318

ORIGINAL, ARTICLES

RABIES, AND ITS PRESENT STATUS IN
CALIFORNIA.*

‘By WILBUR A. SAWYER, M. D., Director of the Bu-
reau of the Hygienic Laboratory of the California
State Board of Health, Berkeley.

Efforts to check the spread of rabies, or hydro-
phobia, among the dogs of California are greatly
hampered by the difficulty in obtaining authorita-
tive statements of fact regarding the present situa-
tion. Many controversial articles and conflicting
theories are being read and discussed, and it is

no wonder that the public and, to a large extent,.

the medical profession of California are unaware of
the true state of affairs. This article will attempt
to present the facts needed by those who are try-
ing to check the spread of the disease among dogs
and to make its transmission to people impossible.
' The early part of the present epizodtic was
reported by Black and Powers! in November,
1910, and the history of the disease up to April
I, 1911, was presented with the available statistics
in an article published by myself? in July of that
year. Since then the involved territory has been
greatly enlarged and the most populous part of the
state has been invaded. The center of maximum
involvement has passed from Los Angeles to
Fresno County and finally to San Francisco.

Figure 1 is a series of maps which shows at a
glance how rapidly the disease has spread. The
change in the shaded areas shows the increase in
the number of counties involved, and the stippled
counties represent an area invaded while the sta-
tistics here presented were being gathered to-
gether. It must be kept in mind that these maps,
except some of the circles representing human
deaths, are based on the results of laboratory ex-
aminations and not merely upon the interpreta-
tion of symptoms.

RESULTS OF LABORATORY EXAMINATIONS.

At the Hygienic Laboratory of the State Board

of Health, in the year beginning April 1, 1911,

and ending March 31, 1912, the heads or brains of.

122 animals were received for examination. Five
of the heads were in an advanced stage of decorn-
position and could not be examined. Sixteen gave
negative results. Of the remaining 101 giving
positive findings, 87 showed Negri bodies in the
hippocampus or in‘other parts of the brain, and 14
others caused typical symptoms of rabies after
inoculation into rabbits or guinea-pigs. "The 101
positive cases were distributed among the dif-
ferent animals as follows: 2 men, 94 dogs, 2 cows,
1 horse, 1 cat and 1 ground-squirrel. Sixty-four
people and seventy-eight dogs were reported as

having been bitten by the animals which showed.

evidence of rabies on examiration. As an in-
dication of the increasing prevalence of the disease
it will not be out of place to mention that in the
two months following the period for which the
statistics have just been given 55 examinations were
made with positive results in 46 cases. The rapid
increase of rabies is shown by the fact that 1o1
positive cases were examined in twelve months be-

 

*Read before the Sacramento Society for Medical
Improvement, June 18, 1912.

CALIFORNIA STATE JOURNAL OF MEDICINE

Vol. X, No. 8

fore April 1, 1912, and nearly half as many, 46,
in the two following that date.

The specimens giving positive results during the
year ending March 31, 1912, are divided between
the counties as follows: Fresno, 29; Kings, 18;
Tulare, 16; San Francisco, 12; Kern, 7; Merced,
4; San Bernardino, 33 Stanislaus, 3; Riverside, 2;
Madera, 2; San Joaquin, 2; Imperial, 1; Contra
Costa, 1; San Mateo, 1.

The number of positive examinations increased
rapidly during the winter, which is our cool and
wet season. This is sufficient answer to the very
general superstition that the disease is caused by
hot weather and to the claim frequently made that
inability to get water is the cause of hydrophobia
in dogs. By months the positive examinations are
grouped as follows: in 1911, April, 3; May, 3;
June, 4; July, 3; August, 5; September, 7; Oc-
tober, 10; November, 9; December, 9; in 1912,
January, 15; February, 18; March, 15.

Many examinations for ‘rabies have been made
in municipal and private laboratories in Califor-
nia. Through the kindness of those in charge the
results of these examinations have been obtained
for publication and have been combined with the
statistics of the State Hygienic Laboratory in the
table below.

 

TABLE 1.
Results of Laboratory Examinations for Rabies,
April 1, 1911, to March 31, 1912.

 

 

 

3 2 ~¢ fF =F ays
os Ss = &
g3 B30 Fe ROBES
<0 ac — ns a2 eng
oe = =8 =3 Sin
a) 57 22 a ex >
ny Bs ces 2 + Low
: ™ SB £4 fm | BSB
ot Co ee og rm = sy
2 B :& ge 9 BS
:§ 5 : 8 5 at
: 8 : 3 1
State Hygienic Lab- .
oratory .......-..5- 122 101 87 14 64
Health Lept. of San
Francisco ......... 70 49 47 2 48
Health Dept. of Los
Angeles .........6. 29 18 18 0 29
Health Dept. of
Long Beach ...... 2 1 1 0 1
Letterman General
Hosp., San Fran-
CISCO 2. Lee eee ee ee 11 8 8 5 0
Dr. W. Ophiils, San
Francisco ......... 5 5 5 5 4
Dr. H. Zinsser, Palo
AltO cece cece eens 3 1 1 1 0
Dr. S. P. Black, Los
Angeles ........00, 18 18 18 0 29
Dr. R. A. Archibald,
Oakland ........... 21 8 8 1 0
San Francisco Vet-
erinary College....143 46 46 0 5
424 255 239 28 180
Subtracted because
examined in more
than one labora-

TOPY oo. cece ee eee 5 5 5 0
Corrected Total....419 250 234 23 180
POSITIVE CASES BY COUNTIES.

San Francisco .......2-e2 cere eee ee 119
Los Angeles ..........+-e+00e-ee> 30
Fresno 0... ee ee eee 30
Kings 2.0... cece eet eee 18
Tulare... 2c cece eee eee 16
San Bernardino ......-.-.02+0+055 8
| 6» 9
Orange oo. ieee ee eens 4
Merced... ee cee eee eee eee 4
: AUG., 1912

Stanislaus 2... 0... cece cece eee eee 3
Ventura ..... scence cece ee neseee 2
Riverside .....ccccc cece sete ences 2
Madera ....c eee eee ccc cee eee 2
San Joaquin ......... cc cece ee eeee 2
Imperial ........ cca s eee esceeees I
Contra Costa ...... 0. ccc cece eee I
San Mateo .....cssececevceceece I
250
POSITIVE CASES BY ANIMALS.
Man ....... cece cece eee e eee eeeee 2-
Dogs ..ccc cece cece eect cereeee 240
Cats ....eeeeeee sete ee eees ose 3
COWS ccc cece ete eee e ne weenees 3
Horse 2... cece cece cee ee cece : 1
Squirrel .......0 ces c eee ee eee 1
250

Those who claim that the disease will soon die
out if unopposed will find food for thought in
comparing the 250 cases of proved rabies of the
year beginning April 1, 1911, with the 164 similar
cases collected in my report of a year ago? for
the seventeen months preceding. This gives a total
of 414 positive cases examined in laboratories
during the present epizodtic.

