Mother's Remedies Part 56

Belgium and Austria average one thousand dogs annually. There was a yearly average in Germany of four hundred dogs, dying of rabies, until the law requiring the muzzling of dogs was strictly enforced and since that time the disease is practically unknown. We do not have strict quarantine laws against dogs, and the result is death from hydrophobia in many states annually. It was formerly believed that rabies was a hot weather disease.

The number of cases during the winter months of late years has disproved that belief, for the records of the inst.i.tute for treatment of hydrophobia at Ann Arbor have shown a decrease of cases during the summer months. This was before 1908. This shows that rabies is not a hot weather disease.

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Ordinarily cases of rabies occur here and there (sporadic), but if the conditions are favorable epidemics break out. One dog may bite several dogs and these dogs bite others and thus spread the disease to many. Not every animal bitten by a mad dog develops the disease. The disease does not always follow the bite. Only about forty per cent of all animals bitten by a mad dog contract the disease. This is given by a noted authority. Statistics also show that in man the disease develops in only about twenty per cent of the cases in those who have been bitten by rabid dogs. But in dealing with those who have been bitten such measures should be taken as would be if they were certain of developing the disease; one cannot tell how much poison enters the system in such cases and preventive procedures should be taken. There are reasons why everyone who is bitten does not contract the disease.

The location and character of the bite must be considered. Bites on the head, neck and hands have been recognized as more dangerous, from early times, and such bites produce fatal results quicker than do bites on other parts of the body, and the reason is largely due to the fact that the other parts of the body are more or less protected by the clothing, and this clothing prevents the entrance of so much poison into the system.

Bites on the head give a high mortality rate and are rapidly fatal. The close proximity to the brain is one reason.

The part the clothing plays in protection is clearly shown by the following quotation from an eminent authority: "In India where the natives dress very scantily, the mortality was exceedingly high up to a few years ago, at which time the British introduced the Pasteur laboratories. The clothing protects the body and it holds back the saliva and can be looked upon as a means of filtering the saliva of the rabid animal, most of the saliva is held back as the teeth pierce the clothing, so that upon entering the flesh the teeth are practically dry, and only a portion of the virus is introduced. Upon entering the wound this small amount of virus is further diluted by the tissue juices to the non-infectious point.

We know from actual experimental work in the laboratory that the higher dilution will not kill."

If a portion of the brain of an animal dead from street virus is taken and made up in a dilution of one to five hundred, and this is injected, we find that it does not produce death. But a dilution of one to three hundred will invariably kill. This is practically what very often happens when one is bitten through the clothing. The saliva may be filtered and held back so that a small amount is introduced; perhaps a dilution of one to five hundred of the virus may get into the wound, but this is usually not enough to cause the disease. There is no possible way of estimating the amount of the inoculation. In such cases one's chances of never contracting the disease are only decreased; that is all we can say.

The treating of individuals, bitten by rabid animals, in the Pasteur Inst.i.tutes, is simply the practical application of results obtained by Pasteur from his original work on rabies virus. Pasteur was a French chemist living in Paris, and he began his search for the cause and cure of rabies in 1880. He hoped to find a sure method of preventing the development of the dread disease, even if he could not find a cure for it after it had developed. While he was pursuing this research Pasteur had access to the cases of rabies in the Paris hospitals, and these numbered sixty each year. He had practically an unlimited supply, for France could furnish him with twenty-five hundred more mad dogs, and a large number of other animals each year.

[INFECTIOUS DISEASES 245]

Pasteur devoted the remainder of his life to the study of this subject. He collected some saliva from the mouth of a child, on December 11, 1880, who had died at the Hospital Trousseau four hours before. This saliva he diluted with distilled water, and this mixture he injected into rabbits, and they all died, and the saliva taken from these rabbits when injected into other rabbits caused their death with rabies. He found also that saliva from rabid dogs almost always caused the disease. The incubation period varied within wide limits, and very often the animals lived. He then used the blood of rabid dogs for inoculation, but these blood inoculations always failed to produce the disease. Pasteur was convinced after careful study of rabid animals during the many months necessary to complete his experiments, that rabies was a disease of the nervous system, and that the poison (virus) was transmitted from the wound to the brain by the way of the nerve trunks. Then to prove his theory Pasteur removed a portion of the brain of a dog that had died of rabies. A part of this was rubbed up in sterile water and used to inoculate other animals; and subcutaneous inoculations with this material almost always produced death.

