed by dogs.

Sheep injured by dogs.

Total No.

of milch

cows.

Total
No. of
dogs.

No. of
sheep.

Value of
sheep.

No. of
sheep.

Value of
sheep.

1880 __

28,763
33,297
34,606
32,955
30,327
21;146
29,006
19,029
31,836
32,080
27,862
25,057
28,469
29,915

$97,277

122,684

133,765

122,788

104,622

85,590

82,183

84,701

107,749

103,531

100,536

94,965

107,181

107,431

23,625
31,609
31,422
24,814
21,685
18,807
19,484
18,283
25,296
26,152
21,823
17,705
22,040
22,840

$41,671
60,394

58,748
51,188
43,256
33,039
35,098
51,490
44,264
48,503
42,857
40,464
44,509
46,893

*

*
556,425
556,425
576,147
579,990
595,524
580,538
610,477
619,483
595,133
613,507
612,766
600,463

121,656

*

*
214,794
160,072
160,018
168,398
162,809
162,644
155,446
148,409
153,892
158,142
152,764

1881

1882.

1883.

1884

1885

1886

1887

1888. __

1889

1890

1191

1892

1893. _

403,348

$1,456,003

325,585

$642,374

* No statistics reported to the Secretary of State.

The Agricultural Statistics of Ohio for the last ten years show that on
an average every year there are about 600,000 milch cows and about 150,-
000 dogs existing in the state, or about one dog to every four cows. These
facts plainly show the prevalence of the dog. The dog is probably as
numerous in other states. Considering the comparative value of the two
animals, it does not seem possible that the citizens of any state will keep
an animal which is of so little value, and no small expense, as the average
dog. Every one knows the value of a milch cow, but there are people who
rather part with a whole herd of milch cows than to part with their pet
dog even though the dog be the worst kind of a mongrel.

From the foregoing table it will be observed that in the state of Ohio
alone, during the fourteen years (1880-1893) 401,348 sheep were killed
and 325,585 were injured, giving an appalling money-loss of $2,098,377.
Supposing such a statement were made for the whole world, and the loss
of human life should be included, would not the facts be a powerful argu-
ment for less dog, less sacrifice of property and less sacrifice of human
life?

46 CHARLOTTE SANITARY CONVENTION, NOVEMBER, 1894.

To counterbalance the immense loss of property and human life every
year there is provided in many cities and countries a dog-tax or license
which is a revenue to the local funds amounting to millions of dollars. In
Chicago the dog-tax without regard to the sex of the animal is two dollars
per year, the number of licenses issued each year averaging from 34,000 to
35,000, which means that in Chicago alone there is turned into the city
treasury a sum averaging about $75,000 yearly.

Of course the number licensed does not cover all the dogs, because they
are "caught and killed," and many are never licensed. I presume a con-
servative estimate would be that in cities where there is an effective dog
ordinance about three-fourths of the dogs are licensed; while in smaller
towns and cities about one-tenth would be a fair estimate of the number
licensed.

In Detroit the ordinance provides a license of $1.00 for male and $2.00 for
female dogs, with an additional ten cents each for the tag. During the
four years, 1890-93, there were 8,507 licenses issued with a revenue to the-
city of $9,574.70. But as Detroit claimed about 250,000 citizens, there
ought to have been in the four years at least 75,000 dogs licensed, with a
revenue of at least $100,000 instead of only $9,57470. It is evident,
the dog ordinance is not being rigidly enforced.

I am informed that there is no law or ordinance in Philadelphia compell-
ing dogs to be registered or providing for a dog-tax. There is, however, an
ordinance requiring all dogs running at large to be muzzled, and if any
are found unmuzzled, they are taken up by the et dog catchers " and
turned over to the pound-master where they may be redeemed by paying:
$2.00. If not redeemed they are killed by some kind of gas. In 1891
there were 6,052 dogs captured, and 4,829 were killed; the redemption
money paid to the city was $2,128. By paying $1.25 at the office of the
Clerk of Quarter Sessions, the owner may receive a life-long registration
certificate for his dog which makes the animal the personal property of
the owner. This certificate may be transferred by paying the sum of 12
cents. From September, 1860, to November 22, 1894, about 8,519 dogs
where registered becoming the personal property of the owner.

