The treatment is free to all residents of Minnesota. The treatment lasts twenty-one days and is given daily at 10:30 a. m., Sundays and holidays included. A fee of $100 is charged non-residents. This fee is paid into the state treasury. The treatment used is essentially the same as when first given to the world by Pasteur, more than twenty years ago. Minor modifications which have been adopted by many other institutes, both in this country and abroad, are used. The treatment consists of daily subcutaneous injections of portions of the dried spinal cord of a rabbit dead of fixed rabies virus. By "fixed" virus is meant a rabies virus that produces in the rabbit symptoms of rabies at the end of a definite or fixed number of days following its subdural or intracerebral inoculation into the rabbit. "Street" virus means the virus in nature, i. e., as it is commonly found in dogs, in the street. Street virus when inoculated into rabbits produces symptoms in from twelve to twentyone days or a longer period of time. Fixed virus is prepared by passing the virus from a rabid dog (street virus) or other rabid animal through a long series of rabbits. After the first few passages the period of invasion gradually becomes shorter and shorter till the fixed period of six days is reached. The cord is removed from the rabbit under the strictest aseptic precautions, a portion of the medulla being reserved to inoculate other rabbits. The cord is at once suspended over potassium hydrate and placed for drying in a dark room which is kept at a temperature of about 68 degrees F. A fresh cord is hung each day and the cords are kept in series up to twelve days. This necessitates having one rabbit die each day from fixed virus infection. In order to be sure of having one rabbit die each day two rabbits are intracerebrally inoculated each day from the medulla of a rabbit dead from a previous intracerebral inoculation of fixed virus. The first injection given a new patient is from a cord that has been dried twelve days. Step by step the number of days of drying is diminished until a cord that has been drying but three days is given. From this time until the end of treatment the stronger cords, i. e., cords that have been drying but five, four and three days, are repeated in sequence. The cord is prepared daily for injection by rubbing it into sterile physiological salt solution, and this suspension is injected into the patient very soon after its preparation. The injections are made into the anterior abdominal wall a little below the waist line. The course of treatment lasts twenty-one days, most patients receiving but one injection daily. Patients appearing for treatment later than two weeks following the infliction of the bite, and patients bitten upon the head are treated more than once daily for the first few days, the total course of treatment covering the same time, however. Indications for Treatment-All persons bitten or scratched either by the teeth or claws of a rabid dog or other rabid animal should receive the Pasteur preventive treatment for rabies. All persons having wounds upon the hands, face, or elsewhere upon the body that have come in contact with a rabid animal in such a manner that the saliva of the animal has gained entrance into these wounds, should likewise receive the preventive treatment. All persons, bitten by or otherwise exposed to infection from an animal within a period of two weeks preceding the development of symptoms of rabies in the animal should receive treatment. Four to six days is usually reported as the limit of time preceding the onset of symptoms of rabies, in which rabies virus has been shown experimentally in the saliva of a dog. The above time limit of two weeks has been fixed upon by this department as a proper one to guard against all possibility of danger. Persons bitten, etc., earlier than two weeks before the exhibition of symptoms of rabies in the animal are in no danger of the development of rabies. In other words if the offending dog is living and well at the end of two weeks from the date of the biting, it is certain that the animal did not have rabies at the time of the biting and could not have had rabies virus in his saliva at that time. All persons exposed to possible infection from a known rabid animal, and all persons exposed to possible infection in a suspected rabid animal or in an animal in which it is impossible to exclude rabies at once as outlined under "Diagnosis in the Living Dog" should be sent for treatment. All such persons should be sent to the Institute without waiting for a report upon the examination of the head of the animal. MINNESOTA STATE BOARD OF HEALTH University Campus, Minneapolis RABIES DATA BLANK (To be carefully filled out and forwarded, immediately) 1. Name, residence and post office address of owner of dog (or other animal). 2. An account of illness of dog, noting any strange actions on the part of the dog, his wan derings, etc.. 5. Names, residences and post office addresses of bitten persons together with dates of biting.. 6. Names, residences and post office addresses of owners of dogs or other domestic animals bitten by the suspected dog together with dates of biting. 7. If there is a history that the suspected animal was bitten by a known or supposed rabid dog, give details as to first dog (name, residence, etc., of owner) stating when and under what circumstances such biting took place.. (More data blanks may be obtained upon request.) BRANCH LABORATORIES. At present, there are two branches of the Laboratory Division of the State Board of Health, one at Duluth and the other at Mankato. Duluth Branch-This branch was established in 1905 and has been in continuous operation ever since. It is supported by co-operation between the State Board of Health, the city of Duluth and St. Louis county. The laboratory is in charge of a trained observer on the staff of the Laboratory Division, who devotes half of his time to the laboratory work. During the period, the Duluth branch has assumed the work of daily examination of the water supply of the city of Duluth, samples being taken at the intake and from one point on the distribution system. The routine work in the Duluth branch consists in the examinations for diphtheria, typhoid and tuberculosis, along the same lines that obtain in the main laboratories. The results of the work done in this biennial period are tabulated in table No. 13, in which a comparison is also made with the amount of work done in the previous biennial period. A large amount of increase is found in several of the The increase branches, namely, diphtheria, milk and water examinations. in the diphtheria examinations is due to the fact that during the period the branch laboratory was availed of to take care in part of an epidemic which occurred nearer Duluth than Minneapolis. By using the branch laboratory, it was possible to transmit results to the locality very much quicker than if all the cultures had been sent to Minneapolis. This is one of the ways in which branch laboratories render very valuable assistance to the locality. The increase in the number of water examinations is due to the fact already noted that daily examinations are made of the water supply of the city of Duluth. As a general rule, examinations concerning water supplies are restricted to those done in the main laboratories. In Duluth, however, the original investigation was undertaken by representatives of the main laboratories and the work continued in the Duluth branch. The increase in the number of milk examinations is due to the fact that the city of Duluth has asked for routine examinations of all milk supplied in Duluth. Frequent inspections of dairies are also made. The work for the Duluth branch is, as might be expected, for the most part done either for the city of Duluth or for St. Louis county. However, Carlton Lake, Aitkin and Itasca counties all derived a certain amount of benefit from their proximity to this laboratory. Mankato Branch-This branch was installed February 1, 1912, and has been in continuous operation ever since. It is maintained by co-operation between the State Board of Health and certain of the local physicians. The bacteriologist in charge devotes part of his time to public health work, serves as health officer for the city of Mankato and does a certain amount of clinical laboratory work for local physicians. The work is to a very considerable extent restricted to Mankato and the territory immediately adjacent to it. The public health work done in the Mankato branch is tabulated in table No. 14. It should be noted that for the year 1912 eleven months only are available, as the laboratory was not in operation until February 1. |