After this Pasteur tried a new method and injected directly into the nervous system, either into the nerve trunk or directly into the brain, after trephining, and all such injections produced rabies in the injected animal and death. He also found that rabbits inoculated in the brain always died in the same length of time. When he injected into the nerve trunk the inoculation period was longer, depending upon the distance from the brain. Two problems now remained for Pasteur to solve, and these were, how could he obtain the definite virulence and how could he reduce the virulence regularly and gradually, so that it could be used by inoculation safely as a vaccine to produce immunity to rabies in healthy animals, and also to prevent the development of rabies in animals bitten by rabid animals. He first tried successive inoculations. These inoculations were made, after trephining, directly to the brain, and he used a portion of the brain as a virus each time. He inoculated rabbit number one with a portion of brain taken from a rabid dog, and this rabbit died on the fifteenth day. He then inoculated rabbit number two with a portion of the brain of rabbit number one; from the brain of rabbit number two the virus was supplied for inoculating rabbit number three, and thus the brain of each inoculated rabbit was taken, after its death, for material to inoculate the next rabbit in the series. This experimentation showed him that each rabbit in the series died a little sooner, showing that the virus was becoming more virulent, till no increase in activity of the poison was shown after the fiftieth successive inoculation. "Rabbits inoculated with a brain suspension of rabbit number fifty all died in seven days." This caused Pasteur to name the virus of number fifty "virus fixe," a virus of definite length. He now had obtained a virus of definite strength and the next question was, how could the virulence be gradually and definitely reduced.

[246 MOTHERS' REMEDIES]

This he accomplished after many experiments. He proved that pieces of the "medulla oblongata" suspended in sterile tubes which contained fragments of caustic potash, steadily and gradually reduced their virulence as they dried, till the fourteenth day, when they were practically inert. New specimens were prepared each day and cords which had dried in one day Pasteur called "one-day virus;" cords which had dried in two days, "two day's virus," and so on up to the fourteenth day. With this graduated virus he now experimented on dogs, and the injection he used on the first day consisted of an emulsion of fourteen-day virus; for the second day, the thirteen-day virus, thus using a stronger virus each day, until on the fourteenth day he used the full strength virus. This treatment produced what is called immunity in the dog, and even the direct inoculation into the brain of the strong virus would not produce death.

After Pasteur had thoroughly satisfied himself by repeated trials, he announced his wonderful discovery, and it was in 1886 that Pasteur considered the preventive inoculation in human beings as resting upon a satisfactory experimental basis. During these five years this eminent man proved that it was possible to protect or immunize the lower animals, rabbits and dogs, against inoculation with the virulent virus.

The efficiency of this immunity was given trials by different methods of inoculation. It was found that sixty per cent of dogs inoculated under the "dura" (a membrane of the brain) were saved if treatment was given the second day. This test is more severe than is required to meet the ordinary infection of rabies. Pasteur, after a series of these final tests were so convincing, prescribed the preventive inoculations in human beings and on July 6th, 1886, the first human patient received the first treatment of his series of inoculations.

The method of obtaining the attenuated virus used in the treatment is as follows: A rabbit is inoculated by the brain method before described, each day, with suspension of the fresh, fixed virus. These rabbits die in six days after the inoculation. In this way a rabbit dies each day; the spinal cord is removed, divided into sections, and suspended in a flask containing pota.s.sium hydrate. The action of pota.s.sium hydrate is drying (desiccating). A series of these cords, which have been hung on fourteen successive days, are always kept in stock for the treatment of patients.

The virus becomes less active with each successive day of exposure to drying (desiccation) and finally the virulence is altogether lost.