DIAGNOSIS BASED ON SYMPTOMS ONLY.

There can be little doubt that the laboratory

examinations represent but a small fraction of the

total number of cases of rabies in the state. Un-
less persons or valuable animals have been bitten
or unless the disease is new in a region, many ani-
mals die or are killed and buried without its being
considered sufficiently important to warrant the
trouble and expense of removing the heads, boxing
and icing them, and shipping them by express to
the laboratory. Diagnoses based on clinical symp-
toms are not apt to be reported to the State
Veterinarian or the local health authorities unless
the suspected animals have come under the ob-
servation of a veterinarian or physician who real-
ized that the officials should be notified. Replies
to a circular letter to the health officers of the
southern two-thirds of the state did not show any
territory to be involved except the counties al-
ready shown to be infected according to the labor-
atory records. The cases reported as being diag-
nosed as rabies from clinical symptoms alone are
probably duplicated in the record kindly furnished
‘by Dr. Keane, State Veterinarian. To his office
between April 1, 1911, and March 31, 1912, 285
cases of rabies were reported. Of these, 120 were
based on laboratory evidence and are probably in-
cluded in the statistics already given. The re-
maining 165 are additional cases reported by veter-
inarians on the basis of clinical symptoms. These
165 cases came from territory shown on the maps
in Figure 1 to be infected. They are divided
among the various animals as follows: dogs 142,
cows 12, hogs 6, horses 3, goat 1, mule 1.

RABIES IN MAN IN CALIFORNIA.

The mortality among human beings seems very
small when comparison is made with the death rate

CALIFORNIA STATE JOURNAL OF MEDICINE

319
among dogs, which are the chief sufferers. Previ-
ous to April 1, 1911, five human deaths had

been reported. These are briefly reviewed below.
The first of these preceded the summer of 1909,
when the disease began to be prevalent..

1. A man, H. M. &., died with the symptoms
of rabies in Pasadena on March 10, 1899, five
weeks after being bitten in the face by his dog.
Inoculation with brain tissue of the patient pro-
duced rabies in rabbits.*

2. M. E. C., a man, aged 30, died with the
symptoms of rabies, in Holtville, Imperial County,
on Dec. 12, 1909. He had been bitten by a cat.

3. J. S., a boy of 10 years, died with symp-
toms of rabies on February 21, 1910, in Los
Angeles. He had been bitten in the leg by a
stray dog. Negri bodies were found in his brain.

. J. B., a man of 62, died of rabies at Rivera,
Los Angeles County, as a result of being bitten
in the face by his own dog. .

5. E. L., a girl of six years, died of rabies on
Dec. 2, 1910, in Los Angeles, seventeen days after
being bitten in the lip and nose by a stray dog.
Intensive Pasteur treatment was begun, but the
unusually short incubation period did not permit
its completion and therefore it did not have time
to produce the immunity needed for protection.
Negri bodies were demonstrated in the head of the
dog and later in the brain of the girl. Inoculation
with brain tissue of the girl produced rabies in a
rabbit.” This case was described in greater detail
in my previous article on rabies in California.’

During the year for which the laboratory sta-
tistics are being given, April 1, 1911, to March 31,
1912, there have been six human deaths from
rabies, bringing the total of reported cases up to
eleven. That there were not more fatalities can
only be accounted for by the large number of per-
sons who availed themselves of the Pasteur treat-
ment for the prevention of rabies. The remaining
six cases are given below.

6. A girl of three years, M. L. C., developed
the symptoms of hydrophobia (rabies) and died on
June 27, 1911, near Tulare, Tulare County. The
typical symptoms, including the spasms of the
throat on attempting to swallow, were present and
left no doubt as to the diagnosis. The source of
the infection was not ascertained although careful
inquiry was made by the attending physician, Dr.
John B. Rosson, to whom we are indebted for our
information.

4. A boy, aged 15, C. V. B., died of hydro-
phobia on August 27, 1911, in Los Angeles.
From the report® of this case published by Dr.
W. V. Chalmers Francis, attending physician, and
from information kindly furnished by him through
correspondence, the following facts have been
briefly gathered together:

About nine months before the boy’s death his
pet dog, as well as several other dogs in the neigh-
borhood, had been bitten by a strange dog. One
or two of the animals which had been bitten were
later killed on the suspicion of having rabies. The
boy’s dog developed an acute illness, supposed at
the time to be poisoning, and died five to seven
320

days after the first symptoms. Among the symp-
toms of the dog were rapid breathing, salivation
and weakness of: the hind legs. The boy’ took
entire care of the sick animal. Whether the boy
was actually bitten is not clearly remembered, but
one of the boys in the family was bitten by the
dog at about this time, and the boy who died had
open wounds on his hands when he was caring for
the animal. The boy was a strong healthy youth
who attended school during. the day and acted as
life-saver and swimming expert at one of the public
baths in’ the evening.

On August 22, he began to feel feverish. The
next day he took to his bed and complained of
stiffness in his legs. He had no appetite. The fol-
lowing night he was unable to sleep. On the third
day, August 24, he disliked to drink on account
of trouble with his throat. He dressed himself and
walked stiffly. The following day he became
much excited and easily angered. His flushed face
wore an expression of fear and anxiety. He com-
plained of slight pains in throat, chest, and abdo-
men and of difficulty in swallowing. He could
not sleep. He answered questions rather clearly,
but contradicted himself frequently. Occasionally
he had outbursts of passion followed by expressions
of regret and apology. He had fear that he
would be forced to drink and he exclaimed that he
would not drink because it choked him. Drafts
of air precipitated spasms of the face so painful
that when the door was opened, the patient
screamed in terror.

Other prominent symptoms were loss of power
in the legs, loss of the patellar reflex, irregular
breathing, irregular and rapid heart action and ele-
vation of temperature to 102° F. Sometimes the
patient would not breathe during a period as
long as forty seconds. During the remaining two
days of life the patient had frequent convulsions
and fits of anger.. There were noisy delirium,
delusions, hallucinations, and unreasoning fear. At
times he became rational and complained of burn-
ing in his throat, but he would -refuse angrily to
try to drink. ‘Toward the end he developed em-
physema of his face, neck and chest. He died on
the 27th of August, the sixth day of his illness.

An examination of his brain performed by Dr.
Stanley P. Black, evealed the presence of Negri
bodies, and confirmed the diagnosis based on symp-
toms.