In Bavaria from 1863 to 1876 the deaths from hydrophobia ranged from
14 to 31 each year. A striking contrast are the statistics for the first seven
years (1893-1889) of the enforcement of the muzzling order which pro-
vides for the killing of stray dogs. During this period of enforcement of
the order, only three deaths have occurred in a population of five and one-
half millions of people.

During the month of August, 1889, the police in London seized 3,290
stray dogs; 47 either rabid or supposed to be were killed on the streets; 19
were proved by post-mortem examination to be rabid; and 1,681 persons
were reported to have been bitten by dogs. In May, 1894, the London
police captured 2,161 stray dogs, and 148 persons were reported to have
been bitten by vicious dogs.

There are reported to be 150,716 dogs in the Seine Department, France.
In 1892 the municipal tax was collected from the owners of 130,716 dogs,
and in 20,000 the tax was avoided.

A vicious dog may cause his owner a considerable expense as well as
trouble. A dog that destroys property may be an expensive pet. In
France only a few years ago a man was bitten by a vicious dog from which
he received a permanent injury. He instituted an action for damages and

RABIES— HYDROPHOBIA. 47

the courts awarded him a judgment of 11,000 francs (about $2,500) and
ruled that the owner of a dog was responsible for any damages done by the
animal. 9

The dog, and especially the house dog, may be a source of contagium in
infectious diseases. The Iowa State Board of Health has recently (Sep-
tember, 1894) reported a death from diphtheria in which the source of
infection was traced to a pet dog. Doctob Stiles, of the Bureau of Ani-
mal Industry tells how animal parasites dangerous to man, such as the
tongue-worm (Linguatula rhinaria) the tape-worm ( Tenia echinococcus),
•et cetera, are conveyed to man by way of the pet dog.

RULES AND REGULATIONS SHOULD BE FRAMED AND PUBLISHED.

One of the most efficient means employed for the restriction of the
•spread of rabies is a set of rules which shall regulate the action and move-
ments of animals infected with the disease. Each local board of health
should frame and publish (in accordance with state laws) rules which
would enable the health officer to act promptly upon the appearance of
a case of this disease so dangerous to the public health and life. If a
health officer is obliged to wait until the local board can be called together,
the disease may have been allowed to spread, instead of restricting it to
the first case.

On the occurrence of a case of rabies the facts should be reported to the
local health officer, and promptly restricted by him in accordance with Act
137, Laws of 1883. The health officer should, in compliance with Sections
5 and 6, Act 125, Laws of 1889, report the fact to the president bf the State
Live Stock Commission, who at present resides at Stanton, Michigan. The
local health authorities should isolate the animal or animals and keep them
so, until they are taken care of by the State Live Stock Commission or
State Veterinarian; but, under no circumstance should the local health
authorities fail to guard the public health and life. Whether in man or
animals the full facts regarding the outbreak of the disease should be
reported to the Secretary of the State Board of Health, at Lansing.

In cities the " Dog Ordinance " generally regulates the action of animals
most likely to be infected with rabies. Every city should be equipped
with an efficient ordinance and should demand its strict enforcement. An
ordinance may be ever so efficient, but if not enforced is useless, and the
stray and ownerless dogs will be permitted to roam about the city to
become infected with rabies and transmit the disease to human beings.
The following is an ordinance in force in a certain city of the U. S. which
it seems to me no city would make a mistake by copying:

Be it ordained by the City Council of the City of ;

Section 1. — Every owner of, or person who harbors or keeps, a dog within the limits of this city, shall
report to the City Collector annually, within thirty days after the first day of May in each year, his or her
name and address, and shall give the name, breed, color and sex of each and every dog owned or kept by
such person, and shall pay to such officer the sum of two dollars for each and every dog, and cause such
dog, or dogs, to be registered for license in the office of the City Clerk, who shall furnish the owner or
keeper of same with a license tag.

Section 2.— Every dog shall be provided by its owner or keeper, with a leather or chain collar, to which
a license tag shall be securely fastened, and every dog shall also be muzzled, if so ordered, as hereinafter

provided. No dog shall be permitted to remain within the limits of the City of , unless the

■owner, or keeper thereof, shall have caused such dog to be registered and licensed, and provided with
such collar and tag, and be muzzled, if so ordered, and any owner, or keeper, of a dog failing to provide

48 CHARLOTTE SANITARY CONVENTION, NOVEMBER, 1894.

such collar, tag or mnzzle, if required, shall be subject to a fine of five dollars for every such dog so-
unprovided, to which fine shall be added, if unlicensed, the amount of the license tax, and costs, if any,,
incurred.

