Part 40

In the farcy of the ox of Guadaloupe there form subcutaneous nodular abscesses, with cordiform swelling of the lymph plexus and trunks, often proving fatal in a year through extension to the lungs. The abscess breaks, discharging a whitish, creamy or caseous, or grumous contents, containing a bacillus (Nocard). The abscesses usually appear under the sternum or belly and later extend to the thighs and legs. In all such cases the mallein test is inoperative.

The treatment of such cases should be actively antiseptic to destroy the germ while still local. After opening and evacuating the abscesses, excise or curette the diseased tissue, or destroy with the actual cautery, pack the cavities with pledgets soaked in tincture of iodine, iodized phenol creolin, lysol, mercuric chloride, zinc chloride, or copper sulphate, or dusted with aristol, iodoform, or iodized starch. The surrounding swelling, if any, may be painted with tincture of iodine, or covered with cloths wet with a sublimate lotion or other antiseptic. Internally, tonics and antiseptics may be given: arsenite of strychnia, quinia, iron or copper sulphate, sulphites or hyposulphites of soda or potash.

RABIES AND HYDROPHOBIA.

Synonyms. Definition: Acute, infectious, cerebral disease, of domestic and wild carnivora, shown by intellectual, emotional, and aggressive nervous disorder, and extreme nervous excitability. Animals susceptible: canine and feline animals, biting animals and those bitten, of all warm blooded kinds; receptivity greatest in carnivora. Geographical distribution: where population is most dense, trade and movement most active—north temperate zone. Australia, Tasmania, New Zealand, Azores, St. Helena immune—protected by quarantine. Islands in Elbe, places with enforced muzzling. Causes: contagion; inoculation; rutting; skunk bites; absence of flowing robes (men, children). Virulent matters: saliva, bronchial mucus, flesh, blood (not in sheep?), milk, (in advanced stages), nerve tissue. Morbific agent particulate; filtered liquid noninfecting: blastomyces, bacillus, found but not uniformly: claims of brain symptoms from each. Viability; saliva virulent for 11 days; brain 3 weeks at 32° to 63° F., for months aseptic and in contact with carbon dioxide; water 20 to 38 days; body in grave 44 days; virulence lost by drying in thin layer yet kennels remain long infecting; glycerine preserves; robbed of virulence by iodine, citric acid, bromine, chlorine, sulphurous and mineral acid and cupric sulphate. Bites of men effective to 50 per cent., protection by clothes, wool, flow of blood, cleaning of teeth by succession of bites. Infection by licking, sneezing, coughing, inhaling, feeding. Incubation 15 to 60 days in dog, 20 to 45 days in horse, 14 to 60 days in sheep, swine and cattle, 14 to 64 days in man. Prolonged cases doubtful. Symptoms in dogs: change in disposition, more amiable or morose, dull, apathetic, excitable, unwonted silence or howling, restless, depraved appetite, swallowing small objects, searching, tearing sticks or clothes, licking cold stone or genital organs, hiding in dark corner, dull expression, irritation where bitten, hoarse voice, rabid howl, eyes follow unreal objects, snaps at them, listens for unreal sounds, irritability, fury when threatened with stick or shown another dog, bites without growl, bears master’s blow in silence, eyes red, fixed, pupils dilated, squinting, lonely wandering, biting, swimming rivers; restless excitement alternates with torpor and seclusion, slouching gait when worn out; in paralytic form; weakness, paresis, palsy of lower jaw, hind limbs, body, dull, prostrate, apathetic; in lethargic form; no fury nor paralysis, but profound prostration and apathy, no coaxing, threat, punishment not even another dog will rouse. Paralytic and apathetic forms wind up the furious; cases with intermittent attacks. Diagnosis: by marked change of disposition or habit, voice, appetite, any hypersæthesia, strabismus, watching or snapping at unreal objects, taciturnity, fury in presence of other dog or stranger, snapping, biting without giving voice, fury when threatened with stick, open mouth without disposition to paw it, lack of muscular coördination, paresis, paralysis. Distinction from lactation anæmia, bone in palate or throat, dislocation of maxilla, stomato-pharyngitis, cutaneous hypersæthesia, pharyngeal anthrax, epilepsy, pentastoma, cysticercus, filaria immitis, nematodes, and tæniæ, auricular acariasis. Symptoms in cats: changed voice, depraved appetite, hiding, restlessness, irritability, bites, scratches, man or dog. Symptoms in solipeds: trembling, hyperæsthesia, easily startled, ears and eyes alert, dilated flashing pupils, roused by dog or stranger, attacks with teeth and heels, mischievous, pawing, kicking, rolling, rising, straining to urinate or defecate, neighing, sniffling, snorting, everting upper lip, grinding teeth, biting, stiffness or impaired control of limbs, generative excitement, spasms, paralysis, hyperthermia, perspiration. Symptoms in cattle: irritability, restlessness, alert head, ears, eyes, squinting, dilated pupils, loud bellowing, lashing tail, or docility, yet pursues a dog, using horns, heels, (exceptionally teeth), stamps, paws, has genital excitement, anorexia, spasms, weakness, paraplegia. Symptoms in sheep and goat: hyperæsthesia, irritability, genital excitement, fury in presence of dog, stamps, butts, paws, snorts, bleats, grinds teeth, becomes paretic, and paraplegic. Symptoms in camels and deer: camels show furious and paralytic forms, biting and snorting; deer have hyperæsthesia merging into paralysis. Symptoms in swine: extreme irritability, restlessness, start at slightest cause or none, tremors, squealing, jerking, grinding teeth, clenching jaws, bite especially a dog, or not, weakness, lethargy, paralysis. Symptoms in rabbits and Guinea pigs; may be furious, more often paralytic. Symptoms in birds: restlessness, ruffling of feathers, pecking or striking man or dog, or at phantom, palsy. Symptoms in wild carnivora: lose fear of man, approach and attack him, are furious and later paralytic. Skunks bite slyly. Symptoms in man: irritable cicatrix, anxiety, sighing, tremor, insomnia, bad dreams, fever, thirst, spasms of throat when seeing, hearing or taking liquids, dyspnœa, retching, vomiting, spasms, roused by noise, squinting, dilated pupils, mental delusions, reticence, taciturnity, suspicion, mania, exhaustion, paresis, paralysis. Lyssophobia, its detection and cure.