8. A man of 30 years, W. L. L., died of rabies
on September 1, 1911, in Los Angeles. We are
indebted to his attending physician, Dr. H. A,
Johnston of Anaheim, and to Dr. Anders Peter-
son of the Los Angeles County Hospital for the
following information: On June 15, 1911, the
man was bitten on the hand by his own pet dog.
There were about four small deep wounds. These
were cauterized with nitric acid. A veterinarian
who examined the dog stated that he suspected
rabies and advised observation of the animal. The
owner killed the dog against this advice, thus de-
stroying further evidence, and refused to take anti-
tabic treatment. .

On August 30, 1911, 59 days after he was
bitten, the man began to feel sick and tired

CALIFORNIA STATE JOURNAL OF MEDICINE

Vol. X, No. 8

and to yawn frequently. The following night
severe symptoms began. He was taken to the Los
Angeles County Hospital on August 31. When
he arrived, he was semi-conscious and the spasms
in his throat were so severe that he could not
swallow or speak. He -died on September 1, the
third day of his illness,

9. A boy six years old, C. W. B., died of
hydrophobia on February 15, 1912, in Santa
Maria, Santa Barbara County. Dr. R. W. Brown
of that city is to be thanked for furnishing us
the important facts in the case.

On January 12, 1912, this little boy was play-
ing in the road in the country near Santa Maria
when a small black dog attacked him and bit him
in the face and on the hand. The dog then
went on its way and was not seen again. Four
hours later the wounds were cauterized. On Feb-
ruary 14th, one month after the biting, the boy
was visited by Dr. Brown, who found his patient
on the bed with an expression of extreme terror
on his face. For four or five days the child had
not been himself, being at first peevish and dis-
inclined to play and later having spells of choking
and of “seeing things” on the wall. During the
doctor’s visit the boy complained of thirst and
asked for water, but, when given as little as a
teaspoonful, he fell backward suffering agony from
the spasm in his throat, and swallowing was im-
possible. Early the following morning the little
fellow died.

10 A man of 21 years, F. A., died of hydro-
phobia on March 9, 1912, in San Francisco.
Through the courtesy of Dr. F. R, Dray, attend-
ing physician, the following facts have been
learned regarding this case. The young man was
the owner of four dogs. One of these was bitten
by a dog supposed to be “mad.” The dog which
was bitten developed rabies and bit one or more
of the other three before it died. All four of the
animals finally succumbed to the disease. While
attempting to give the last of his dogs castor oil,
the owner was bitten in the right thumb near the
nail, This occurred on February 3, 1912, before
the outbreak of rabies in San Francisco had re-
ceived sufficient publicity to be generally recog-
nized. The young man contented himself with
cauterizing the wound with phenol two days after
it had been inflicted.

On March 2, four weeks after the bite, he be-
gan to have pain in the right arm. Two days
later he became very nervous and troubled and °
consulted -a physician. He was unable to swallow
some pills intended to quiet him. On the same
day he was sent to the German Hospital. On
admission he was unable to swallow liquids except
with greatest difficulty. During the following
night he was rational, but after that he had fre-
quent periods of intense excitement, delirium, and
convulsive twitching. He had hallucinations lead-
ing him to believe that there were various animals
in his bed, and his face bore a peculiar drawn ex-
pression resembling a smile. Noises or contact
precipitated attacks of twitching and rigidity of his
muscles. There were no true convulsions. ‘There
was moderate fever. As he was unable to swallow,
AUG., 1912 °°

nourishment was maintained by rectal feeding. I
was invited to visit the patient on March 8th.
The disease was far advanced and death was
evidently not far away. The patient’s face wore a
markedly drawn and worried, or frightened. ex-
pression and his open mouth was filled with foamy
saliva.. There was moderate cyanosis and the
breathing was heavy. He was unable to articulate.
The extremities were very weak and somewhat
rigid. The patient-died early on the morning of

March oth, eight days after he began to feel pain

in his shoulder and six days after symptoms of
nervousness began.

A post-mortem was performed and. parts of :the
brain were sent to several laboratories for diag-
nosis. The results were uniformly positive. for
rabies. At the State Hygienic Laboratory, Negri
bodies were demonstrated in the hippocampus. A
rabbit anda. guinea-pig were inoculated and both
developed , tabies. The guinea-pig showed symp-
toms of furious rabies for five days. | CS

11. A. man of 63 years, J. M:, died of rabies

on March 21, 1912, in San Francisco. On Feb-
ruary 25th this man was bitten deeply in the left
wrist and more superficially in the left foot by a
dog on the streets of San Fraricisco. The wounds
were cauterized half an hour afterward. The brain
of the dog inflicting the wounds was examined at
the laboratory of the San Francisco Health Depart-
ment and was found to contain Negri bodies. Af-
ter a delay of five days the patient came to the
Laboratory of the Health Department on March 1,
and was put under the Pasteur treatment with
virus distributed through the State Hygienic Lab-
oratory. -On the 17th day of treatment, four
days before the treatment would have been finished,
the patient complained of pain in his arms and
chest, but especially in his left shoulder. The
location of the pain was probably due to the fact
that the more serious wounds had been inflicted
in the left wrist. He also complained of. a gen-
eral aching. ‘The next day he took to his bed.
His chief symptoms were loss of appetite, insomnia,
nervousness, and pain in his left shoulder and
chest. He had a mild fever reaching a maximum
temperature of 99.2° F. The next day I had the
privilege of seeing the patient. The symptoms
were much aS already described. The patient’s
mind was clear and he did not seem specially
apprehensive. On the evening of the following
- day, March 20, more characteristic symptoms de-
veloped. There was difficulty in swallowing. The
‘next morning he had convulsions and spasms.
Chloroform was given for relief. The patient
finally became comatose and died at noon, March
21, 1912. A portion of the brain was. examined
at the State Hygienic Laboratory and Negri
bodies were found in the hippocampus. Animal
inoculations were impossible as the specimen had
been sterilized by embalming.

We are indebted to Dr. W. H. Kellogg of the
San Francisco Health Department and Dr. Paul
Castelhun, attending physician, for information re-
garding this case.

This is the second case in California where the

CALIFORNIA ‘STATE JOURNAL OF MEDICINE

321

Pasteur treatment was begun but was unable to

save the patient because the incubation period was
much shorter than usual and not sufficient for the
development of immunity.

COURSE OF THE DISEASE IN MAN.