When the patient comes for treatment the fourteenth and thirteenth-day cords are used for the first inoculation, and on each successive day the patient receives inoculation, the strength of which has been regulated by the number of days the cord has been hanging. During the first four days patients receive injections of six cubic centimeters of emulsions made from cords aging from fourteen to seven days, and from the fifth day until the completion of the course of treatment patients receive emulsions from cords of higher immunizing properties, but no cords desiccated for less than four days are used.

[INFECTIOUS DISEASES 247]

Death rate from 1878-1883 before Pasteur treatment was inst.i.tuted taken from doc.u.ments in the department of the Seine:

1878 143 bitten. 24 deaths.

1879 76 " 12 "

1880 68 " 5 "

1881 156 " 22 "

1882 67 " 11 "

1883 45 " 6 "

Average of one death to every six bitten, or seventeen per cent mortality.

Incubation period from eleven days to thirteen months, average one hundred and twenty days, depending upon location of bite. Pasteur Inst.i.tute records during the years 1886-1887 and first half of 1888, show that Pasteur had under his supervision 5,374 persons bitten by animals either proven or thought to have been mad. Mortality for 1886 was 1-34 per cent, during 1887 it was 1-12 per cent, during 1888 it was 77/100 per cent. With the later treatment the mortality has decreased to 3-10 per cent in 1908.

The Pasteur method of treatment is a process of immunization which must be completed before the development of the disease. It is of no value after the symptoms have appeared.

Those who have not been affected can be immunized the same as those who have been bitten. The individual who has been bitten by a mad dog realizes when and how severely he has been bitten, and were it not for the so-called period of latent development of the virus, it would not be possible to carry out the Pasteur treatment. The patient may, if he will, take advantage of this fact and be immunized by treatment before the disease has developed. Deep and severe bites are most dangerous, but the disease may develop simply from a rabid dog licking a scratch of the skin.

As before stated bites on exposed or uncovered surfaces, are more dangerous than those through clothing. There is a very easy access of the saliva to the wound in the unprotected part, while in the protected parts the teeth in pa.s.sing through the protection, clothing, are freed of their saliva at least partially. The virus is conveyed from the bitten part or inoculation to the central nervous system through the nerve trunk, and the rapidity of extension depends upon the resistant powers of the patient, the virulence and the amount of virus deposited in the bitten part at the time the person was bitten. This disease develops only in nerve tissues.

Virus can be found in the nerves of the side bitten, while the corresponding nerves on the opposite side are free from it. It can be ascertained that the virus is present in the medulla oblongata before the lower portion of the cord.

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Comparative danger.--A wound of the hand after a delay of three weeks is as dangerous as a bite on the head exposed only a few days. There is always a possibility of an acc.u.mulative action and extension of the virus along the nerve trunk to the central nervous system during the interval of exposure, and this should be always borne in mind. It is stated by authority that the virus is not transmitted by the bite of a rabid animal until two days previous to the appearance of the first symptoms. It is with some difficulty that a decision is reached in advising patients who are bitten to take treatment early in the course of the disease. The symptoms are often so very obscure and slight that they are not recognized. If a dog which is not naturally vicious suddenly bites without any cause it should be tied securely and watched for seven days; and should it develop symptoms of the disease during this period the bite should be considered dangerous.

Immediate treatment of the wound.--A temporary measure is the cauterization of the wound; do not neglect this because a few hours have pa.s.sed since the person was bitten, for wounds may be cauterized with advantage even after two or three days have elapsed. Of course the earlier it is done the better. If they are thoroughly laid open and scrubbed it is more effective. Nitric acid used freely is the best method to use. Wash the wound freely with boiled water after the acid has been applied; ninety-five per cent carbolic acid may be used if nitric acid cannot be obtained.

If carbolic acid is used it is necessary that it be washed from the wound by the free use of absolute alcohol, followed by boiled water and a dressing of bichloride of 1-7000. This prevents the ulceration of the wound by the carbolic acid. Cauterization thoroughly done destroys a part of the inoculated virus. Thorough cauterization is especially necessary with large wounds in which large quant.i.ties of the virus is inoculated.

