When the patient comes for treatment the fourteenth and thirteenth-day cords are used for the first inoculation, and on each successive day the patient receives inoculation, the strength of which has been regulated by the number of days the cord has been hanging. During the first four days patients receive injections of six cubic centimeters of emulsions made from cords aging from fourteen to seven days, and from the fifth day until the completion of the course of treatment patients receive emulsions from cords of higher immunizing properties, but no cords desiccated for less than four days are used.
[INFECTIOUS DISEASES 247]
Death rate from 1878-1883 before Pasteur treatment was instituted taken from documents in the department of the Seine:
1878 143 bitten. 24 deaths. 1879 76 " 12 " 1880 68 " 5 " 1881 156 " 22 " 1882 67 " 11 " 1883 45 " 6 "
Average of one death to every six bitten, or seventeen per cent mortality.
Incubation period from eleven days to thirteen months, average one hundred and twenty days, depending upon location of bite. Pasteur Institute records during the years 1886-1887 and first half of 1888, show that Pasteur had under his supervision 5,374 persons bitten by animals either proven or thought to have been mad. Mortality for 1886 was 1-34 per cent, during 1887 it was 1-12 per cent, during 1888 it was 77/100 per cent. With the later treatment the mortality has decreased to 3-10 per cent in 1908. The Pasteur method of treatment is a process of immunization which must be completed before the development of the disease. It is of no value after the symptoms have appeared.
Those who have not been affected can be immunized the same as those who have been bitten. The individual who has been bitten by a mad dog realizes when and how severely he has been bitten, and were it not for the so-called period of latent development of the virus, it would not be possible to carry out the Pasteur treatment. The patient may, if he will, take advantage of this fact and be immunized by treatment before the disease has developed. Deep and severe bites are most dangerous, but the disease may develop simply from a rabid dog licking a scratch of the skin. As before stated bites on exposed or uncovered surfaces, are more dangerous than those through clothing. There is a very easy access of the saliva to the wound in the unprotected part, while in the protected parts the teeth in passing through the protection, clothing, are freed of their saliva at least partially. The virus is conveyed from the bitten part or inoculation to the central nervous system through the nerve trunk, and the rapidity of extension depends upon the resistant powers of the patient, the virulence and the amount of virus deposited in the bitten part at the time the person was bitten. This disease develops only in nerve tissues. Virus can be found in the nerves of the side bitten, while the corresponding nerves on the opposite side are free from it. It can be ascertained that the virus is present in the medulla oblongata before the lower portion of the cord.
[248 MOTHERS' REMEDIES]
Comparative danger.—A wound of the hand after a delay of three weeks is as dangerous as a bite on the head exposed only a few days. There is always a possibility of an accumulative action and extension of the virus along the nerve trunk to the central nervous system during the interval of exposure, and this should be always borne in mind. It is stated by authority that the virus is not transmitted by the bite of a rabid animal until two days previous to the appearance of the first symptoms. It is with some difficulty that a decision is reached in advising patients who are bitten to take treatment early in the course of the disease. The symptoms are often so very obscure and slight that they are not recognized. If a dog which is not naturally vicious suddenly bites without any cause it should be tied securely and watched for seven days; and should it develop symptoms of the disease during this period the bite should be considered dangerous.
Immediate treatment of the wound.—A temporary measure is the cauterization of the wound; do not neglect this because a few hours have passed since the person was bitten, for wounds may be cauterized with advantage even after two or three days have elapsed. Of course the earlier it is done the better. If they are thoroughly laid open and scrubbed it is more effective. Nitric acid used freely is the best method to use. Wash the wound freely with boiled water after the acid has been applied; ninety-five per cent carbolic acid may be used if nitric acid cannot be obtained.