_ The chief symptoms of rabies in human beings
have most of them been depicted in the cases al-
ready .described. In the majority of the people
bitten by rabid animals the disease does not de-
velop even without treatment, but all of the cases
which advance to the point of showing symptoms
are fatal in spite of any treatment: as yet known.
By taking an average of a large number of cases
it has been found that about 15 per cent of un-
treated people, who ‘have been bitten by rabid ani-
mals, develop the disease, while all but 1.3 per
cent’ could have been saved by treatment. These
figures are based only on cases of persons receiving
significant bites from animals conclusively shown
to be rabid. The mortality is highest from bites
which are most severe and those inflicted nearest
the central nervous system or large nerve trunks
and from virus of special virulence for man, as,
for example, the virus received from wolf bites.
The wound inflicted by a rabid animal heals or
fails to heal without being noticeably affected by
the presence or absence of the virus. After an in-
cubation period varying in man from 14 days to
a year, or even longer, but in the great majority
of cases lying betwen thirty and seventy days,
symptoms make their appearance. There may be
redness, pain, numbness, or itching. at the wound
or near it. Nervousness, irritability, and inability
to sleep may be the only symptoms for a day or
two. A moderate elevation of temperature is a
fairly constant symptom. ‘These earliest symptoms
are usually followed within a day or two by
marked nervous excitability and sensitiveness to ex-
ternal stimuli. A draft of air, a touch, or: a
noise may cause painful local spasms of the facial
or other muscles, or general muscular spasms.
Moderate difficulty in swallowing is followed, as
the symptoms develop, by excruciating pain due to
spasms of the throat brought on in greatest severity
by any attempt to drink. The dread of these
spasms will sometimes lead patients to scream at
the sight of a glass of water or at the suggestion
of drinking. These symptoms were early inter-
preted as fear of water and the disease was named
hydrophobia. There are hallucinations and there
may be violent fits of anger and even furious mania,
but intervals usually occur in which the mind is
clear. The breathing becomes irregular and the
heart action is rapid. Finally paralysis becomes the
predominant symptom and convulsive seizures, con-
trollable only by general anesthetics, cease, and
death ends the suffering. The course of the dis-
ease is usually between three and eight days from
the first symptoms. The duration of the disease
is shorter in the more severe form, known as the
dumb or paralytic type, where the stage of excite-
ment is not very marked, than in the furious type
of the disease.
322

COURSE OF THE DISEASE IN THE DOG. —

In dogs, as in man, the incubation period is
long, varying from 8 days to one year, but seldom
exceeding six months and usually lying between 15
and 60 days. As in man, about 15 per cent of the
dogs bitten by rabid animals develop the disease.
The symptoms in the dog resemble those of man in
being chiefly the effects of greatly increased sus-
ceptibility of the nervous system to external stimuli.
The first symptoms noticed are apt to be a change
in behavior. The animal may be more affectionate
than usual, but he is more apt to be morose and
agitated. He tends to snap and bite, probably be-
cause of hallucinations. The voice is frequently
changed. Soon difficulty in swallowing appears
and paralysis of the jaws and hind legs is apparent.

CALIFORNIA STATE JOURNAL OF MEDICINE

Vol. X, No. §

Dogs fairly well advanced in the disease will
frequently try to drink and they succeed in wet-
ting their dry noses and tongues, but are usually
entirely unable to swallow. The water runs back
out of their open mouths. The paralysis gradually
spreads to the whole body and the animal dies
in a few days after the first symptom, usually in
4 or 5 days, possibly in 2 to 10 days. The symp-
toms of rabies vary greatly, and frequently some
characteristic symptoms, such as the hanging of the
jaw, may be absent.

The cases of rabies in dogs are arbitrarily
divided into two merging types, furious and dumb
rabies. This classification only serves to indicate
whether the nervous symptoms show themselves
chiefly in excitement and activity or in helpless

 

 

 

 

 

Fig. 2. Dogs showing symptoms of rabies.

The jaw is allowed to hang down and can be
closed with difficulty, if at all. Figure 2 shows
pictures of three dogs suffering from rabies,

They all show the dropping of the jaw, and
some of the pictures suggest the muscular weak-
ness, especially of the hind legs. The swollen dry
tongue, the bleary eyes, and the emaciation cannot
very well be made out in the pictures. The first
in the series of four pictures shows a dog which
came down with rabies at the Presidio of San
Francisco, and I am indebted to Dr. John R.
Barber for the opportunity of securing the photo-
graph. The other three pictures were taken in
Riverside and were kindly furnished by Dr. Geo.
H. Tucker, Health Officer of Riverside County.

the

paralysis. The dumb form is as a rule
more severe and more rapidly fatal.

In the furious type the dog is apt to leave
home and to travel long distances, running along
aimlessly and attacking without warning animals
or persons wha may happen to be in his path.
Such rabid animals usually look dirty and_ tired,
and the beginning muscular weakness may show
itself in a wavering gait. The dog may travel for
many miles and for a couple of days before weak-
ness brings it to the ground to die. Attempts
to treat such dogs have resulted frequently in
their biting the persons attempting to relieve thei
suffering.

As an example of the distances which rabid dogs
AUG., 1912

sometimes run, introducing their disease into new
territory, the following case is of interest. A bull
terrier left his home in San Francisco at 10 a. m.
on April 21, 1912. No abnormality was noticed
by his owners. The next day he killed and tore
a dog and attacked a woman in Half Moon Bay,
twenty-five miles or more from his home. The
dog was shot and the head was sent to the State
Hygienic Laboratory, where Negri bodies were
demonstrated in the brain tissue.
CHARACTERISTICS OF THE DISEASE.

Rabies, or hydrophobia, is a specific infectious
disease to which all warm blooded animals are
susceptible. The disease can only be contracted
through the introduction of virus from a previous
case of rabies into a wound which enters or pen-
etrates the skin and thus permits the infectious
agent to come in contact with nerve filaments.
The infectious agent, differing in this respect from
other known causes of disease, spreads slowly up
the nerves to the central nervous system, where
it develops and produces characteristic symptoms
leading in almost all cases, at least in all human
cases and probably in all canine cases infected in
the usual way, to death in from two to eight (or
possibly ten) days.

The organism causing this disease has not been
isolated, but many of its characteristics are known.
It is small enough to pass through the coarser
Berkefeld filters. Many consider the characteristic
Negri bodies found in the brain tissue to be forms
of the parasite and point to the evidence of internal
structure shown by the grouping of the granules
within these bodies,

The dog is the principal factor in the spread of
rabies. Remlinger® tells us that the dog trans-
mits the disease to man in 93% of the human
cases. The virus is present in the saliva and is
introduced by the teeth in biting, although it may
be introduced into existing wounds. The virus
may be present in the saliva for two or. three days
before the onset of definite symptoms, as has been
shown by the experiments of Roux and Nocard.

The most virulent tissues of a rabid animal are
the brain and spinal cord. The peripheral nerves
and several of the glandular structures (salivary
glands, pancreas, lachrymal glands, suprarenal cap-
sules, and rarely the mammary glands) are infec-
tious, but other parts of the body do not contain
the virus. Most of the period of incubation is

‘taken up by the traveling of the virus along the
nerves to the central nervous system and, as a
result, the incubation period, when inoculation has
been made into the extremities, is longer than
when the virus has been introduced near the
brain.