Synonyms. Canine madness; Rabidus Canis; Lyssa; Lytta; Cynolyssa.

Definition. Rabies is an acute, infectious disease, affecting the cerebral and medullary nervous centres and characterized by intellectual, emotional, aggressive and other nervous disorders and by extreme reflex excitability.

Animals susceptible. While the disease is seen most frequently in the canine races (dogs, wolves, foxes and jackals), and in the cat family (cat, lion), it is liable to spread widely among animals that use the teeth as weapons of offense, and such as they can readily attack. When inoculated, all warm blooded animals contract the disease. Thus the carnivora and omnivora (dog, wolf, fox, hyena, jackal, cat, lion, badger and skunk and, to a less extent, the pig and horse) may become active propagators of the infection, which may spread widely among their herbivorous victims (cattle, sheep, goats, deer, rats, mice, chickens and pigeons) through their bites. Man suffers mainly through the attacks of dogs, cats and, in certain localities, wolves or skunks, but he is also liable to become infected from handling rabid domestic herbivora. Different genera differ in susceptibility, the receptivity being apparently greatest in the carnivora.

Geographical Distribution. Rabies is confined to no country nor climate but it attains its greatest prevalence in the north temperate zone, where there is the densest population and where activity of travel favors the propagation of infection. The facility for inoculation is the one determining cause, thus the islands of Australia, Tasmania, New Zealand, the Azores and St. Helena have never suffered and the first three exclude the disease by rigid inspection and quarantine. During the Hamburg epizoötic of 1852–53, the islands in the Elbe escaped though both banks were ravaged. Again, where the muzzling of all dogs has been rigidly enforced, as in many German cities and districts the disease has been practically extirpated.

Etiology. Long before the days of pathological bacteriology rabies was recognized by veterinarians as a disease due to infection alone. Its absence from the various countries above named, and from South and West Africa, its rapid propagation in other countries (La Plata, Malta, Hong Kong) into which it had been introduced for the first time, and its restriction and disappearance wherever muzzling had been strictly carried out, had practically settled this question. The development of the disease in animals which had been experimentally inoculated was no less significant of this truth.

Other alleged causes are based on secondary factors that favor inoculation. The alleged evil influence of the hot season (dog days) is accounted for by the period of rutting of the dog which occurs in spring, and brings together troops of jealous dogs following individual bitches and fighting for their favors. This gives a great impetus to the propagation of the disease which accordingly becomes more prevalent during succeeding months. The statistics of Bouley show, however, that the season of its greatest prevalence in France is March, April and May, that it subsides slowly up to midwinter and encreases again in spring. Boudin’s statistics show the greatest number of cases in man toward midsummer which is explained by the long period of inoculation after bites sustained in the spring, but also because clothing is lighter in summer and infection more likely to reach the skin, and because the heat of the weather tends to cause hyperthermia and encrease susceptibility.

