794

Jeo) ls Rabies ii Califorhia.
By W. A. SAWYER, M.D.,; ‘Director of State Hygienic
Laboratory, Berkeley.

For a yéaY and a Half there has been prevalent
among dogs in ¢értain parts of California, a diséase
frequently transmitted to other warm-blooded ani-
mals; incltiding cattlé ‘aiid hotses, and: also to: man.
Rabies, or hydrophobia, is. -sttiking- example of

 

those diseases which-ate ‘perpetuated among certain.

-atiinals and o¢casionally are‘ trarismittéd in one way
or another to man. Other familiar dxamples of such
diseases are glanders in horaés and mules, anthrax in
cattle,-and . bubonic: plague:in.-todents, all three of
which: diseases. exist. :in: California -in. animals,. but
“seldom. attack! mari: -Rabies;, while essentiallya dis-
; ease of ‘dogs,: is: very
valuable: domestic animals-.and. human beings, owing
:foithe excitement and. delirium. which cause many of
the infected dogs to travel about and to introduce
infections saliva: with their teeth through the skins
of -animals.-and . persons.. While the control of
anthrax and:, glanders:. offers ,.dificult and complex
problems, and. while: the. safety of human beings from

- plague was.accomplished in. our, state only through.
the. expensive: destruction of ‘rats. and their. hiding

places, rabies: can be; suppressed and ‘even. entirely
etadicated in a definite circumscribed area by making
-it;impossible, by: muzzling, for dogs to bite, and by
preventing dogs from entering infected regions until
proved: by.'a-six, months’. quarantine to be free from

the diseasé.. Such methods Have freed the island of .

Great Britain from -the disease, and quarantine has
kept, the .malady out of. Australia? : These experi-
_ettees, ahd niany others in: Earope and ‘America, have
‘shown’ that -rabies may be suppressed . with simple
méasures if they are ‘thoroughly ‘enforced, and that
it. is. ‘therefore. a.‘disedse. so ‘decidedly prevéntable
“that‘it'is a reptoach to any’ community to have an

“oatbreak “occur and “spread:

<The Pacific Slope, after a long freedom from the:

_ disease,hasat last: been forced, to.add rabies to the
list df, diseases ‘Which demarid ‘sugipression through

concerted” activity: of the. defenders of, the public’

health... This:-disease, -known for many centuries. in
Ewropé, was. recognized>in: New -England in 1768.
In1908 it was prevalent: in’ the eastern half of the
United States: and! occtrred in:rare-instances some-
what further west?) 5) oo ocyore 2
In-a-recent article Black and Powers describe a
small-outbreak of rabies:among the dogs of Los An-
geles in- 189838... Fortunately, the disease was. sup-

pressed. by -a.muzzling. ordinance. In the same -

_ atticle are, the reports ‘of a fatal human case which
was infected in 1899, froma dog in .Pasadena, and
‘of;;anz outbreak- in..1905 among. the. animals :at the

‘Soldiers’ Home ‘near .Los .Angeles,:.. With these ex-.
ceptions we have no authentic record of the existence .

of. abies. in, California, previous .to. the. summer of
1909; when the present epizootic first attracted atten-
tion-in:. Dos Angeles. 0 08th cere le
:: The. disease -may. have, been: slowly carried to. the
state from the. east by dogs and wild. animals, such
as’ covotes.and. skunks, or,,it may easily have been
introddted through the transpottation“over the: rail-
road:of,an ‘infected dog during:the incubation period

of the disease. . It.is only to be wondered at that the”
westward spread’ of the disease from the Atlantic-to —

‘the:.Pacifie-seaboard: requited :more::than.a céntuty.
- The:spread:of ribiesithrough* railroad transporta-
-fion is-well shown inthe story of a.dog: whose head
was sent: from “Imperial: to. the State: Hygienic Lab-
oratory, whére-;examination proved the presence of
rabies. This dog was ‘thé pet: of:a schoolteacher
and , accompanied her..on _a:visit. to Los Angeles,
whith is ‘tieafly two, Nundred, miles fron Imperial.
A few. weeks after retiirning, the. dog suddenly be-
eamé frenzied and killed fifteen chickeris, but did not

CALIFORNIA: STATE JOURNAL OF MEDICINE

apt.to:secufe victims among § ‘

‘and human beings.

