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(A.) Furious rabies.

1. A change in the dog's disposition - either more affectionate or
more sullen than normal.

2. Restlessness, passing into a tendency to wander from home.
3. Tendency to bite or snap anything which moves, often developing
into a maniacal fury.

4. Refuses food and usually drink; but may eat indigestible objects
like stones, leather, his own feces, or lick up his own urine.

5. Change of voice so that it becomes hoarse-half-bark, half-howl, like a "tired hound's when treeing game."

6.

Paralysis, usually beginning in hind legs, gradually becoming total, and ending in dyspnoea and death.

7. He does not froth at the mouth, seldom has marked fits and does not throw an obliging fit for diagnosis when he sees water or when it is thrown on him.

(B.) Dumb rabies.

Symptoms 1, 2, 4, 5, 6, 7, are common to both types, but dogs with dumb rabies seldom attempt to bite, or become violent. The lower jaw is paralyzed and drops (hence the name drop jaw). The animal acts as though it had a foreign body in its throat, and persons are sometimes inoculated in attempting to remove the imaginary bone. In the early stage of both types the dog often persistently attempts to lick its owner's face and hands and as the saliva may be infectious five to nine days before morbid symptoms develop, people occasionally contract the disease in this way.

Laboratory Diagnosis. The laboratory examination is made with the brain. Material is taken from Ammon's horn, the cerebral cortex and the cerebellum for examination. This material is spread in thin films on glass slides. These films are fixed and stained and a search is made for definite bodies known as Negri bodies. In this laboratory the method of Williams is used for staining. If Negri bodies are found a positive report is made at once. However, if these bodies are not found a report to this effect is made and some of the material is inoculated into a guinea pig or rabbit. These animals are then kept under observation for a period of six months, unless they develop rabies in the meantime. If the material injected into these animals contained rabies virus they usually develop the disease in about three or four weeks.

Negri bodies (named after the discoverer, Negri) are definite structures which are found only in rabies. Their exact nature is not absolutely known, but most observers adhere to the belief of Williams and Negri whose studies in this line led to the conclusion that the bodies are probably protozoa and the cause of rabies. These bodies are found principally in the brain. They increase in number and size as rabies develops in an animal. In the early stages of the disease they may be too small or too few in number to be found under the microscope. For this reason the failure to find Negri bodies in suspected brains is not conclusive evidence that the suspected animal did not have rabies. These negative findings should be correlated with all available clinical history. in diagnosing a case, and deciding whether any persons exposed should receive anti-rabic treatment.

The presence of Negri bodies is conclusive evidence that a suspected animal was rabid.

The laboratory diagnosis, in positive cases, requires but a short time. and a report on this is forwarded by telegraph or telephone very soon after the specimen is received. Negative cases require more time, but a report is made as promptly as possible.

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DIRECTIONS FOR SHIPPING SPECIMENS

Inasmuch as the brain is used for laboratory diagnosis, it is very important that this material be received at the laboratory in good condition. The head of a suspected animal should be removed after death and packed in a small bucket which in turn should be placed in a larger bucket which can be filled with ice. Specimens packed in this manner will keep in good condition, even during several days in transit. Specimens should not be expressed so that they will reach the laboratory on Saturday, Sunday or a holiday, but instead should be kept on ice and shipped later. Where there is any doubt that the package will not get prompt delivery it should be brought to the laboratory by a messenger. Transportation difficulties at present make this procedure advisable in serious cases. Information concerning the specimen, date of shipment, etc., should be sent to the laboratory at the earliest possible date by special delivery letter, telephone or telgraph.

CARE OF PERSONS BITTEN

Local. When a person has been bitten by a rabid animal or otherwise exposed to rabies virus, he should at once consult a physician. The wounds should be thoroughly cauterized, preferably with fuming nitric acid or formalin. Carbolic acid is practically valueless and tincture of iodine is of comparatively little value.

Pasteur (antirabic) Treatment. The Pasteur treatment consists of the injection of modified rabies virus in order to establish immunity in the patient before the virus injected by the rabid animal can reach the vital nerve centers. This treatment is preventive and not in any sense curative. There is no known cure for rabies, once the disease has developed. There are a few deaths in Ohio from rabies each year. The question, "Who should receive the antirabic treatment?" is difficult to answer at times but it has been well summarized by the Minnesota State Health Department as follows:

1. 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

2. 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.

3. 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 biting, it is certain that the animal did not have rabies at the time of biting and could not have had rabies virus in his saliva.

5. 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 should receive treatment.

Antirabic treatment is not supplied or administered by the Ohio State Department of Health. It can be obtained by the attending physician either from physicians who are equipped to prepare this material or from commercial firms who supply it. If desired the physician can administer the treatment at home. This saves expense and inconven ience to the patient. The county commissioners are authorized to reimburse individuals for expenses incurred in the treatment. The state has nothing to do with this. Treatment should never be delayed pending the decision of the county commissioners regarding payment but whenever convenient it is well to advise them that treatment is being administered so that there may be no misunderstanding about expense accounts to be submitted after the treatment is completed.

CARE OF ANIMALS BITTEN

The care of animals exposed to rabies infection is a matter that comes under the jurisdiction of the veterinary department of the State Board of Agriculture. It is advisable to call a competent veterinarian for advice regarding animals that have been bitten and he in turn should take up the question with the state veterinarian.