Section 8.— The City Clerk shall keep a complete registry^ in a book to be kept for that purpose, of all
licensed dogs, describing same by name, breed, color and sex, and shall also enter the name and address
of the owner or keeper as given, and the number of the city license tag.

He shall provide, each and every year, such number of metal tags as may be necessary (the shape to be

changed each year) having stamped thereon the year for which the tax is paid, the letters D. T., and

also the number of the tag, and it shall be the duty of the City Clerk to deliver one of such metal tags,
number to correspond with the number of the registry of the dog, to the person having paid the tax upon
any such dog.

The City Clerk shall also send a duplicate of such registry to the Pound-master, who shall record the
same in a book to be kept by him for that purpose, and such record shall be open to public inspection.

Section 4. — Whenever the Mayor of this city shall deem it necessary, he shall issue an order prohibit-
ing for a certain time therein specified all dogs from running at large on any street, alley, or other public
place, in this city, unless such dog be securely muzzled, or led by a line or chain, so as to effectually pre-
vent them from biting any person or animal, which order shall be published in a daily newspaper of gen-
eral circulation in the City of .

Section 5.— It shall be the duty of the Superintendent of Police, his assistants, and of all the police-
men of the City of , to take up and impound in such suitable place, or places, as may be

designated by the Mayor (of which place or places, notice shall be given by posting a card or notice in
some conspicuous place in the office of the Chief of Police, and in the office of the City Collector, and

also by publication, of such place or places, in some daily newspaper of the City of , of general

circulation, to be designated by the Mayor), any dog found running at large in the City of ,

contrary to the provisions of any ordinance, or of any order issued by the Mayor.

Section 6.— The City Pound- master shall, immediately upon receiving any dog at the pound, make a
complete registry of same, enter the breed, color and sex, and whether licensed or not, if ascertained, and
if licensed, he shall, if known, enter the name and address of the owner or keeper, and the number of the
license tag, if any, and shall keep impounded licensed dogs separate from unlicensed dogs.

A list of all licensed dogs impounded, if any, shall be immediately sent to the City Clerk, for entry, by
the Pound-master, who shall also forthwith give notice, through the postoffice, to the owners or keepers
of such licensed dogs, of their being impounded.

Section 7. — For every dog taken up and confined in the dog pound, as provided in this ordinance, for
which no license tax has been paid, a redemption fee of three dollars, together with the amount of the
tax, shall be paid to the City Collector for the use of the city ; and upon procuring a certificate from the
City Collector, stating that said amount has been paid, and paying to the Pound-master for taking up
such dog the further sum of fifty cents, and the cost of keeping such dog, not to exceed twenty-five cents
per day, and cost of advertising, if any, as hereinafter provided, the owner or keeper thereof, within five
days after the impounding, or any other person, after five days, shall be entitled to redeem such dog, and
if such dog shall not be redeemed within five days after being taken up, such dog shall be destroyed by
the Pound-keeper, except that at the expiration of the five days allowed for the redemption of impounded
dogs, the Pound-master shall advertise immediately in a daily newspaper of general circulation in this
city, all unredeemed licensed dogs, if known or identified as such, and if such dogs be not redeemed at the
expiration of the fifth day after such advertising, they shall then be destroyed.

Section 8.— Any dog for which a license has been paid, which may be impounded for being at large
without collar or tag, or without a muzzle, if required (if it shall be made to appear to the satisfaction of
the City Collector by the affidavit of the owner or keeper, or by other sufficient testimony, that a license
for such dog was procured, and a collar put around its neck, with license tag attached, as provided in
this ordinance, or was muzzled, as required by any order of the Mayor, but that such collar, tag or muzzle
has been accidentally lost) , may be redeemed upon the payment to the City Collector, for the use of the
city, of two dollars, and payment to the Pound-keeper his charges, as provided in Section 7 of this ordi-
nance, and the City Collector may deliver to the person redeeming such dog, a duplicate license tag to
correspond with the registry, for which duplicate tag twenty-five cents shall be paid.

Section 9.— It shall be the duty of the Chief of Police, or any police officer, to kill any dog which may
be found in the City of without an owner or keeper, or found at large contrary to any ordi-
nance, or to any order of the Mayor : Provided, Such dog cannot be safely taken up and impounded,
and unless a dog cannot be safely taken up and impounded, it shall not be lawful for any officer of the

RABIES— HYDROPHOBIA. 49

City of , or any other person, to kill, or attempt to kill, any dog at any other place than the

dog pound.