METHODS OF DIAGNOSIS.

The diagnosis of rabies in man or animals can
usually be based, with a small percentage of error,
on clinical symptoms alone when the disease has
advanced to a point where marked symptoms are
shown. After death, examination of the body
does not reveal any gross changes sufficiently char-
acteristic to warrant the making of a diagnosis.
There is apt to be marked rigor mortis. In dogs
the stomach frequently contains foreign bodies such

CALIFORNIA STATE JOURNAL OF MEDICINE

323

as grass, sticks, and stones, but this may occur
in other diseases. The only conclusive post-mortem
evidence is found through microscopic examina-
tion of nervous tissues. Important, chiefly as con-
firmatory evidence, are the multiplication of the
cells of the endothelial capsule in certain of the
nervous ganglia with more or less destruction of
the ganglion cells. These lesions were described
by Van Gehuchten and Nelis. Other changes of
similar importance were described by Babés. They
are the accumulations of newly formed cells around
the ganglion cells in certain parts of the central
nervous system.

Of far greater practical importance are certain
small round or oval bodies which were discovered
and described by Negri and bear his name. They
are found chiefly and characteristically within the
ganglion cells of the brain, but frequently are seen
away from those cells. The finding of Negri
bodies alone is considered by the highest author-
ities to be sufficient evidence on which to base the
diagnosis of rabies. As a rule they are found most
easily in the hippocampus but they can be dis-
covered in other parts of the brain. The simplest
way of demonstrating them, and the method used
in most cases at the State Hygienic Laboratory, is
to make, on glass coverslips, smears of gray matter

 

 

 

 

 

Fig. 3.
and free.

within ganglion vells
Photomicrographs

Negri bodies (marked N)
Magnification 800.
by Sawyer.

from the hippocampus, and to stain with methylene
blue and fuchsin according to the method of Wil-
liams. The coverslips are then mounted in balsam
and are carefully searched, for several hours if
necessary. Figure 3 shows photomicrographs of
preparations made in diagnostic work at the State
Hygienic Laboratory.

In the first picture is a large ganglion cell from
the hippocampus from a dog’s head which was sent
to the laboratory from San Francisco. In each
324

end of the cell: is seen a large round body. - These
are Negri bodies and are an indication that rabies
is present. As already stated, many -suppose
that the Negri bodies are the actual. pathogenic
organisms, .but others consider them to be _struc-
tures pro fed by the .action, of the toxin of rabies
on tissue cells. ‘The second picture is a photograph

of a ganglion cell in a stained paraffin section

from the hippocampus of one of the human cases
which died in San Francisco. The Negri body is
shown in the protoplasm close to the cell nucleus.
The third and. fourth pictures show free Negri
bodies, one having the usual round shape . and
granules, which are indistinct in the picture, and
the other having the more unusual oval shape. :
Although Negri bodies, when’ found, are proof
of the presence of rabies, failure to :demonstrate
them does not completely rule: out the: existence
of the disease. The Negri bodies may be so few or

so small, either because the animal was killed early

in the disease or because of factors which we do
not .know, that their detection is not accomplished
in several hours’ search. In order to be able to
make an absolute diagriosis, which in many- cases
is: very important to persons who have been: bitten
or who own animals which have been bitten, it is
necessary to inoculate brain tissue from the negative
cases into laboratory animals, usually rabbits or
guinea-pigs. The material in small quantity (0.1
to 0.2 c. c. of the suspension in physiological salt
solution) can easily be injected through a small
trephined opening into the space between the skull
of the anesthetized animal and the brain. The
animal should not be noticeably affected by this
operation. If the brain tissue contains the virus of
rabies, the animal will come down with the disease
and exhibit symptoms in a varying length of time,
usually 15 to 30 days in rabbits, although in some
cases the incubation period is several months.

The laboratory examination for diagnosis is car-
ried on at several points in California, The State
Board of Health does this work at its Hygienic
Laboratory in Berkeley, when the specimens are
properly iced in some watertight container and are
sent by express prepaid. When the head arrives in
the laboratory the top of the skull is removed and
the- brain taken out. By dissection the hippo-
campus is secured and smear preparations are made
as already described. .

It is advisable, when animals are under suspicion
of having rabies, not to kill them if they can be
safely captured and confined for a period of ten
days. The symptoms usually develop rapidly and
are in most cases sufficiently characteristic to leave
no doubt, and at least to enable a decision with
regard to the advisability of Pasteur treatment for
any persons bitten. A decisive diagnosis is also
important so that dogs which were bitten by the
suspected animal can be killed in order to prevent
their developing the disease later and spreading it
further. If the animal dies, the laboratory exam-
ination is apt to be more conclusive than when
it is killed early in the disease.

TREATMENT OF RABIES.

When the symptoms of rabies have once made
their appearance, the disease cannot be checked and

CALIFORNIA ‘STATE JOURNAL OF. MEDICINE

Vol.. X, No. 8

treatment is of no avail except for the amelioration
of suffering. ‘The agony of the few days of in-
tense suffering can be lessened by careful protection
of the patient from noises and drafts and, in
the early stages of the disease, by the administra-
tion of sedatives, but when the agonizing spasms
are frequent and severe it is only humane to bring
about relaxation and unconsciousness by means of
ether or chloroform.

In the absence of.a cure for rabies, the pre-
ventive -treatment becomes very important.
Cauterization of the wound has been found
through long experience to diminish the chances
of development of the disease, and this has been
confirmed by experiment. The most practical and
efficient method of cauterization is the application
of concentrated nitric. acid to the wound with a
small stick or swab, as soon as possible after the
biting. If the wounds are very large, as in the
case of severe lacerations of the face, cauterization
may be unwise and it may be necessary to depend
on careful washing with bland sterile solutions and
the intensive Pasteur treatment. :