Vol. IX, No. 7

bite any humian beings or dogs. No other cases have
octutred in Imperial, and it is highly ‘probable that
the dog had become infected during his unwise visit
to a city in which rabies was prevalent. The travel-

._ ing of doge to and from infected districts ought cer-

tainly to be discouraged if not strictly prohibited ky
aw. : :
- The spread of the disease by wild animals is well
illustrated by the first case reported in Oregon of
the biting of a person by an aninial suspected of
rabies. In November, 1910, a child was bitten by a
coyote showing symptoms suggesting rabies. The
coyote was destroyed before its head could be se-
cured for examination, and the child was given the
Pasteur treatment without further evidence. A few
weeks later a sheep and a pig which had been bitten
by the same coyote developed rabies and their brains
showed Negri bodies. I am indebted to Dr. Calvin
S. White, State Health Officer of Oregon, for in-
formation regarding this interesting case, which
shows that Oregon, as well as California, has been
reached by the westward march of the disease. .
The responsibility of the wild animals of Cali-
fornia for the spread of rabies has not been clearly
demonstrafed. Thé tales of probable infections from
skunks and from a mountain lion, were all, as far as
I have been able to learn, unconfirmed by latoratory
evidence, It is desirable that the heads of wild
animals which display paralysis or ferocity unusual
for theit kind should be sent to the laboratory for
examination in order that it may be definitely known
whether: these animals are playing a part in the per-
petuation and spread’ of rabies. .
The principal object in presenting this paper is to
bring together for the use in the campaign against
rabies a collection of reliable statistics with clear
differentiation between fact and inference. The need
for the dissemination of knowledge concerning rabies

is indicated by the. continued opposition to efficient

treasures for the eradication of the disease, Sur-
prising as it may seem, the people most affected,
namely ‘the owners and lovers of dogs, through
bitter opposition show a lack of appreciation of the
fact that their pets are the chief sufferers from this

‘terrible disease, as well as the means of its spread

and transmission to horses, mules, cattle, pigs, sheep

‘In ofder to combat successfully the usual opposi-
tion to the enforced muzzling of dogs, health officers
should arin themselves with facts rather than
opinions. To gain proof of the presence of the dis-
easé a laboratory examination of the suspected
animal-is. imperative.- A prompt and decisive labora-

+ tory. examination becomes of greatest importance in

those cases where human beings have been biiten,
and where the’ patient is unwilling to spend the
necessary money and time for treatment unless the
need is clear. In such cases a positive report usually
results in prompt and successful preventive treat-
ment..-If the report is negative, the patient is freed
from the haunting fear that at any time in the en-
suing months he may suddenly develop. serious
symptoms. Where dogs have been bitten by rabid
animals, a positive laboratory report determines the
advisability of having the dogs killed. It is unwise
to'kéeep infected animals about as they are apt to
develop symptoms unexpectedly and spread the dis-
eased to othets. . The danget-of keeping under ob-

‘servation and confinement horses or cattle which
. have been bitten by rabid dogs is not so great.

The routine examination of heads at. the State
Hygienic. Laboratory consists of the careful removal
ofthe brain, the making of smears from the hippo-
campus: major, staining with Williams’ modification
of Mann's method,’ and careful search of from one
to twenty preparations for Negri bodies. If the re-
sults are negative, one or two experimental animals,
usually ‘rabbits, are inoculated subdurally with an
emulsion of the brain. If diagnosis is urgent, a
guinea pig is inoculated, since that animal shows a
very short incubation period, frequently only ten
days. «

In drawing: conclusions from the laboratory sta-
JULY, ror |

tistics presented in this paper it must be borne in
mind that the great majority of rabid animals are
not examined in the laboratory. The opinion has
been published’ that in Los Angeles not one case in
ten has been reported.to the Health: Department.
In that city 174 cases were reported between Sep-
tember, 1909, and April, 1911. During the same time
fifty-nine positive examinations of heads from Los
Angeles were made in the city laboratory. This
means that approximately one-third of the reported
eases received laboratory confirmation... From these
statements it seems probable that the positive lab-
oratory examinations represent less than one-twen-
tieth of all the cases of rabies. In Stockton the pro-
ortion is more striking. We have the statement of

r. Charles Keane, State Veterinarian, that one hun-
- dred cases have occurred in and near Stockton. Ac-
cording to our records only three heads were sent
to the State Hygienic Laboratory from Stockton.
These instances show that the laboratory statistics
represent only a small fraction. of the total number
of cases. : . .