The large preponderance of male dogs among the victims of rabies (7:1) has led to the theory that sex predisposes, but the explanation is rather that the males bite each other in their jealousy while they respect the female, the object of their sexual passion. In inoculated cases, males, females, and castrated contract the affection indifferently and with equal readiness.

The skunk is found to be infected in certain localities, and it has been claimed that the affection is native to this animal, and that the form differs from that which prevails in the dog, but the restriction of the disease to sharply circumscribed areas in Michigan and Kansas, while skunks elsewhere show no such malignant quality, demonstrates that this is but an accidental infection of the family of the Mephitis in a given locality.

Men and children suffer in far greater numbers than women, the difference being mainly due to the protection furnished the female by the flowing skirt, though also in part because of the more frequent contact of men with dogs.

Virulent Matters. In 1813 Gruner and Count Salm demonstrated the virulent properties of the saliva of the rabid dog. This has been many times repeated, though as shown by Pasteur, Raynaud, and others, inoculations with saliva often kill in one or two days by reason of the presence of other infective germs, or suppuration ensues and destroys the rabific virus so that oftentimes not more than one in four develops rabies. Galtier succeeded in inoculating 3 rabbits, 1 dog and 1 sheep with the juice expressed from the salivary glands, and Nocard, Leclainche and Peuch have found this to be very virulent. Paul Bert found the bronchial mucus virulent. Rabies has been frequently conveyed by consuming the bodies of rabid animals, yet Peuch and Galtier have failed to convey infection by the flesh. Eckel and Lafosse successfully inoculated the blood of goat to sheep, of man to dog and of dog to dog. Yet many of the older observers agree with Peuch and Galtier in pronouncing the blood non-virulent. Pasteur, Roux, Bujwid, and Helman failed to obtain virulent cultures from blood. Peuch and Nocard have found the milk virulent, and Bardach found the same to be the case in a woman for two days before her death of rabies. In some partially refractory animals like the sheep, the blood seems to destroy the virus, as intravenous inoculations have been made with impunity. The probability is that the blood is habitually non-virulent in the early stages and in mild cases, but becomes virulent in violent and advanced cases. Pasteur first showed that the virus has a special election for the brain and nervous matter and that the central nervous organs are constantly infecting. Rossi inoculated with a piece of nerve trunk, and Doubouc and Babes advanced the hypothesis that the virus advances along the nerve to reach the brain.

It was formerly supposed that the saliva of omnivora and herbivora was non-virulent but repeated experiment has proved it to be infecting. The blunder was due to the fact that these animals did not often transmit the disease by biting. Some writers even deny that rabies exists at all as an infectious disease. One alleges that the danger of rabies is “less than the gallows.” Experiment shows most conclusively that it is much more certain when the conditions are fulfilled. One may live a long lifetime without seeing a genuine case of rabies, but so he may without seeing leprosy or plague, and he is no more entitled to doubt their existence than he is the existence of Manila, or of the other side of the moon.

Morbific Agent. The actual factor which produces rabies is not certainty known so that we cannot speak of its bacteriology. That it is due to a specific particulate germ is now indisputable. Paul Bert and Nocard filtered the virulent fluid through plaster and found the clear fluid that had passed through non-virulent. Rivolta, Babes, Bouchard and Peuch severally passed a solution of the rabific brain matter through a Chamberland filter and found the clear filtrate harmless. The virulent agent is therefore not a body in solution but a solid (organism) which is held back by the filter. Hallier, Klebs, Galtier, Gibier, Pasteur, Fol, Babes and Dowdeswell have respectively attempted the cultivation and inoculation of organisms found in rabific liquids but none has stood the test of further experiment. Memmo found a blastomyces in the brains of six rabid rabbits and one hydrophobic child. It stains with the aniline dyes but not by Gram’s method; when thrown into the peritoneum of Guinea pigs it produced clonic spasms and death in 24 hours, and in the dog, after an incubation of 8 days caused emaciation, salivation, a disposition to bite, paralysis of the hind limbs and death in 48 hours. Bruschettini using agar or bouillon, containing lecithin or cerebrin and defibrinated dog’s blood, inoculated with pieces of the brain of an inoculated rabbit, obtained in 24 to 36 hours a group of small transparent drop-like colonies at first microscopic, but becoming larger with each new culture on fresh media. These colonies contained a very small, short, thick bacillus, which stains readily in Ziehl’s carbol-fuchsin, and then presents a central clear band giving the appearance of a diploccus. In fluid media spherical forms are produced, but in fresh cultures the diploccus aspect reappears. Injected subdurally in rabbits it gave rise to what appeared to be paralytic rabies and could be inoculated from animal to animal, with similar results. It failed to grow in the usual culture media from which the brain products are absent, thus fulfilling the conditions, of a microbe the point of election of which was the nerve cells. Marx who has sought for Bruschettini’s organism in 60 cases of rabies has only once found anything resembling it and concludes that it was merely a contaminating organism, which caused a paralysis (Centr. f. Bacter. 1896.)