No method of cauterization saves a large
enough percentage of cases to warrant the neglect
of further preventive treatment. Fortunately, an
efficient method of immunization was found for us
by Pasteur. Soon after Pasteur began his studies
on rabies he discovered that the virus’ was located
chiefly in the central nervous system, and, after
failing to grow the microOrganism of rabies on
artificial culture media, he conceived the idea that
it could be grown in pure culture in the living
animal. He therefore inoculated the brains of rab-
bits with brain tissue from rabid animals and kept
his culture alive by transplanting it from rabbit to
rabbit. The virulence for rabbits increased rapidly
with these serial passages until the incubation
period in rabbits became as short as six or seven
days. Then no further change in virulence was
apparent on further transplantation and the virus
was known as fixed virus for rabbits, im contrast
to the virus found in nature and called street
virus. In several infectious diseases, for example,
anthrax and chicken cholera, Pasteur had been
able to produce immunity in animals by treating
them with cultures of the infectious agent after
the microdrganism had been rendered less virulent
by being grown on artificial media under unfavor-
able circumstances. Pasteur took the pure culture
which he had produced for rabies, i. e., the spinal
cords of rabbits which had just died of rabies,
and attempted to render it less virulent in various
ways, finally adopting as most practical a method
of drying the cords in glass bottles over sticks of
potassium hydroxide. After a cord has been
dried in this way for eight days, it is no longer
able to produce the disease, even in rabbits, which
are specially susceptible to the fixed virus. Inocu-
lation with such cords gives no symptoms but
makes the person or animal inoculated resistant to
a stronger virus, i. e., a cord which has dried a
shorter time. By gradually increasing the
strengths of the attenuated virus injected under
the skin a considerable degree of immunity can
be developed in an animal or person in from
AUG., 1912 .

eighteen to twenty-one days. This immunity con-
tinues to increase after treatment and as a rule
reaches a high level fifteen days after the end of
treatment. In order, therefore, to give the highest
protection, the Pasteur treatment must be begurr
about thirty-six days before symptoms would de-
velop; if that can be done, the treatment is prac-
tically certain. But as incubation periods shorter
than 36 days are not very rare, the importance of
losing no time between being bitten by a rabid
animal and receiving treatment is apparent, al-
though very few persons. develop rabies if they
have had time to finish the 21 days of treatment.

The duration of decided immunity after the
Pasteur treatment probably averages about two
years. Experiments on dogs have shown that 33%
of them are immune after two years. Remlinger ®
concludes that persons who have taken the Pasteur
treatment and are bitten more than one and one-
half years later should again be immunized. He
cites a case of death from rabies in a man who
was bitten by a rabid dog four years after he had
taken the Pasteur treatment.

Calmette has made a valuable addition to the
Pasteur method. He introduced the keeping of
antirabic virus in pure, sterile glycerin, thus
making it possible to use fewer rabbits than before
in manufacturing virus and to have nevertheless
a sufficient amount on hand for emergencies. In
glycerin the unground virus will remain practically
unchanged in virulence for a month.

There are a number of radical modifications of
the Pasteur method in use. Perhaps the most
important of these is the method of Hdgyes who,
instead of using virus attenuated by drying, dilutes
fixed virus and begins treatment with extremely
small doses, increasing them gradually. This
method has been found to produce results almost
identical with those of the classical Pasteur
method. Other deviations from the usual methods
differ chiefly in the way in which the cords are
attenuated.

Much hope for a cure for rabies has been
placed in the fact that the serum of animals im-
munized by the Pasteur treatment, especially when
it is followed by injections of virus of full
strength, has considerable power of destroying the
virulence of fixed virus. Unfortunately the most
potent serum yet tried has been unable to cure
rabies and its best use at present is in the serum-
virus mixture of Marie. He mixes fixed virus
with not quite enough immune serum to neutralize
it. A dose of this mixture immunizes patients
more rapidly than the usual Pasteur treatment.
Marie ® has used this mixture during the first three
days of the Pasteur treatment in the more severe
cases under his care. In this way, he has shortened
the course of treatment by five days, and has prob-
ably saved lives by hastening full immunity. Serum
alone has failed to immunize or cure, and in the
serum-virus method it acts probably chiefly by at-
tenuating the fixed virus.

The Pasteur method, according to Remlinger ®
had been applied before 1907 to 131,579 cases with
only 549 deaths occurring more than 15 days after

CALIFORNIA STATE JOURNAL OF MEDICINE

325

the end of treatment. This indicates that the true
failures were 41 hundredths of one per cent. of the
total number of treatments. When it is con-
sidered that approximately fifteen per cent. of all
untreated persons who are bitten by dogs known
to be rabid, develop the disease, it is appdrent, even
when liberal allowance is'made for the number of
persons who: take treatment without definite proof
that the biting animal was rabid and also for the
few persons dying during treatment or within fif-
teen days of the end of treatment, that many
thousands of people have already been saved.

With these figures in mind, it would be sur-
prising if any one bitten by a rabid animal failed
to report for treatment. There is no question
that all persons bitten far enough into the skin
to draw blood should take Pasteur treatment.
When the saliva of rabid animals has entered
fresh wounds, treatment should be taken. If
small, partially healed wounds of several days
standing are wet with the virus of rabies the
question of treatment is not.so easily settled, for
Babés and Vasilu?® have shown by experiment
that such wounds cannot be easily infected. When
there is serious doubt, treatment should be advised.

PASTEUR TREATMENT IN CALIFORNIA.

The accepted methods of preventing dogs from
spreading rabies, although proven by experience to
be efficient, have not been applied with sufficient
thoroughness to give the people of California the
protection they need and should demand. As a
result, it has been necessary for many persons,
who have been bitten by animals which were either
proved to be rabid or strongly suspected, to un-
dergo the Pasteur treatment. The treatment
usually involves an expense of about a hundred
dollars, when obtained privately, and, when the
patient cannot afford to pay for treatment, he is
subjected to the expense of traveling to a branch
of the State Hygienic Laboratory as well as the
loss of time and cost of board during the three -
weeks of treatment. The economic loss due to
rabies is therefore far in excess of the value of
the cattle, horses, and dogs which die from the
disease. In my previous article,? I collected the
following statistics regarding Pasteur treatment in
California from the entrance of rabies into Cali-
fornia to March 31, 1911. One hundred and
forty-one treatments were sent to California by
the government and at least 20 came from other
sources. Definite information was obtained regard-
ing the administration of 125 treatments, 105 with
government virus. One patient in the series died
of rabies because the incubation period was so short
that the treatment with government virus could
not be completed. One patient showed a slight
transient paralysis. With these exceptions the
treatments were succcessful and free from complica-
tions.

During the period for which we are reporting
in detail in this article (April 1, 1911, to March
31, 1912,) many Pasteur treatments have been
given in the state. After September 1, 1911, all
government virus sent to California for adminis-
tration by the State. Board of Health was: ad-
326

ministered by the State Hygienic Laboratory and
its branches. Therefore the statistics of the labor-
atory regarding Pasteur treatment begin with that
date. Except for emergency purchases of parts of
a few treatments, all virus used by the. State Hy-
gienic Laboratory came from the government.
The chief facts regarding Pasteur treatments at
the State Hygienic Laboratory during the year
under consideration are given below.