In. the State Hygienic Laboratory between No-
vember 2, 1909, and April 1, 1911, a period of seven-
teen months, the heads of eighty-two animals were
received. ‘Two of the heads could not be exam-
ined owing to decomposition; thirty-six gave neg-
ative results, Of the remaining. forty-four show-
ing positive results, thirty-six showed Negri bodies
and the other eight caused typical symptoms of ra-
bies in rabbits. One of these eight heads could not
be examined for Negri bodies owing to decomposi-

tion, but the brain material was used for inoculation.

after the activity of the putrefactive bacteria had
been inhibited by emulsifying with glycerin and
allowing the mixture to stand for over twenty-four
hours. This substance when injected deeply in the
neck caused typical symptoms of rabies to appear
at the end of fourteen days.
tive cases, one was a cat and another‘a ‘cow. The
forty-two dogs examined were known ‘to have bitten
at least twelve human beings, the majority of whom

received Pasteur treatment pr iptly. Eight of the

dogs were stated to have bitten other dogs, one of
them biting fifteen or twenty dogs and another biting
two dogs and a mule. /

The laboratery of the Los Angeles Health Depart-
ment presents very interesting statistics of the pres-
ent epizodtic. Between September 14, 1909, and April
1, 1911, this laboratory examined 104 heads, 97 of
which came from the city of Los Angeles. One of
the heads could not be examined owing to putrefac-
tion. The sixty-four heads giving positive results
were divided among the various animals as follows:
Fifty-nine dogs, three horses, one cow and one. goat.
‘The first five examinations in 1909 were made by
inoculation of experimental animals. Since then the
results have depended on microscopic search for
Negri bodies alone. The horse and eleven of the
dogs which proved to be rabid were reported to
‘have bitten human beings. . oo

The laboratory of the Health Department of Long
Beach examined the heads of four dogs between July
1, 1910, and August 11, 1910, and found Negri bodies
‘in each case, Two of these dogs had bitten human
‘beings who received Pasteur treatment. All four
were found in Long Beach. . .

In the pathological laboratory of Dr, Stanley P.
Black in Los Angeles, between December 10, 1909,
and April 1, 1911, the .brains of fifty-seven animals
and two human beings were examined. In both the
human cases Negri hodies were found, and in one of
them animal inoculation was performed and resulted
in confirmation of.the diagnosis of rabies. Of the
fifty-seven examinations of animals’ brains fifty-two
revealed Negri bodies and were therefore positive,
four. were negative, and one was doubtful. In-one
of the cases animal inoculation was performed and
resulted in rabies, confirming the positive diagnosis
based on finding Negri. bodies. Of the fifty-two
animals’ brains giving positive results, forty-seven
were from dogs and five from cats. Thirty-seven of
these rabid dogs and all five of the cats had bitten

CALIFORNIA STATE JOURNAL OF MEDICINE

Of the forty-four’ posi-.

295

human beings. The heads came from the following
counties: Los Angeles, Orange, San Bernardino and

ngs. ,

Summing up the evidence of the four laboratories
we find that out of 247 examinations of the brains
of animals for rabies, 164 gave positive results. Qne
hundred and fifty-two of the positive cases were
dogs and the remaining cases were distributed as
follows: Six cats, three horses, two cows and one
goat. At least sixty-eight huraan beings were bitter:
by the animals which were proved to be rabid by
laboratory investigation. If our previous estimate
that not more than one out of every twenty cases
of rabies in animals is examined in the laboratory,
is true for the whole state, these positive cases
would indicate that there had occurred a total num-
ber of cases in California of over 3200.

