234 



NA TURE 



\yuly 7, 1887 



Between the end of last December and the end of March, 

 M. Pasteur inoculated 509 persons bitten by animals proved to 

 have been rabid, either by inoculation with their spinal cords, 

 or by the deaths of some of those bitten by them, or as certified 

 by veterinary surgeons. Only 2 have died, and one of these was 

 bitten by a wolf a month before inoculation, and died after only 

 three days' treatment. . If we omit half of the cases as being too 

 recent, the other 250 have had a mortality of less than I per 

 cent., instead of 20 or 30 per cent. 



It has been objected that the number treated by M. Pasteur, 

 which, from October 1885 to the end of 1886, included 1929 

 French and Algerians, was much greater than could reasonably 

 be supposed to have been bitten by rabid animals. But there 

 had hitherto been no careful registration of such cases, and the 

 numbers that have occurred in the present year are not less than 

 in the same part of last year, when the alarm about hydrophobia 

 was greatest. 



From the evidence of all these facts, we think it certain that 

 the inoculations practised by M. Pasteur on persons bitten by 

 rabid animals have prevented the occurrence of hydrophobia in 

 a large proportion of those who, if they had not been so inocu- 

 lated, would have died of that disease. And we believe that 

 the value of his discovery will be found much greater than 

 can be estimated by its present utility, for it shows that it may 

 become possible to avert by inoculation, even after infection, 

 other diseases besides hydrophobia. Some have, indeed, thought 

 it possible to avert small-pox by vaccinating those very recently 

 exposed to its infection ; but the evidence of this is, at the best, 

 inconclusive ; and M. Pasteur's may justly be deemed the first 

 proved method of overtaking and suppressing by inoculation a 

 process of specific infection. His researches have also added 

 very largely to the knowledge of the pathology of hydrophobia, 

 and have supplied what is of the highest practical value, namely, 

 a sure means of determining whether an animal, which has died 

 under suspicion of rabies, was really affected with that disease 

 or not. 



The question has been raised whether M. Pasteur's treatment 

 can be submitted to without danger to health or life ; and, in 

 answering it, it is necessary to refer to two different methods of 

 inoculation which he has practised, and which are fully described 

 in the Appendix. 



In the first, w hich may be called the ordinary method, and 

 which has been employed in the very large majority of cases, 

 the preventive material obtained from the spinal cords of rabbits 

 that have died of rabies derived, originally, from rabid dogs is 

 injected under the skin, once a day for ten days, in gradually 

 increasing strengths. 



In the second or intensive method {methode intensive) which 

 M. Pasteur adoptel for the treatment of cases deemed especially 

 urgent, on account either of the number and position of the bites 

 or of the long time since their infliction, the injections, gradually 

 increasing in strength, were usually made three times on each 

 of the first three days, then once daily for a week, and then in 

 different degrees of frequency for some days more. The highest 

 strength of the injections used in this method was greater than 

 the highest used in the ordinary method, and was such as, if 

 used at first and without the previous injections of less strength, 

 would certainly produce rabies. 



By the first or ordinary method, there is no evidence or pro- 

 bability that anyone has been in danger of dying, or has in any 

 degree suffered in health even for any short time. But after 

 the intensive method deaths have occurred under conditions 

 which have suggested that they were due to the inoculations 

 rather than to the infection from the rabid animal. 



There is ample renson to believe that in many of the most 

 urgent cases the intensive method was more efficacious than the 

 ordinary method would have been. Thus, M. Pasteur mentions 

 that, of 19 Russians bitten by rabid wolves, 3 treated by the 

 ordinary method died, and the remaining 16, treated by the 

 intensive method, survived ; and he contrasts the c:.ses of 6 

 children, severely bitten on the face, who died after the ordinary 

 treatment, with those of 10 similarly bitten children who were 

 treated by the intensive method, and of whom none died ; and 

 M. Vulpian reports that, of 186 persons badly bitten by ani- 

 mals that were most probably rabid, 50 treated by the intensive 

 method survived, and of the remaining 136 treated by the 

 ordinary method 9 died. 