When to send patients to an Inst.i.tute.--Send them immediately, if there is good reason to believe the animal had rabies. It is not wise to wait until the animal dies; it is very important that treatment is begun as soon as possible, especially in severe bites.

What to send for examination.--The entire head may be sent by express, or better, the health officer should bring it in person. This saves time and relieves anxiety; or a portion of the brain may be removed under thoroughly clean conditions and placed in a sterilized twenty per cent solution of glycerin and water. In this way the virus retains its virulence and putrefaction is diminished. The first method is the best, taking the head directly. The head after it reaches the laboratory is examined microscopically for "negri bodies," and if there is no contamination the microscopic findings are verified by animal inoculations. The presence of negri bodies in a specimen is of great value owing to the rapidity with which a diagnosis can be made. In one case a positive diagnosis was reported within twenty minutes after the specimen entered the laboratory and within the next hour and a half the patient bitten by the dog the same day had begun her course of protective injections and was saved.

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Protection.--To stamp out this disease city authorities, etc., can enact laws. All ownerless dogs should be killed, and the keeping of useless dogs should be discouraged by taxation. All dogs should be thoroughly muzzled where the disease prevails. This article is made up from an article written by an acknowledged authority on this disease, a man in charge of a Pasteur Inst.i.tute.

Cities where Pasteur Inst.i.tutes are located: Ann Arbor, Michigan. Baltimore, Maryland.

Chicago, Illinois. Austin, Texas.

Minnesota. Toronto, Ont.

New York City.

DISEASES OF THE BLOOD AND DUCTLESS GLANDS.

Anaemia, or Anemia.--This may be defined as a reduction of the amount of blood as a whole or of its corpuscles, or of certain of its more important const.i.tuents, such as alb.u.min and haemoglobin. Primary or essential anemia includes chlorosis and pernicious anemia; secondary anemia results from hemorrhages, poor nourishment or intoxications, poisons. Chlorosis, a primary anemia chiefly of young girls, characterized by marked relative decrease of haemoglobin.

Causes.--It usually occurs in blondes of from twelve to twenty years of age and most often from fourteen to seventeen years of age, when the menstrual function is being established and during which time they are rushed with their school work. There may be a family history of chlorosis or tuberculosis. Poor food, hard, unhealthy work, confinement in close unventilated rooms are other causes.

Symptoms.--Rounded fleshy appearance may continue. There is some difficulty of breathing, palpitation of the heart on slight exertion, from a fright or from excitement, tendency to faint feeling or even fainting, headache, a tired feeling, hard to stir or do anything, irritable temper, poor or changeable appet.i.te, the digestion is disturbed, there is constipation, coldness of the hands and feet, difficult menstruation, irregular menstruation, leucorrhea, amenorrhea, and sometimes there is a slight fever. The color is often of a yellowish-green tinge, and this is more noticeable in the brunette type, though the cheeks may be flushed; the whites of the eyes bluish white in color. The heart sounds are not right. The blood is pale in color. The red cells are diminished, but usually are not below eighty per cent of the normal; the haemoglobin is greatly reduced, sometimes to thirty-five or forty per cent. The age, greenish tint of pallor, bluish whites of the eyes, poor nutrition, etc., aid in making the diagnosis.

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Treatment.--Fresh air, good food, care of the bowels and rest if the symptoms are severe. When it is not so severe, plenty of outdoor exercise is necessary and beneficial. That takes them away from their cramped sedentary life and gives the sunshine, good pure air, and change of the scene. Horseback riding is a very good form of exercise, but it should be slow riding. "Tending" the horse is also good, and sleeping in the open air is excellent. Automobile riding is too straining and should not be indulged in.

1. Blaud's pills are very much used. The formula follows:

Dried Sulphate of Iron 2 drams Carbonate of Potash 2 drams Syrup Sufficient

Mix thoroughly, and make forty-eight pills. Take one to three pills, three times a day after meals.

2. Fowler's solution of a.r.s.enic is also very good remedy; three to four drops three times a day. It must be watched for bad symptoms and should only be taken under a physician's supervision.