No dog shall be subject to molestation under this ordinance, or under any order of the Mayor, while on

the premises of its owner or keeper, and any officer of the City of •., or other person, who shall

invade private premises to capture, entice, or take any dog out, of the enclosure of the possessor of such
dog, or who shall molest or seize any dog while held, or led by a line or chain by any person, or who shall
bring into the city any dog, for the purpose of taking up and impounding the same, shall, on conviction,
be fined in a sum not less than five, nor more than fifty dollars.

Section 10.— If any fierce or dangerous dog shall be found at large in the streets of , or upon

any public place, or upon the private premises of any other person than the owner or keeper of the dog,
and shall there annoy or endanger any person thereon, the owner or keeper thereof shall forfeit and pay

to the City of a sum of money not exceeding ten dollars, for the first offense on the part of

said owner or keeper, in permitting such fierce and dangerous dog to be at large ; and upon a second or
further conviction, for the same offense, a sum not exceeding twenty-five dollars ; and it may be part of
the sentence, upon such second conviction, that such fierce and dangerous dog immediately be killed, and
this sentence shall be forthwith executed by the Chief of Police or any police officer, for which^killing
the owner or keeper shall pay the further sum of one dollar, which sum shall be included in said
judgment.

Section 11. — Whenever complaint shall be made and filed with any Justice of the Peace, or Police Mag-
istrate, setting forth that any dog has, in any manner, disturbed the quiet of any person or neighborhood,

or has bitten a person within the City of , and that the person so bitten was not at the time

trespassing upon the person or property of the owner or keeper of such dog, the Justice of the Peace or
Police-Magistrate, shall issue a summons directed to the Sheriff, Constable or Police Officer, which sum-
mons shall be returnable forthwith, and upon the return of such summons the Justice of the Peace or
Police Magistrate, shall proceed to hear and determine the matter, and if it shall appear that such dog
has so disturbed any person or neighborhood, or that the person so bitten by such dog was not at the time
trespassing upon the person or property of the owner or keeper of such dog, the Justice of the Peace, or
Police Magistrate, shall order said dog to be removed or killed, and shall issue an order to the owner, or
keeper of such dog, to remove or kill it within twenty-four hours from the time of receiving a copy of
such order.

The owner or keeper of any such dog who shall refuse or neglect to remove or kill, or cause such dog to
be removed or killed, within twenty-four hours after having received a copy of said order from the Justice
of the Peace, or Police Magistrate, aforesaid, shall be fined in a sum not exceeding twenty-five dollars,
and the further sum of twenty-five dollars for every twenty-four hours thereafter until such dog shall be
removed or killed.

It shall be the duty of any Police Officer, or Constable, to kill said dog whenever it shall be found at

large in said City of r.., twelve hours after the service of a copy of said order on the owner or

keeper of such dog.

Section 12.— The word dog, whenever used in this ordinance, shall be intended to mean a female as
well as a male dog.

Section 13.— All ordinances or parts of ordinances inconsistent with the provisions of this ordinance
are hereby repealed.

ISOLATE ALL INFECTED OE SUSPECTED ANIMALS.

For the restriction of the spread of rabies and hydrophobia, it is important
that prompt action should be taken with any suspicious animal. When a
dog or other animal acts strangely and there is suspicion of madness, the
animal should be immediately confined, not killed, and kept under observa-
tion for a week or ten days. Have the animal examined by a competent
physician or veterinary surgeon, and if the animal is rabid the characteris-
tic symptoms will soon be observed. Pasteue says " the animal will cer-
tainly die within eight days. If at the end of that time no symptoms of
rabies have been observed, the bite cannot cause hydrophobia, and there
is no reason why the animal should be destroyed." If symptoms of rabies
do appear in the animal thus under observation, it should be immediately
7

50 CHARLOTTE SANITARY CONVENTION, NOVEMBER, 1894.

killed; and, if the animal has bitten a human being, a small portion of the
medulla oblongata should be secured and placed in a small vial containing
pure glycerine only, for use in experimental inoculations of other animals
to determine without doubt whether the animal suspected of rage was
really rabid.