 

TABLE 2.
PASTEUR TREATMENTS BY THE STATE
HYGIENIC LABORATORY,

 

 

Sept. 1, 1911, to March 31, 1912,
: Diagnosis in Biting
e 4a 2 wt g Animals Based on
soe ° oe 6 z 9 2
ag° 8 g2 2 oe sy 38
a g ge 3
2 Q@ .B : 3 ad “@
‘bo e : : =o g a)
> am o : : 2 : [fs
: 3 2 :Q: a
:B : 76 : © : :
Fg ; Boo: BB gig
: « of ‘ ° oO -@
: : : : 5 : 3 24
Southern Branch, .
Los Angeles...... 5 0 5 0 0
San Joaquin Valley
Branch, Fresno.. 6 6 0 6 0 0
City Health Dep't,
San Francisco... 22 16 1 18 1 3
City Health Dep’t,
Los Angeles..... 2 1 0 2 0 0
Letterman Gen’l .
Hosp., Presidio,
"B. ORL cece e ee eee 4 4 0 3 0 1
Total ........- 3908 1 38 21. 4

 

The 39 cases came for treatment from the sev-
eral counties as follows: San Francisco, 26; Los
Angeles, 5; Tulare, 2; Fresno, 2; Orange, 1;
Kern, 1; Ventura, 1; and Merced, 1.

The infection came from the bites of dogs in
35 instances, and in two cases from the bites of
cats. The two remaining cases were inoculated
with virus from a human case. In. one instance
the nurse attending this case of rabies accidentally
injured his thumb while it was covered with the
patient’s saliva, and in the other instance the
inoculation happened through an accident in one
of the laboratories which examined the patient’s
brain after death. The one fatal case developed
symptoms before the treatment was completed.
There were no complications in any of the cases,
except an abscess at the site of inoculation in one
instance. This was not serious beyond the tem-
porary inconvenience. A certain amount of lgcal
reaction usually occurs at some time during the
treatment and most of it is probably due to an-
aphylaxis. In our experience this reaction has
been most marked between the 7th and 11th days
of treatment. There may be malaise and slight
elevation of temperature for a day or two when the
local redness and soreness is at its height.

The time between the infliction of the bite and
the beginning of treatment averaged 7.1 days. The
longest delay was 21 days and the shortest, one
day.

The following table shows all cases for which
full statistics could be obtained and which were
treated in California between April 1, 1911, and
March 31, 1912. ~The facts were kindly fur-
nished by the physicians administering the treat-
ment.

CALIFORNIA STATE JOURNAL OF MEDICINE

Vol. X, No. 8

TABLE 3.

PASTEUR TREATMENTS ADMINISTERED IN
LABORATORIES IN CALIFORNIA,

April 1, 1911, to March 31, 1912.

 

Diagnosis in Biting

 

= Pr ze wt Animals Based on
aes ee f£ 2 29 8
gg? 2 g2 @ oR Sk SB
a8 ® oF 53° aS
p 2 et g- a2 “8
Pe a  : Ey S o
om © : &o ou S
28 a :Q : oe wa °
: oo : 7 6 : 52 ee :
> Be : :Boo: : :3 006:
: . ot . ar) 8 +m
. . . 4 eo eo
State Hygienic
Laboratory of
California State
Board of Health. 39 31 1 34 1 4
Dr. S. P. Black,*
Los Angeles...... 58 56 0 43 13 2
Dr. W. W. Cross,*
Fresno .......+:. 22 22 0 22 0 0
City Health Dep’t,*
San Francisco... 4 2 0 3 0 1
Total ......... 123 111 1 102 14 7

* Treatments additional to those officially administered
a government virus for the State Hygienic Labora-
ory.

The 123 patients came from the various counties
of California as follows: Los Angeles, 40; San
Francisco, 30; Fresno, 23; Tulare, 10; Orange, 5;
Kern, 5; Ventura, 3; San Bernardino, 2; River-
side, 2; Merced, 1; Kings, 1; Santa Barbara, 1.

The infection came from the various animals as
follows: dogs, 112; horses, 4; man (not from
biting), 4; cats, 2; and ground-squirrel, 1.

The longest delay before beginning treatment
was 70 days and the next in length was 49 days.
Excluding these two extreme figures the length of
time betwen the biting and the beginning of treat-
ment ranged from 1 to 29 days and averaged
6.6 days.

Between April 1, 1911, and March 31, 1912,
the United States Hygienic Laboratory sent to Cali-
fornia virus for 99 treatments. This virus was prob-
ably all used for patients included in the statistics
just given. During the same period, three commercial
houses, to whom I am indebted for these figures,
distributed virus in California for 63 cases. Of
these at least 54 are not included in the statistics
already given. The 54 cases treated were situated
in the following counties: San Francisco, 26;
Los Angeles, 11; Fresno, 7; Tulare, 2; Orange,
2; Modesto, 2; San Joaquin, 1; Stanislaus, 1;
Imperial, 1; Kern, 1.

Adding together the 123 treatments given in
the last table and the 54 treatments sent out by
commercial houses, we find that 177 patients were
treated in the year ending March 31, 1912. Pre-
vious to that year at least 125 treatments were
administered as already stated. This gives a total
of 302 treatments in California since March 13,
1910, when, as far as I have been able to ascer-
tain, antirabic treatment was first administered in
California. Of the 302 persons treated, two de-
veloped rabies before the treatment was completed,
giving a mortality of 66 hundredths of one per
cent. No deaths occurred among those completing
treatments.
327

CALIFORNIA STATE JOURNAL OF MEDICINE

AUG., 1912

 

 

     

VY IY ij
«,, VK
Wi

 
   

   
 

NOV. 2,1909, 70 DEC..31, 1510

Fe

  
  
  
 
  

LASSEN

 

 

 

a

Us
“7
aA

7/4
Say
a eo,

NS

  
  
 
  
  
       

- JAN,I, 191,70 AUG. 31,1914.

 
  
  
  
   
  
   
    

ee
ora Be, Le, 6 YH

CHART
SHOWING THE SPREAD OF

L NM
sae BY COUNTIES
Wn aed Easorsrony.
=== ADDITIONAL COUNTIES, RABIES
=== PROVED BY OTHER LABORATORIES.
¥

sist? NEW AREA, APRIL 1, TO MAY3I,1912
SS3#ii PROVED BY STATE HYGIENIG LABORATORY.
e IUMAN DEATH

 

 

  

Se

    
   
   

 

   
 

SEPT. 1,191 1,70 MAR. 31,1912.
328

As an indication of the ‘increasing need for
Pasteur treatment it is of interest that during the
two months (April and May, 1912,) immediately
following the period for which statistics have been
collected, the State Hygienic Laboratory treated
66 cases in the several laboratories where anti-
rabic treatments are administered for the State
Board of Health.

THE PASTEUR INSTITUTE.