Viability of the poison. Galtier found that the virulent saliva remained potent for 11 days if preserved from drying. It persists for 3 weeks in the brain and medulla kept at 0° to 12° C., for a month in sealed tubes, or for several months if protected against septic microbes and in contact with carbon dioxide.

In water it is preserved for 20 to 38 days so that water soiled with saliva may easily become a means of infection. In graves it has been found virulent as long as 44 days after burial so that in medico-legal cases results may be obtained by exhuming a suspected animal (Galtier).

Haubner found that drying the saliva in thin layers rendered it non-virulent and Pasteur has shown that the rabbit’s medulla loses its virulence in 14 or 15 days when dried in contact with air, and apart from putrefaction. Such laboratory results must however be qualified by the facts recorded by Blaine, Youatt and others in which hound after hound died of rabies from living in a dry kennel in which a rabid animal had preceded them. Until we know something of the living germ itself of rabies, it is unwise to infer too positive results from experiments on that microbe, in what may be but one stage of its existence.

The virus is very resistant to cold, having survived a temperature of −60° C. (−76° F.) for several hours (Roux), −10° C. (−14° F.) for ten months (Jobert). Virulence is destroyed however by a temperature of 48° C. (118.4° F.) in five to twenty minutes (Galtier). Light destroys the virulence in 14 hours at 30° to 35° C. (Celli), but encreased pressure has little effect on it (16 atmospheres, Nocard and Roux).

Glycerine at room temperature preserves the medulla in its full potency for four weeks, but destruction ensues if it is heated (Protopopoff). An aqueous solution of iodine (6:100) destroys the virulence (Galtier), as does also citric acid, bromine, chlorine, sulphurous acid, the mineral acids and cupric sulphate.

Ratio of successful inoculation to bites of rabid animals. As rabies is usually transmitted by the bite, it is well to note that not all the bites of rabid animals are effective. Of 183 dogs confined with and bitten by a rabid dog 91 contracted rabies; of 73 cattle bitten 45 became rabid; out of 121 sheep bitten 51 succumbed and of 890 persons bitten, 428 took hydrophobia. Of 440 persons bitten by rabid wolves 291 contracted the disease. The escape of such a large proportion is variously accounted for. Wolves naturally attack the face, throat or hands where there is no protection by clothing, and inoculation is therefore much more certain. Dogs, especially in cold weather usually bite man through the clothes which wipe off the virus from the smooth conical teeth before they reach the skin. Long haired animals are often protected in the same way. In other cases the bite is sustained on a very vascular part and the free flow of blood washes out the poison. In still other cases the rabid animal making a number of snaps in rapid succession comes to the last with the teeth wiped clean and harmless. Again the prompt washing or cauterizing of the wound tends often to protect against infection.

Under favorable circumstances however every bite infects, and the writer has seen six animals, bitten in the same stable, all contract rabies, while a man bitten through the coat sleeve by the same dog, and cauterized an hour later entirely escaped. If the bites are multiple, deep and irregular, the danger is greater.

The licking of wounds is an occasional mode of infection, the rabid dog in the early stages of the disease sometimes showing an unusual disposition to fawn upon his owner.

Again particles of saliva may be projected by sneezing or otherwise and lodge on sores, or on the mucosa of the nose, eye or lip so as to cause infection. Galtier has conveyed the disease experimentally to rabbits in 11 cases out of 75 by making them breathe the atomized infecting liquid, or by dropping it into the nose. In the same way he infected Guinea pigs and sheep.

Galtier and Bujwid have conveyed the disease, exceptionally, to rabbits and rats by feeding infecting emulsions. Galtier has also produced rabies in ⅒th to ⅓d of the cases operated on by instilling the virus into the eye.

Incubation. The duration of incubation varies with the species, individual, the seat and character of the bite, the amount of virus instilled, the potency of the virus, the age, size and weight of the subject, the excitement of rutting, climatic or weather vicissitudes, fatigue, and nervous or febrile disorders.

In the dog incubation ranges from 15 to 60 days, and perhaps 4 to 6 months. It is claimed to have lasted a year but this is somewhat doubtful. In cats it has varied from 15 to 60 days.