By C.A. Shore, M.D.
Director, State Laboratory of Hygiene
(An address delivered before the annual session of the Tri-State Medical Society, Fayetteville, N.C.)
My subject is chosen not because the disease of rabies is one of our greatest problems, nor because I have new facts to present, but because it is the one disease which, at the present time, could actually be exterminated if we would but apply the knowledge we possess. We know the germ which causes it, we know the way in which it is conveyed from animal to animal or from animal to man. We know the behavior of the germ in the body and the explanation of the peculiar symptoms, we know how to give protection, and above all we know how it may be eradicated.
Rabies is one of the oldest of recognized diseases; its peculiar symptoms and the inevitable fatal outcome have always made a power impression on the human imagination. Medical literature on the subject extends well beyond the Christian era and in general literature there are many references in ancient writings. There is an excellent description written by Apuleius in the second century in his Metamorphosis, and, there are said to be references in Horace, Virgil, Ovid and Plutarch. This ancient history is exceptional, for the great scourges of the human race, like tuberculosis, bubonic plague, and influenza, if mentioned at all, can be recognized only with difficulty.
During the hundreds of years in which rabies was recognized as a separate entity, a great mass of superstition had collected around it and remnants of this ignorance still remain in the popular mind. We all know person who believe that a dog’s bite is dangerous only in that season of the year when Sirius, the Dog Star, is in the ascendant. I have not seen a “mad-stone” in several years, but formerly I have been permitted to examine fragments of pumice stone, several pebbles and one bit of pottery from a broken domestic vessel all of which were treasured for their curative powers. One ancient therapeutic belief alone stands the test of modern experimental proof; that is the value of cauterization. If done early this is still good practice although nitric acid is substituted for the red hot metal.
In common with most other diseases, accurate scientific knowledge begins with the time of Pasteur. Pasteur never succeeded in finding the infecting agent—this was reserved for Negri—but he did begin scientific study of the disease and found an effective prophylaxis which saves about 99 per cent of exposed persons. Briefly, this is a vaccine made from the spinal cords of rabbits which have been infected with a very rapid form of the disease. The cords are attenuated by drying and by passage through many generations of rabbits. The history of the trial of this vaccine, by Pasteur, forms one of the most dramatic chapters in the history of medicine. The vaccine is still used with only slight modifications. In North Carolina we use the original Pasteur strain of virus and the chief modification is a somewhat larger number of injections.
The germ of rabies discovered by Negri, is generally believed to be a Protozoan. The examination of a rabid animal can be made rapidly by staining a smear-preparation of a small portion of brain tissue and the round or oval organism shows plainly and distinctly in the nerve cells. A brain which contains these organisms will invariably reproduce the disease if a portion of it is injected into another animal. On entering the body, the germ causes no inflammation and so far as we know it is not carried by the blood stream, but it does find a small nerve tissue and travels through the body in nerve tissue. It apparently at once begins to multiply in this tissue but causes no symptoms until it reaches the brain, where it enters and destroys the nerve cells. It may have taken weeks or months to reach the brain, but once entrenched there the final course is extraordinarily rapid and the fatal outcome invariable. The symptoms of madness and paralysis, so apparently variable and inexplicable to the unenlightened mind, have the simplest explanation that they depend upon the destruction of nerve cells.
The infection not only goes to the brain but also to certain secretory glands, notably the salivary glands, and the infection is excreted in the saliva. It is by means of the inoculation with infectious saliva, that is by biting, that the disease is spread from animal to animal or from animal to man. All mammals, including man, are susceptible.
The dog is no more susceptible than is the sheep, or the cow or man, but the dog and his relatives, the fox and the wolf, when their brains are diseased, commonly exhibit the instinct of biting. The cat only occasionally shows this symptom, as does the horse. The rabid cow may be just as belligerent as the dog, but her instinct is to hook or butt, rather than to bite. Other animals exhibit varying symptoms of a diseased brain, but it is seldom that they want to bite.
The problem of the spread or rabies is therefore almost wholly confined to the dog and it is just this animal which has easiest access to human beings. If we could prevent rabid dogs from biting other dogs and other animals, we could eradicate the disease.
The statement just made is not based on theory alone. Rabies has actually been exterminated in Denmark, Norway and Sweden for 30 years. Before the war it was unknown in Germany except along the borders, and in England there was no rabies for over 20 years until reintroduced by returning soldiers who brought back infected dogs from France. It has now again been eradicated in England. In Australia there has never been a case of rabies, for that continent has always had a quarantine law for dogs and each animal is confined at the port of entry for six months before it can be delivered to the owner.