The Director of the State Hygienic Laboratory
requests that, if any pathologist making examinations
for rabies has been overlooked during the compila-
tion of these figures, he will kindly furnish his totals
to the laboratory in order that the statistics com-
piled may be kept up to date.

The geographical ‘distribution of the cases is
graphically shown on the accompanying map. In

‘addition to the dots and circles which indicate the,

locality from which.the heads of rabid animals were
sent to the laboratories, and the figures indicating
the number of heads from each county, small crosses
may be seen. These represent, as nearly as could be
ascertained, the locations at which fatal human cases
of rabies became infected. The first case antedates
the present outbreak. :

A summary of the human cases follows:

1. On March 10, 1899, in Pasadena, a man (H. M.
S.) was bitten in the face by his dog. Five weeks
after the infection symptoms of rabies appeared, and
five days later the man died (April 36, 18693. Inecu-

lation of rabbits with the brain tissues of the patient

produced rabies.7 :

i The remaining cases all belong to the present out-
reak.
2. On December 12, 1909, a rancher (M. E. C.)

aged 30, died of rabies at Holtville, Imperial County.

This man was infected through the bite of a cat.
3. About December 17, 1909, in Los Angeles, a

boy (J. S.) aged 10 years, was bitten in the leg by

a stray dog. Nine weeks later symptoms appeared

and death came three days afterward (February 2},

1910). Negri bodies were found in the brain of this

patient.8 . :

4. On May 2, 1910, a rancher (J. B.), aged 62,
died of rabies at Rivera, Los Angeles. County. He
had been bitten in the face by his own dog. .

. On November 15, 1910, in Los Angeles, a girl
(E. L.) of 6 years was bitten through the lip and
on the nose by a dog. Intensive Pasteur. treatment
was instituted the next day, but symptoms of rabies
appeared ‘sixteen days after infection and death oc-
curred two days later (December 2, 1910). Negri
bodies. were demonstrated in the child’s brain® A
rabbit inoculated with some’ of the brain tissue
showed the paralyses of rabies on the nineteenth

ay.

The last of these cases was a patient of Dr. David
D. Thornton of Los Angeles, and with his consent
I will present a short account derived from the full
report which he sent me: . |

In the morning of November 15, 1910, a little girl
of six years was sent by her mother.to.a neighbor-
ing grocery store. While she was in the store a
small, wet and dirty dog entered and sprang upon
her, biting through her upper lip and scratching
her nose with his teeth, The dog then bounded
through the door and ran away. Later in the day
the same dog bit another child in the leg, about a
mile from the store where Dr. Thornton’s patient
had been attacked. The dog was examined in the
Los Angeles City Laboratory and Negri bodies
were demonstrated. The next morning, thirty hours
after the biting, the Pasteur treatment was instituted
by Dr. Stanley P. Black and was continued sys-
tematically through November 30, the fifteenth day
296

 

  
 
 
 
 
 
 
  
 
    

 

 

CALIFORNIA STATE JOURNAL OF MEDICINE

Vol. LX, No. 7

- RABIES
CALIFORNIA

© Posiriva cases (6 ANUAALG EXAMINED
1M POE STATE MPOEINE LAGORATORY, Aon 11,1904
Fe apa £1981,

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TM A Ade areas OF THE HEARTH PCPARTONNTS
OF LOS ANOEAGE 42ND LOD BEACH AWD lat THE
PATHOL OOH AL. LABOAATOAY OF tucren 5%.
MACK OF 80s ABEL TS BArweEn wey 184,
AND, APRIL 1, 14

OLA IES OF man 221 FRE AANA, NOK 10,

fete Te Amma 1, 108,

 

of the. treatment, when the litle girl was noticed. to
be: peevish: and :irritable..§ On.the way -home from
the doctor’s office her mother bought her some soda

|: water, but: the child ‘complained’ that it tasted hot.