The large number of Pasteur treatments needed
in California by the State Board of Health for
administration to people who are financially unable
‘to secure the treatment from their physicians, and
the disadvantages of depending for virus on a
source so far away as the government laboratory in
Washington, D. C., led the State Board of Health
to pass a resolution on May 18, 1912, authorizing
the State Hygienic Laboratory to manufacture
antirabic virus. On June 3, 1912, Dr. Donald H.
Currie of the United States Public Health and
Maririe-Hospital Service inspected the Pasteur In-
stitute, which had been established as a department
of the State Hygienic Laboratory, and approved
of the equipment and methods in use. Since that
date all virus used by the laboratory has been of
its own manufacture.

The virus is produced by inoculating anes- ©

thetized rabbits intracranially with fixed virus,
chloroforming them when paralysis is almost com-
plete and removing their spinal cords by pushing
them out of the canal in accordance with the
method of Oshida.2? ‘The cords are hung: from
silk threads over sticks of potassium hydroxide in
Pasteur drying bottles and are kept in a dark
cabinet. The temperature in the cabinet is main-
tained at 20° C. by an electric regulator. As the
cords are cut day by day, the segments are imme-
diately placed in glycerin and are stored in an ice
chest until needed for administration or shipment
to one of the branches. The virus is discarded if
unused at the end of three weeks.

The treatments are administered at the State
Hygienic Laboratory in Berkeley, at its Northern
Branch in Sacramento, at its San Joaquin Valley
Branch in Fresno, at its Southern Branch in Los
Angeles, and also by deputized bacteriologists in
the City Health Departments of San Francisco,
Sacramento, and Los Angeles, and in the Letter-
man General Hospital at the Presidio of San
Francisco. In order to receive free antirabic
treatment from the State Board of Health, it is
necessary to make application to the local health
officer. He will apply by telegraph to the Secre-
tary of the State Board of Health, vouching for
the suitability of the case, financially and other-
wise, fot free antirabic treatment. Tf the Secre-
tary approves, he will give instructions as to the
branch laboratory to which the patient is to be
sent.

METHOD OF SPREAD OF RABIES.

Rabies in California is harbored and_ carried
chiefly by domestic dogs, but it is possible that
wild animals will take a greater and greater part
as the disease becomes thoroughly established. Coy-
otes are under heavy suspicion and there is strong
testimony that the disease in California has been

CALIFORNIA STATE JOURNAL OF MEDICINE

Vol. X, No. 8

conveyed in a few instances by these animals, but
laboratory proof is still lacking. The skunk, xnown
to carry the disease in Arizona, has not been
convicted in California. The only wild animals
of California so far definitely proved to carry
rabies are a ground-squirrel, which bit a girl in
San Bernardino County, and a large gray fox
which was killed in the mountains of Ventura
County about: the middle of April, 1912. This
fox entered the tent where several campers were
sleeping and ran over the bed, pulling the covers.
The animal bit a man, who tried to push him
away, and then escaped, but the next night the
animal returned and was killed. The fox’s head
was examined in Los Angeles and showed many
large characteristic Negri bodies. Dr. R. B.
Durfee was good enough to send me the story of
this case. Coyotes seem to have played a larger
part in the spread of rabies in Oregon than in
California. Dr. Calvin S. White, State Health
Officer of Oregon, informs me that between April
I, 1911, and June 10, 1912, the thirteen animals
whose brains were examined and found to con-
tain Negri bodies were classified by kinds as fol-
lows: Five coyotes, five horses, two pigs, and one
dog. .

The rapid distribution of rabies by rabid dogs
who run for long distances has already been illus-
trated. Much more rapid is the conveyance of
the disease through the transportation of dogs
during the incubation period over the railroads or
in automobiles. Two recent examples of this
method are striking and will be cited.

On May 7, 1912, a bull dog went mad in
Berkeley and bit four children and a woman and
was finally shot on the street in Oakland by a
policeman. Three of the children were bitten in
the face. Examination of the animal’s brain at
the State Hygienic Laboratory revealed Negri
bodies. The dog’s license tag made it possible
to find the owners, from whom it was learned
that the animal had been brought by train six

“weeks before, from Fresno, a heavily infected re-

gion, to Berkeley, which had previously been free
from rabies.

On April 1, 1912, 2 San Francisco dog, which
was known to have played with a dog proved rabid

at the city laboratory, was taken approximately

300 miles to Likely in Modoc County by his
owner,.who was later joined by a brother. On
May 7th, the dog began to show symptoms of
rabies, and the next day he bit both men. The
dog’s head was sent to the University of Nevada
where Negri bodies were found in the brain and
rabies was produced by inoculating some of the
brain tissue into an animal.

The stories of these two dogs show how rabies
can jump over long distances and start outbreaks
in new territory. When once established in a re-
gion containing many dogs, the disease spreads
rapidly from animal to animal.

CONTROL OF RABIES.

In order to protect dogs, cattle and people from
rabies several precautions should be taken. The
roaming dog population should be diminished as
AUG., 1912 CALIFORNIA STATE JOURNAL OF MEDICINE 329

rauch as possible and every dog at large should be
muzzled with a well fitted metal muzzle which
projects beyond the end of the dog’s nose and
absolutely prevents biting. If the disease is thor-
oughly under control within a certain area, quar-
antine against dogs from infected areas should be
considered. It has been proved possible to keep
rabies out of isolated countries, such as Great
Britain and Australia, by a six months’ quarantine
on all dogs.

Rabies is a disease very easily held in check by
simple measures directed toward the control of the
chief reservoir and distributing agent of the dis-
ease, the domestic dog. It is therefore a disgrace
for any community to permit rabies to become
prevalent within its boundaries. .

REFERENCES.

1. Black, S. P., and Powers, L. M., History of Rabies
in Southern California, Cal. State Jour. of Medi-
cine, Nov., 1910, Vol. VI, pp. 869-372.

2. Sawyer, W. "A. Rabies in California, Cal. State Jour.

. of Medicine, July, 1911, Vol. EX, pp. 294-298.

3. Radebaugh; J. M., quoted by Black and Powers,
an Jour. of Medicine, Nov., 1910, Vol. VIII,
Pp 7

4, Colburn, J. R., quoted by Black and Powers, Cal.
State Jour. of Medicine, Nov., 1910, Vol. VIII,

p._ 371.
5. Black, S. P., Southern oe Practitioner, Feb.,
; 1911, Vol. XXVI, P
Francis, W. V. 7 > sivdrophobla—Report, of of Case,
Southern catitorgia Practitioner, Jan., 1912.

7. Stimson, A. M., Facts and Fronioue of Rabies,
Bull. No. 65, Hyg. Lab. U. Pub. Health and
Mar. Hosp. ‘Serv., Wash., p. 1.

8.. Remlinger, P., Antirabic Vaccination, in ‘Bactério-
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