On account of the danger to the public from rabid dogs the health officer should provide for the control of these animals. When it is definitely known that a dog has been bitten by a rabid animal, the health officer should give the owner of such animal the option of killing it or keeping it confined on his own premises for a period of at least three months. If the dog leaves the premises of the owner it must be properly muzzled, otherwise the health officer will order such animal killed. When a dog suspected of having rabies has been astray in a community the Board of Health should adopt measures to require the muzzling of all dogs for a period sufficient to cover the incubation of any cases that may develop as a result of exposure to such animals.

PREVALENCE OF RABIES

The increase in rabies cases in Ohio as indicated by the examinations made in the laboratory of the State Department of Health is shown in the figures in Table II herewith.

Statistics collected in Ohio in 1912 (Phillips) show that the amount paid out for the treatment of persons exposed to rabies infection was over $30,000, while the loss in live stock for the same year was estimated at about $35,000. These figures have no doubt increased in the years since this data was collected.

The spread of the disease in the United States is shown by figures collected by Kerr and Stimson to have extended at one time or another to every state and territory in the Union. At the time of their inquiry. (1908) there were only 10 states or territories free from the disease. Some of these states have reported cases in large numbers since that date.

One must bear in mind of course that statistics of this character do not represent actual increase in cases because facilities for diagnosing and recognizing rabies have in recent years brought cases to the attention of officials while in earlier years many cases undoubtedly went unrecognized.

CONTROL AND PREVENTION

Rabies is a disease which is easily controlled and prevented. The experience of England, where, through proper muzzling of all dogs, rabies has been practically exterminated, is sufficient evidence of the efficacy of this measure alone. In Australia, where regulations prevent the importation of dogs, except after a proper period of quarantine, rabies has never been reported. There have been no definite preventive measures adopted in Ohio and until some measures are taken rabies may be expected to increase. It is possible in any community to practically exterminate rabies by muzzling, although of course co-operation of adjacent communities would be absolutely essential - otherwise there would

probably be reinfection due to imported cases.

References

(1) Stimson, Facts and Problems of Rabies, Hygienic Laboratory Bulletin No. 65, 1910.

(2) Williams, "Rabies," Reference Handbook of the Medical Sciences (3d ed., 1917), pp. 443-47.

(3) Williams and Lowden, "The Etiology and Diagnosis of Rabies," Jour. Inf. Diseases, 1906, 3, p. 452.

(4) Minnesota State Board of Health, Report of Laboratory Division, 1911-12.

(5) Phillips, "Rabies and Its Prevention," Monthly Bulletin, Ohio State Board of Health, II (1912), 131.

I

Health Indications in Data on Draft Rejections

NTERESTING indications as

to the health conditions of the country's male population between the ages of 21 and 31 have been given by the publication of detailed figures on the physical examinations of men called in the first draft. In general the statistics indicate that health conditions are better today than at the time of the Civil War, that they are better in the plains and mountain states than elsewhere and are worst in the North Atlantic and New England states, that there is little difference between city and country health (what margin there is being in favor of the rural sections), and that eye defects are more common than any others.

Of the men called for exami

nation throughout the country 70.89 were found physically acceptable and 29.11 were rejected. The total figures are: Called 2.510,706, accepted 1,779,950, rejected 730,756. Draft rejections in Civil War days amounted to 31.69 percent, according to Provost Marshal General Crowder, who points out that the higher standards of medical diagnosis today make this difference even greater than it appears.

West Rejects Few

A striking feature of the draft results is that the Mississippi River forms an almost absolute boundary between two health zones of the country. East of the Mississippi only one state Alabama

— out of 26 passed as many as 75 percent of the men called. West of the Mississippi 13 out of 22 states achieved this record, and one of them-South Dakota. stood alone among all the 48 states in passing more than 8ɔ percent. Only two states west of the river Nevada and Louisiana fell below 70 percent; in the East 12 states were under 70 percent, seven of them being under 65 percent and four of them being under 60 percent.

As applied to individual states, these figures cannot be taken as an infallible index to conditions, since those same differences in standards of medical diagnosis, which General Crowder pointed to as between Civil War times and the present, may exist also as between different states today. However, in the broad comparison between East and West, exceptions to the general indications are so rare as seemingly to preclude the possibility of this explanation.

Others Discharged Later

It must also be remembered in weighing the figures that these statistics do not take into account discharges of men whose defects were found after they had entered the service and gone to camps. This process of further sifting is still in progress and no figures are available.

Grouped by the percentages of men accepted to men called, and by sections as well, the states stand as follows:

Less Than 60 Percent

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More than 80 Percent
East: None.

West: South Dakota.

Deductions as to the comparative healthfulness of city and country were based upon a special study of typical sections in both groups. Of the men covered by this investigation, 72.04 percent of the rural residents were accepted and 27.96 percent rejected; 71.53 percent of the city men accepted and 28.47 percent rejected.

Causes of Rejection

To obtain data as to causes of rejections, approximately 10,000 typical cases from eight camp areas were studied. In this group the 10 principal causes of rejection, with figures for each, were:

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East of the Mississippi: Maine, Vermont, Connecticut, Pennsylvania. West of the Mississippi: None.

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60 to 65 Percent

Mental deficiency.

465

4.53

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