. On setting the glass down on the counter a sudden
jerking of: her: hand overturned it. and she: became

- ‘alarmed and cried violently. On reaching the street,

“she became ‘nauseated..and vomited, and:later she
had: ‘another severe crying spell. As she seemed ill,
she. was put to. bed. Food was repugnant and she
‘ate no supper.. During the. night the child. awak-
ened-at intervals and talked rapidly. At midnight
’ she asked for a drink of water and the mother ob-
served that her daughter -had some difficulty in
swallowing. The following morning the. child arose
as usual, and asked for water. Upon attempting to
drink. she: experienced great ‘pain in her throat and
was unable to swallow. She ‘became very irritable
and extremely sensitive to noises. A window shade
slipped from her mother’s hand and went up with
a ‘sudden noise. This. excited the child so that it
_ could: not be quieted for.a long time. In ‘the after-
noon. she: rolled from side ‘to side in bed and spoke
rationally althongh she had been delirious at times
during. the day. . The mere suggestion of drinking
seemed to ‘produce pain and there was fear’ of being
‘touched or handled in-any manner. The pupils were
dilated: “Chloral and bromides were given. by rectum

' insan attempt.to quiet the child. At about two
o’clock in .the-morning: she ‘began having one con-
vulsion after. atiother.. The pupils were dilated, the
pulse was rapid, and signs of exhaustion were ap-
parent: Chloroform inhalations. gave only tem-
poraryrelief. “Any slight irritation as wiping the
saliva from ‘het lips’ would precipitate a convulsive

 

 

seizure. The convulsions grew weaker and weaker
and further apart until death ended the suffering at
six o'clock in the morning.

This case is a striking example of an extremely
short incubation period, due in large part to the
nearness of the wound in the face to the central
nervous system. About two-thirds of the Pasteur
treatment had been given and consequently the im-
munity was far from being established. Usually
the inctlbation period is between forty and seventy
days, which allows sufficient time for immuniza-
tion. :

In order to prevent the recurrence of these hor-
rible cases of rabies in man until the disease shall
have been eradicated among dogs, it is necessary
that the -Pasteur_ treatment should be given as
promptly as possible wherever a patient has been
bitten by an animal proved to have had rabies or
strongly suspected of the disease. The importance
of treatment is apparent to any one who considers
that approximately fifteen per cent of all untreated
persons who have been bitten by rabid animals de-
velop the disease and die, while only-13 per cent
of those treated die.!° Almost half of the failures
are in‘cases like one of those reported above, where
the nearness of the wound to the central nervous
system and the virulence of the infection so short-
ened the incubation period that there was insuffi-
cient time for the Pasteur treatment to establish an
immunity before the onset of symptoms.

An-example of very short incubation periods in
animals has come recently to the attention of the
State Hygienic Laboratory. A man living in one
of the suburbs of Los Angeles reported to the lab-
oratory that on November 24, 1910, his pet dog had
JULY, 191

been bitten in the inner corner of the eye by a’

strange dog or coyote. Fourteen days later the dog
became restless and the next day it.was excessively’
playful and noisy. It refused to eat or drink, and
it bit the man and his child on their hands. The
dog died the following morning causing suspicion

that it had been afflicted with rabies, and its head’

was sent to the State Hygienic’ Laboratory in
Berkeley. Pending the arrival of the head, the

Director of the Laboratory, influenced by the his- .

tory of the case, telegraphed that he advised be-
ginning treatment without delay. The Pasteur treat-
ment. was begtn immediately. The dog's head was
carefully examined but Negri bodies were not
found, <A rabbit was inoculated subdurally and in
nine days it came down with typical symptoms and
it died three days later: Negri bodies are said to
‘be better developed in the slower cases, and in the
rapidly developing case of this dog they were not
discovered. In this case, the dog received a par-
ticularly virulent inoculation in a_ situation which
“permitted a quick spread of the infection up the

nerves through the short distance between the eye .

and the brain. Usually the incubation period .in
inoculated rabbits is seventeen days,or more. Dogs
who have become rabid from bites usually have an
incubation period of .from fifteen to sixty days.
Fortunately there was no delay in the treatment of
the people bitten. . :