If other animals have been bitten by a suspicious animal, they should
likewise be confined until it is proved whether or not they are rabid, or
until the period of incubation* has past. It is quite frequently the case
that valuable stock has been bitten by animals not rabid, and it would be
a useless destruction of property destroy such animals. Do not kill
an animal unless you have good reason to believe it is rabid, or unless it
is a source of danger to other animals and to human life. Of course a dog
may run mad when it is quite impossible to secure the dog, and extremely
dangerous for it to run at large, where shooting the animal may be the
only safe way. In such a case the animal should not be disposed of until
it is absolutely certain that no person has been bitten. If a person has-
been bitten a portion of the medulla should be prepared as described above.
If a human being has been bitten and the animal is destroyed there is no
way left to ascertain whether or not the dog was really mad, and whether
the person bitten has been inoculated with the virus of a terrible disease.

WHAT SHOULD BE DONE WITH A PEBSON BITTEN.

It is important that prompt measures be taken for the care of the patient.
The wound might be " sucked " and thoroughly cleansed with a large
effusion of hot water, at the same time pressing the wound to cause any
liquid, poison, et cetera, to ooze out and to promote bleeding. A solution
of boric acid would promote bleeding and aid in cleansing the wound. If
the wound is on the leg or arm a bandage might be placed between it and
the heart. As soon as possible cauterize the wound. There are many-
cauteries recommended, such as caustic potash, nitrate of silver •(lunar
caustic), carbolic acid, bichloride of mercury, f match of Paquelin, et cetera,
but as these cauteries, with the exception of the lunar caustic, cannot well
be used except by a physician, the white-hot iron will probably be most
available in all cases, especially in places where the physician is not acces-
sible. Where a physician can be called without much delay, it is best to-
leave to him the method, and cautery to be used. Very little time should
be lost, however, in calling a physician, because immediate action is import-
ant and the most effective cauterizations are those performed within half
an hour. The hot iron can be used by a non-professional person; while
the other cauteries require more care in their application.

Cauterization may or may not be effective in destroying the poisonous
virus; but surely, in most cases, will do no harm, and may be the means
of preventing an attack of hydrophobia. Most people believe, as does the
illustrious Pbofessob Keen, that there is " no treatment that will prove
effective in cases of hydrophobia except that of Pasteur." Pasteur
preventive inoculations have been described on preceding pages of this
paper.

* For period of incubation in animal Bee page 27 of this pamphlet.
t The bichloride of mercnry should not be used stronger than 1 to 500.

RABIES— HYDROPHOBIA. 51

The Pasteur treatment can be secured from two central points in the
United States; one in New York City, at the corner of Central Park and
Ninety-seventh street, and the other in Chicago, at 65 Randolph street.
The New York Institute is under the directorship of Doctor Paul Gibier,
and the Chicago Institute is directed by Doctor A. Lagorio. The statis-
tics on preceding pages of this paper will show the results of the work of
each institute.

The cost of treatment is small compared with the value of a human life.
I understand that the charge for the treatment alone is ordinarily $200.00,
which does not include the expense of living during the period of treat-
ment, which lasts about 15 days.

When it is proposed to send a patient to a Pasteur institute it should
be remembered that it is important to send at the same time the piece of the
medula oblongata prepared in the vial of pure glycerine only.

If the person suspected of being infected is himself able, or has friends
who are financially able, the problem of securing the treatment is not
great. But when the patient or his friends are not able the problem is not
so easy, and the question is —

how can the preventive inoculations be secured?

In Michigan there is a law which provides that the local board of
health! shall see that no'person sick or infected with a disease dangerous to
the public health shall suffer for want of nurses or other " necessaries,"
which certainly implies that no person is to suffer for want of medical
attendance; and, as long as it is recognized that Pasteur's inocula-
tions is the only known preventive, no person should be permitted to suffer
for want of that treatment. This same statute provides that the expense
is chargeable to the county in cases where the patient or the patient's
friends are not able. It is not at all improbable that the expense of the
Pasteur treatment might be chargeable to the county in such cases.

In Great Britain and especially in Scotland the municipality has sent
many patients to the Paris Pasteur institute; and in some cases has gone
so far as to furnish a medical attendant to accompany the patient. This
plan could be employed in the United States. 4

There is still another way by which the necessary funds might be
secured. It is well known that there are many liberal, wealthy men, who are
public spirited, and might loan a patient the money to secure the treat-
ment. Then, again, the funds might be secured by means of the subscrip-
tion paper so commonly used in the relief of the suffering.

<gm

m

«o&

fv:v