The rate of mortality after the intensive method was not 

 greater than that after the ordinary method ; for among 624 

 patients thus treated only 6 died, or, counting one doubtful case, 



7. But that which excited suspicion was the manner of deatl 

 in some of them ; and this manner was observed in a mai 

 named Goffi, sent from England. On September 4 last, he wa 

 severely bitten at the Brown Institution by a rabid cat, to which 

 in spite of repeated warnings, he exposed his naked hand 

 Twelve wounds were inflicted. They were at once treated witl 

 pure carbolic acid, and, six hours later, he was put under thi 

 influence of chloroform at St. Thomas's Hospital, the wounde( 

 portions of skin were freely excised, and the wounds thus madi 

 were treated with carbolic acid. On the same evening he wa 

 sent to Paris, and on the following morning M. Pasteur com 

 menced the intensive treatment, and it was continued durini 

 twenty- four days. During all this time the man was repeatedl; 

 intoxicated. 1 He once fell into the Seine ; and while crossing 

 the Channel on his return home he was severely chilled. 



On October 10 he returned to his work, and appeared to bi 

 in his usual health ; but he became unwell, with pain in thi 

 abdomen, like colic, and with pain in the back. On the iStl 

 he had partial motor paralysis in the lower limbs, and on tht 

 19th complete motor paralysis of these limbs and of the trunk 

 and partial motor paralysis of the upper limbs and face. H( 

 was taken to St. Thomas's Hospital, where he died on thi 

 20th. 



To the last he was free from all the usual symptoms of hydro 

 phobia, and the progress of his disease and the manner of hi 

 death were so similar to those of what is de-cribed as acuti 

 ascending paralysis, or Landry's paralysis, that a verdict to thi 

 effect was given at a coroner's inquest. But the certainty tha 

 his death was due to the virus of rabies was proved by experi 

 ments by Mr, Horsley. A portion of his spinal cord was takei 

 to provide material for inoculations, and rabbits and a do| 

 inoculated with it died with characteristic signs of paralytii 

 rabies, such as usually occurs in rabbits. 



In most of the other cases of death after treatment by th' 

 intensive method, the symptoms have been nearly the same a 

 those just related ; but in none of them has the same test o 

 death from hydrophobia been applied. The likeness of th( 

 symptoms to those of the form of rabies called dumb or para 

 lytic, usually observed in rabbits, has suggested, as we hav( 

 said, that the deaths were due not to the virus of the rabid dot 

 or cat, but to that injected from the spinal cord of the rabbit 

 But this is far from certain. In the case of Gofii, especially 

 the incubation period was such as would have followed the biti 

 of the cat, not the inoculation of highest intensity ; and th( 

 incubation period in the rabbits and dog inoculated from hi: 

 spinal cord were such as have been observed after similar in 

 oculations with virus derived, not only from rabbits inoculatec 

 in series by M. Pasteur, but from a dog, a cat, and a vvolf tha 

 died of ordinary rabies. It may well have been, therefore, tha 

 the intensive inoculations in him and in the other persons whc 

 died after them were not themselves destructive, but that thei 

 failed to prevent the rabies which was due to the bites. The; 

 may also have modified the form in which the rabies manifeslec 

 itself; giving it the characters of the paralytic rabies usual ii 

 rabbits, instead of the convulsive or violent form usually, bu! 

 not always,- observed in man after bites of cats or dogs. 



The question is likely to remain undecided ; for to avoid th< 

 possible, however improbable, risk of his intensive treatment 

 M. Pasteur has greatly modified it, and even in this modifiec 

 form employs it in none but the most urgent cases. 



The consideration of the whole subject has naturally raisec 

 the question whether rabies and hydrophobia can be preventec 

 in this country. 



If the protection by inoculation should prove permanent, th( 

 disease might be suppressed by thus inoculating all dogs ; but ii 

 is not probable that such inoculation would be voluntarilj 

 adopted by all owners of dogs, or could be enforced on them. 



Police regulations would suffice if they could be rigidly en 

 forced. But to make them effective it would be necessary : (i 

 that they should order the detraction, under certain conditions, 

 of all dogs having no owners and wandering in either town 01 

 country ; (2) that the keeping of useless dogs should be dis 

 couraged by taxation or other means ; (3) that the bringing o 



^ Other cases, as well as this, have led M. Pasteur to believe that the risl 

 of death fr )m liydrophobia is much increased by habits of drunkenness. 



^ Cases of paralytic hydrophobia have been observed, though rarely, ii 

 men bitten by rabid animals, and not treated by inoculation. It may 

 indeed, be suspected that at least some of the cases of " acute ascendini 

 paralysis " may have been cases of this form of hydrophobia, although, ii 

 the complete absence of the usual violent symptoms, no suspicion of th 

 source of the disease was entertained. 