Those who have observed the symptoms of rabies
in human beings, the anxiety and mental excitement,
the painful spasms of the throat preventing swallow-
ing, the convulsive seizures, and the final paralysis,
are impressed with the horror of this agonizing dis-
ease. Inasmuch as the individual who has been
bitten is seldom to blame, it seems only right that
the commuait the
ease among dogs should do ‘everything within its
power to enable the human victims to receive Pas-
teur treatment promptly and with moderate ex-

ense. Tam of the opinion thet there should be at
east one place in California w- re_a salaried officer
of the state will administer the Pasteur treatment
for a moderate set fee. This will not prevent the
treatment being given by physicians to patients who
desire to be treated at. home and prefer-to pay a
higher fee, rather than to interrupt their work and
travel to the Pasteur Institute of the State Hygienic
Laboratory, wherever the State Board of Heéalth
might see fit to establish such an. institution. An
Institute is needed immediately for the adminis-
tration of the free virus furnished by .the United
States Public Health and Marine-Hospital Service
pending the beginning of the production of-our own

virus as soon _as such a course will seem wise. The
demand for Pasteur treatment is indicated by the
fact that the Hygienic Laboratory of the United

States Public Health and Marine-Hospital Service
sent, previous to April 1, 1911, the virus for 14!
Pasteur treatments to California. In addition to this
virus the material for many treatments has been
obtained by physicians of California from other
sources. eo

Most. of the cases given in California have been
administered by Dr. Stanley P. Black and Dr. D. D.
Nice of Los Angeles. who have kindly furnished me
with brief reports of rhe extent of this work.

Dr. Nice has treated twenty cases of which three
came from Arizona, where they had been bitten’ by
skunks. No reports of rabid skunks in California
have heen received and it is to be regretted that the
heads in the Arizona cases were not examined.
Seventeen of Dr, Nice’s cases came from Southern
California; sixteen of these were bitten by dogs and
the remaining case received the saliva of a rabid cow
in a cut of the hand; Eleven of the dogs showed
Negri bodies on examination and the remaining ani-
mais. were not investigated in the laboratory. None
of the twenty cases developed rabies, Treatment
was begun from one to six days after the bite, ex-
cept in one case when it was instituted eleven days
after. oo ‘ .

Dr. Black has given Pasteur treatment to 102 peo-

CALIFORNIA STATE JOURNAL OF MEDICINE

which has failed to suppress the dis- |

297

ple from Southern California. Most of these pa-
tients came from Los Angeles, San Bernardino an

Orange counties, brt one came from each of the
following: Kings. Riverside and Ventura. “Dogs
were the source of infection in 93 of the cases, cats
in 5, horses in 4. The diagnosis of rabies in the in-
fecting animal depended on the discovery of Negri
bodies in 77 cases (73 dogs, 3 cats, 1 horse), and in
two additional cases on animal inoculation. One
of the cases showing Neari bodies was confirmed
by inoculation. The remaining 23 infecting animals
(18 dogs, 2 cats, and 3 horses) were considered rabid
owing to symptoms which thev presented, or to the
circumstances of the biting. The great majority of
the people treated had been bitten, but in a few
cases the virus had entered wounds otherwise in-
flicted. Three physicians took the treatment after
receiving wounds while making post-mortem exam-
inations of rabid animals. One of the 102 patients:
died of rabies long before the treatment could be
completed, as has been already reported in this
paper, and therefore this case cannot be looked upon
as a failure of the method, Another patient showed:
some paralysis. ‘With these two exceptions, no
symptoms, in any way referable to rabies developed
during or after the treatment. The time elapsing
between infection and the beginning of treatment
averaged 5.7 days. : . .

In Berkeley treatments have been given since
November, 1909, by the writer to a helper in the
State Hygienic Laboratory, who cut himself while
opening the skull of a rabid dog, and also to a boy.
who was bitten by a rabid dow in Concord. Califor-
nia. This dog’s brain showed Negri bodies. Neither
case showed any symptoms. ott

A man who had been bitten while visiting in Mis-
souri by a dog suspected of rabies, received . treat-
ment in San Francisco from Dr. Raymond: Russ.

