514 APPENDIX B. 



The success of the treatment has been very marked. The statistics of the cases, 

 treated in Paris are published quarterly in the Annales de rinstitut Pasteur, and 

 general summaries of the results of each year are also prepared. As we have said, 

 the ordinary mortality formerly was 16 per cent of all persons bitten. During the 

 ten years 1886-95, Z 7337 cases were treated, with a mortality of .48 per cent. It 

 has been alleged that many people are treated who have been bitten by dogs that 

 were not mad. This, however, is not more true of the cases treated by Pasteur's 

 method than it was of those on which the ordinary mortality of 16 per cent was 

 based, and care is taken in making up the statistics to divide the cases into three 

 classes. Class A includes only persons bitten by dogs proved to have had rabies, by 

 inoculation in healthy animals of parts of the central nervous system of the diseased 

 animal. Class B includes those bitten by dogs that a competent veterinary surgeon 

 has pronounced to be mad. Class C includes all other cases. During 1895, I22 cases 

 belonging to Class A were treated, with no deaths ; 949 belonging to Class B, with 

 two deaths ; and 449 belonging to Class C, with no deaths. Besides the Institute in 

 Paris, similar institutions exist in other parts of France, in Italy, and especially in 

 Russia, as well as in other parts of the world ; and in these similar success has been 

 experienced. It may be now taken as established, that a very grave responsibility rests 

 on those concerned, if a person bitten by a mad animal is not subjected to the Pasteur 

 treatment. 



Antirabic Serum. In the early part of the nineteenth century an 

 Italian physician, Valli, showed that immunity against rabies could be 

 conferred by administering through the stomach progressively increasing 

 doses of hydrophobic virus. Following up this observation, Tizzoni and 

 Centanni have attenuated rabic virus by submitting it to peptic digestion, 

 and have immunised animals by injecting gradually increasing strengths 

 of such virus. This method is usually referred to as the Italian method 

 of immunisation. The latter workers showed from this that the serum 

 of animals thus immunised could give rise to passive immunity in other 

 animals ; and further, that if injected into animals from seven to fourteen 

 days after infection with the virus, it prevented the latter from producing 

 its fatal effects, even when symptoms had begun to manifest themselves. 

 They further succeeded in producing in the sheep and the dog an 

 immunity equal to from 1-25,000 to 1-50,000 (vide p. 472), and they 

 recommended the use, in severe cases, of the serum of such animals in 

 addition to the treatment of the patient by the Pasteur method. We do 

 not, of course, know whether the serum contains antitoxic or antimi- 

 crobic bodies. 



Methods, (a) Diagnosis. When a person is bitten by an animal 

 suspected to be rabid, the latter must under no circumstances be killed. 

 Much more can be learned by watching it while alive than by post- 

 mortem examination. In the latter case only such things as the occur- 

 rence of broken teeth, marked congestion of the fauces ; or the presence 

 of unwonted material in the stomach throw any light on the condition. 

 By examination of the spinal ganglia (vide supra}, an early and pro- 