The contrast of these countries with the United States is not to our credit. Here only sporadic and ineffectual attempts at control have ever been made, and for the last decade the disease has been on the increase in the greater part of our country. This is especially true for our own section. The states with the worst records are North Carolina, South Carolina, Georgia, Florida, Alabama and Mississippi. Virginia’s record is considerably better than that of North Carolina and South Carolina, and Georgia’s is a trifle worse.
The increase in North Carolina may be illustrated by a comparison of the record of 1909 (the first year of complete statistics) with that of 1925. In 1909 there were 83 rabid animals examined at the state laboratory of hygiene, in 1925, 813. In 1909, 157 persons were treated for bites of rabid animals, in 1925, 1,850. The intervening years show an increase with almost annual regularity.
Last year we had four, possibly five, human deaths from rabies in North Carolina. This number is insignificant if compared with the death from tuberculosis, but if it is true that each should have, and could have, been prevented, they are not a credit to our civilization. We must also charged against this disease an enormous loss of cattle, hogs, sheep and horses, but no accurate statistics are kept of these deaths.
In the far west, rabies has been comparatively rare until within the last few years. In a stock-raising country, the predatory dog is never shown much mercy, but with the decline of stock-raising on the unlimited range, dogs have increased. In the Rocky Mountain section, the disease is now said to be prevalent among the wild coyotes and rabies will probably exist in that region until these wily animals are exterminated.
We have seen that certain European countries have been freed from rabies, and we find that this was accomplished in each case by preventing the dog from running at large. This is a very simple procedure theoretically, but we must admit that it would be difficult of application in our town states. Sooner or later however, we must come to it, and since the problem is rather one of education and legislation than of medicine, it is important that information should be broadcast in every justifiable way. The public must be informed as well as the medical profession.
The extermination of rabies does not mean the extermination of the dog. There is no country on earth where the dog is held in so high esteem as in England, and no other country where the pack of hounds is such an institution. In that country the restriction of dogs is just as popular as a means of protection for the dogs themselves as it is for the protection of farm animals and for man.
In the South the dog lover constitutes a large percentage of our population, but too often he presents the truth that rabies is primarily and solely a problem of the dog. With more complete knowledge the owner of a valuable dog would be the first to advocate complete protection. Up to this time, however, the dog owner and the stock-raiser have shown little interest in North Carolina at least, is the only known effectual method of controlling rabies. On the other hand, they appear eager to try the half-effective method of dog vaccination.
The only country which has tried this seriously is Japan, and the first reports, before practical application was attempted, were certainly encouraging. In this country no such uniformly successful results have been secured as were first reported in Japan. If it were possible to give all dogs a full series of injections by the Pasteur method we could undoubtedly protect them all, but this is manifestly impossible. The methods in practical use attempt to give a concentrated dose in from one to three injections. There are many failures by this method and we see many of them at the state laboratory of hygiene. Further than this the vaccine occasionally actually causes the disease itself. This is not surprising when we remember that the antirabic vaccine is not a dead vaccine but that it contains the living germ attenuated by drying and by passage through rabbits.
On the whole, the widespread vaccination of dogs, would in my belief, reduce the incidence of rabies, although an occasional case produced by the vaccine itself must be expected, but my point is that we have a more effectual and almost ideal method of accomplishing something which is the hope of every man interested in public health. That is the actual extermination of the fatal disease.
So far as my knowledge goes, there is only one disease which has ever been wiped off the face of the earth, and that disease was one which was not known to attack man. It was a certain infectious pneumonia of cattle which was prevalent in Texas some 30 years ago. Theobald Smith, then in the government service, found the cause of the infection and succeeded in actually stamping it out. We believe that, today, that particular disease germ is as extinct as the Dodo.
We now have another such an opportunity in rabies. It might take many decades to exterminate it in Russia and in China, but even there it is not hopeless, and in our own country it could be done in five years.
One state alone could not do it, and my talk is therefore appropriate for a meeting of neighborly states, but so far as I am concerned, I would like to see my own state make the beginning.
From page 3 of the Concord Daily Tribune, Monday, March 21, 1926
A madstone is a calcified mass found in the stomach of a ruminant animal, most commonly a deer, cow, or goat. It was widely believed in 18th and 19th century America to cure rabies and neutralize snake venom when pressed against a bite wound. In scientific terms, a madstone is a type of bezoar, a compacted ball of hair, calcium, and other organic matter that forms in an animal’s digestive tract over time. scienceinsights.org/what-is-a-madstone-folk-medicines-rabies-cure/
And Sirius, the Dog Star, was believed to be related to the heat of summer and the onset of fever. The star was believed to be related to fever, drought and madness, and also rabies.
newspapers.digitalnc.org/lccn/sn92073201/1926-03-22/ed-1/seq-3/
