1 IVERSITY BULLETIN New Series, Vol. XIV, No. 25. June, 1913 UNIVERSITY OF MICHIGAN PASTEUR INSTITUTE Suggestions as to the Proper Procedure in Cases of Suspected Rabies — the Safe-Guarding of Persons Bit- ten by Dogs — the Care of Suspected Mad Dogs Attn Arfcuur PUBLISHED BY THE UNIVERSITY 1913 SUGGESTIONS AS TO THE PROPER PROCED- URE IN CASES OF SUSPECTED RABIES— THE SAFE-GUARDING OF PERSONS BITTEN BY DOGS— THE CARE OF SUSPECTED MAD DOGS By James Gordon Cumming, M. D., In charge of the Pasteur Institute of the University of Michigan The first fact which should be borne in mind when dealing with a case in which a dog has bitten a human be- ing or other animal, is this: Rabies can be caused only by the bite of, or the entrance into a wound of the saliva from, an animal actually mad. A dog which is merely vicious may wound severely, but its bite cannot cause the disease. Therefore, the important question when a person is bitten, is to determine whether or not the dog was mad at the time the injury was inflicted. In order to decide this the dog should, if possible, be chained or otherwise confined and observed for at least ten days. As long as the dog remains healthy, the individual bitten is in no danger. If the animal shows no symptoms during the entire ten-day period one can conclude that the per- son bitten was not exposed to the disease. A rabid ani- mal can transmit the disease only during the stage of illness and during two days preceding the first symptom. The duration of the disease is not more than ten days, usually from three to five days. A rabid dog inevitably dies within ten days after the appearance of the first symptom. If the animal suspected of having rabies is proved, by the fact that it continues to live , to be free from the disease, there is no reason for apprehension on the part of those exposed. While it may be desirable to kill a dog on account of its vicious disposition, this should not be done in any case within ten days of the time that it has actually bitten anyone. In many cases, when a per- son is bitten, the dog is immediately killed. This is jus- tifiable only in case the disease in the dog was well de- veloped and there was danger in attempting to appre- hend the animal. Under such conditions the procedure to be followed is as in “Points 2 and 3” below. When a person is bitten by a stray dog, which dis- appears and cannot be observed, or its status otherwise learned, it is advisable to take the Pasteur treatment without delay. There are two forms of rabies, the so-called mania- cal, or furious rabies, and the dumb rabies. In either form the chain of symptoms is fairly well defined. In maniacal rabies, the animal is excited, changing its position frequently and attacking whatever comes in its way, especially dogs. This excitement may be marked or mild; usually it is marked. Following this is the stage of partial paralysis, which makes its appearance usually by the second or third day. There may be partial paraly- sis of the hind legs, which is shown by the tendency to sway from one side to the other when walking, and by a humped back. Drooping of the lower jaw, due to paralysis, is a definite symptom of rabies. Owing to this paralysis and that of the throat muscles, the dog is unable to eat or drink even though it may make repeated attempts to< do so. The paralysis may be confined to one side of the body. When in this condition the head is turned side- wise and when the animal is lying down the fore legs are often crossed. If while in this unilateral paralytic condition, the dog should move about it almost invariably turns to the same side. There is finally complete paraly- sis during which the animal may have spasms. This stage may last two days, ending in death. In the second or dumb form of rabies there is no general excitement; the paralytic symptoms, however, are marked. In this form of rabies the dog takes no notice of its surroundings. He wanders aimlessly and as a rule, does not attempt to bite. Paralysis of the lower jaw is the most common symptom of dumb rabies. In this condition the dog may present the appearance of an animal having a bone in its throat. An attempt to examine the dog’s throat should not be made, for in so doing saliva may be introduced into wounds on the hands. Infection through an open wound is not to be considered less dangerous than the actual bite of a rabid animal. Following this symptom any one of the other forms of 3 0112 105759192 partial paralysis — general, posterior, or unilateral — be- comes apparent. There is finally complete paralysis and inevitable death, usually within five days. IN BRIEF The following points should be borne in mind : Point i. If possible to avoid doing so, do not kill a supposedly rabid dog ; keep him securely chained or con- fined for ten days. A negative diagnosis may be made from the living animal, if during the ten-day confinement it remains healthy. As long as it remains healthy it should not be killed and there is no need to send it for laboratory diagnosis. Point 2. If an animal suspected of rabies, dies, its head should be sent immediately, or better, brought by messenger, to the Pasteur Institute for laboratory diag- nosis. Address all such parcels : '‘Pasteur Institute, Med- ical Building, University of Michigan, Ann Arbor, Mich- igan. Rush. Prepaid.” Point 3. If the report of the Institute states that the dog had rabies, anyone infected by the saliva, either through a bite or other wound, should report immediately at the Pasteur Institute for treatment. The cost of this treatment is $25.00 to residents of Michigan. No provis- ion is made by the Pasteur Institute for board or room, but these may be obtained in Ann Arbor at a nominal cost. Point 4. In localities where the disease is known to exist, all dogs should be muzzled with either wire or properly fitting idrap muzzles. The ordinary strap muz- zle is in most cases useless in serving the purpose for which it is intended To prevent the animal’s biting the muzzle should be properly fitted. Point 5. All dogs known to have been bitten by a rabid dog should be killed. Point 6. As an essential preliminary measure all wounds through which the saliva of the animal may have entered, whether bites or scratches, should be cauterized immediately with commercial formalin. This precaution- ary measure, indeed, should not be neglected after a delay of one or even two days. Entered as 2d-class matter at the postoffice at Ann Arbor, Mich. THE ANN \RBDR PRESS