138 



SCIENTIFIC NEV/S. 



[Aug. 1st, li 



to prove the inutility of M. Pasteur's treatment is, as nearly 

 as we can ascertain, 40 out of the 2,682 ; and in this num- 

 ber are included the seven deaths from bites by v\'olves, 

 and probably not less than four in which it is doubtful 

 whether the deaths were due to hydrophobia or to some 

 other disease. Making fair allowance for uncertainties and 

 for questions which cannot now be settled, we believe it 

 sure that, excluding the deaths after bites by rabid wolves, 

 the proportion of deaths in the 2,634 persons bitten by 

 other animals was between i and i'2 per cent., a 

 far lower than the lowest estimated among proportion 

 those not submitted to M. Pasteur's treatment, and showing 

 even on this lowest estimate, the saving of not less than 100 

 lives. 



The evidence of the utility of M. Pasteur's method, indi- 

 cated by these numbers, is confirmed by the results 

 obtained in certain groups of his cases. 



Of 233 persons bitten by animals in which rabies was 

 proved, either by inoculation from their spinal cords, or by 

 the occurrence of rabies in other animals or in persons bitten 

 by them, only 4 died. Without inoculation it would have 

 been expected that at least 40 would have died. 



Among 186 bitten on the head or face by animals in 

 which rabies was proved by experimental inoculations, or 

 was observed by veterinary surgeons, only 9 died, instead 

 of at least 40. 



And of 48 bitten by rabid wolves only 9 died ; while, 

 without the preventive treatment, the mortality, according 

 to the most probable estimates yet made, would have been 

 nearly 30. 



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 inocu- 

 lation, 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. 



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 inoculated, 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, in- 

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

 first proved method of overtaking and suppressing by in- 

 oculation a process of specific infection. His researches 

 have also added very largely to the knowledge of the patho- 

 logy of hydrophobia, and have supplied what is of the 

 highest practical value, namely, a sure means of determin- 

 ing 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 treat- 

 ment 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, which 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 (tnethode intensive) 

 which M. Pasteur adopted 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 inflic- 

 tion, 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 

 probability that any one 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 reason 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 con- 

 trasts the cases 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 animals that were most 

 probably rabid, 50 treated by the intensive method sur- 

 vived, and of the remaining 136 treated by the ordinary 

 method 9 died. 



The consideration of the whole subject has naturally raised 

 the question whether rabies and hydrophobia can be pre- 

 vented in this country. 



If the protection by inoculation should prove permanent, 

 the disease might be suppressed by thus inoculating all 

 dogs ; but it is not probable that such inoculation would be 

 voluntarily adopted by all owners of dogs, or could be en- 

 forced on them. 



Police regulations would suffice if they could be rigidly 

 enforced. But to make them effective it would be neces- 

 sary (i) that they should order the destruction, under cer- 

 tain conditions, of all dogs having no owners and wandering 

 in either town or country; (2) that the keeping of useless 

 dogs should be discouraged by taxation or other means; (3) 

 that the bringing of dogs from countries in which rabies is 

 prevalent should be forbidden or subject to quarantine ; (4) 

 that in districts or countries in which rabies is prevalent, 

 the use of muzzles should be compulsory, and dogs out of 

 doors, if not muzzled or led, should be taken by the police 

 as " suspected." An exception might be made for sheep- 

 dogs and others while actually engaged in the purposes for 

 which they are kept. 



Theie are examples sufficient to prove that, by these or 

 similar regulations, rabies, and consequently hydrophobia, 

 would be in this country " stamped out," or reduced to an 

 amount very far less than has hitherto been known. 



If it be not thus reduced it may be deemed certain that a 

 large number of persons will every year require treatment 

 by the method of M. Pasteur. The average annual number 

 of deaths from hydrophobia, during the ten years ending 

 1885, was, in all England, 43; in London alone, 8-5. If, 

 as in the estimates used for judging the utility of that method 

 of treatment, these numbers are taken as representing only 

 5 per cent, of the persons bitten, the preventive treatment 