There are many persons who do not understand
the best procedure to be followed when’ a. person
has ‘been bitten by a dog suspected of rabies. The
animal should be captured, if this can he safely
done, and should be shut.in a pen-where he should
be well cared for during a period of ten days. If
the animal is alive and well at the end of that time,
rabies may be excluded. If the dog dies, or if it is
killed at the time of the ‘biting, the head should be
carefully removed by a physician or. veterinarian,
should ‘be packed in ice in a large can or bucket.
and should be sent by express to the State Hygienic
Laboratory, Berkeley. The wounds inflicted on the
person bitten should be promptly cauterized with
nitric acid by the nearest physician. If there is lit-
tle doubt of the presence of rabies in the dog, or if
the wounds are about the face, there must be no
delay in beginning Pasteur treatment. Otherwise
it may be safe to wait twenty-four to forty-eight
hours for a telegraphic report of the microscopic
examination of the laboratory. ATIl dogs and cats
bitten by rabid dogs should be killed, for they would
be apt to spread the disease should they develop it.
As soon as it is known that the disease is present
in the community, the health authorities should be
notified and support should be given to the estab-
lishment and enforcement of ordinances compelling
the destruction of ownerless dogs and the muzzling
of all dogs until six months after the disease wiil
have disappeared. If a neighboring community con-
tains rabies and is not properly handling the situa-
tion, steps should be taken to prevent dogs from en-
tering from the vicinity where rabies prevails.

The proper application of the precautions which
have been outlined will diminish rabies to a mini-
mum, and possibly entirely free our state from the
disease. This would prevent a great deal of suffer-
ing among dogs and cattle, and would annually keep
a few human beings from the tortures of a hortible

cath, REFERENCES. ;

1 Stimson, A. M., Bull. No. 65, Hyg. Lab. U. 8. Pub.
Health and Mar. Hosp. Serv. Wash. Pp. %4 and 79.
2 Kerr and Stimaon, Pub, Health Bull... No. 29,

Pub. Health & Mar. Hosp, Serv, Wash., pp. 3 and
298 CALIFORNIA STATE JOURNAL OF MEDICINE Vol. IX, No. 7

a Black, S P., and Powers, L. M. Cal, State Jour. of |
' 1, VILL, pp. $69-871. ;

Medicine, Nov., 1910, Vol.
4 Stimson, A. M., Bun, 5, Hyg. Lab., U. 8. Pub, Health

& Mar. Hosp. Serv. Waash., p. 64. : .
5 Black, a P. and Powers, L.. M., Cal. State Jour. of

Medicine, Nov., 1910, Vol. » Pp. 871,

; ont Cal, State Jour, of Med., Nov., 1910, Vol.

, B. ¢ “ . ‘ :
7 Radebaugh, J. M., quoted by Black and Powers, Cal.
State Jour. of Med., Nov., 1910, Vol VIN, p. $70.
$ Colburn, J. R., guoted by Black and Powers, Cal.

State Jour. of Med., Nov., 1910, Vol. VI, p. .
Black, 8. P., Southern California Practitioner, Feb.,

9
1931, Vol. XXVI, p. 78.

10 Stimson, A, be Bull, No. 65, Hyg. Lab., U. 8. Pub.
Health & -Mar. Hosp. Serv. Wash., p. 61. .
oO . -. Discussion.

“Dr. Wm. Ophuls: I have listened with interest
to Dr. Sawyer’s splendid presentation of the ‘sub-
ject. YT examined the cerebellum of a girl who was
killed by a mountain lion in the Santa Clara Val-
ley; the lion was suspected to have had rabies, but
in, spite of careful examination we were unable to
discover Negri bodies in the brain. I have not
known of any cases which occurred in San Fran-
cisco. “At the hospital a few months ago we had a
dog which behaved as if he had rabies, but it turned
out that our fears were without foundation of fact.
Certainly” sooner or later the disease is. going to
eome to San Francisco, and it would be better to
take time by the forelock and prepare an ordinance
and enforce it in case of need. , oo.

Dr. W. A. Sawyer: The geographical distribution
of the disease is interesting. Around Los Angeles,
where the population is crowded and where there
are many dogs; the disease is found prevalent over
a fairly large area. Around: San Francisco Bay,
where the disease has not yet broken out, there is
a distinct need for the authorities to prevent the
disease from slowly working its way into that dense-
ly populated region. Over'a year ago the. disease
was in Stockton and a single case has been found
as near as Concord.’ If-we can only keep rabies
from getting: into the Bay region we will be doing
a distinct service to that community. 7