Part 33

After Pasteur had thoroughly satisfied himself by repeated trials, he announced his wonderful discovery, and it was in 1886 that Pasteur considered the preventive inoculation in human beings as resting upon a satisfactory experimental basis. During these five years this eminent man proved that it was possible to protect or immunize the lower animals, rabbits and dogs, against inoculation with the virulent virus.

The efficiency of this immunity was given trials by different methods of inoculation. It was found that sixty per cent of dogs inoculated under the "dura" (a membrane of the brain) were saved if treatment was given the second day. This test is more severe than is required to meet the ordinary infection of rabies. Pasteur, after a series of these final tests were so convincing, prescribed the preventive inoculations in human beings and on July 6th, 1886, the first human patient received the first treatment of his series of inoculations.

The method of obtaining the attenuated virus used in the treatment is as follows: A rabbit is inoculated by the brain method before described, each day, with suspension of the fresh, fixed virus. These rabbits die in six days after the inoculation. In this way a rabbit dies each day; the spinal cord is removed, divided into sections, and suspended in a flask containing potassium hydrate. The action of potassium hydrate is drying (desiccating). A series of these cords, which have been hung on fourteen successive days, are always kept in stock for the treatment of patients. The virus becomes less active with each successive day of exposure to drying (desiccation) and finally the virulence is altogether lost.

When the patient comes for treatment the fourteenth and thirteenth-day cords are used for the first inoculation, and on each successive day the patient receives inoculation, the strength of which has been regulated by the number of days the cord has been hanging. During the first four days patients receive injections of six cubic centimeters of emulsions made from cords aging from fourteen to seven days, and from the fifth day until the completion of the course of treatment patients receive emulsions from cords of higher immunizing properties, but no cords desiccated for less than four days are used.

[INFECTIOUS DISEASES 247]

Death rate from 1878-1883 before Pasteur treatment was instituted taken from documents in the department of the Seine:

1878 143 bitten. 24 deaths. 1879 76 " 12 " 1880 68 " 5 " 1881 156 " 22 " 1882 67 " 11 " 1883 45 " 6 "

Average of one death to every six bitten, or seventeen per cent mortality.

Incubation period from eleven days to thirteen months, average one hundred and twenty days, depending upon location of bite. Pasteur Institute records during the years 1886-1887 and first half of 1888, show that Pasteur had under his supervision 5,374 persons bitten by animals either proven or thought to have been mad. Mortality for 1886 was 1-34 per cent, during 1887 it was 1-12 per cent, during 1888 it was 77/100 per cent. With the later treatment the mortality has decreased to 3-10 per cent in 1908. The Pasteur method of treatment is a process of immunization which must be completed before the development of the disease. It is of no value after the symptoms have appeared.

Those who have not been affected can be immunized the same as those who have been bitten. The individual who has been bitten by a mad dog realizes when and how severely he has been bitten, and were it not for the so-called period of latent development of the virus, it would not be possible to carry out the Pasteur treatment. The patient may, if he will, take advantage of this fact and be immunized by treatment before the disease has developed. Deep and severe bites are most dangerous, but the disease may develop simply from a rabid dog licking a scratch of the skin. As before stated bites on exposed or uncovered surfaces, are more dangerous than those through clothing. There is a very easy access of the saliva to the wound in the unprotected part, while in the protected parts the teeth in passing through the protection, clothing, are freed of their saliva at least partially. The virus is conveyed from the bitten part or inoculation to the central nervous system through the nerve trunk, and the rapidity of extension depends upon the resistant powers of the patient, the virulence and the amount of virus deposited in the bitten part at the time the person was bitten. This disease develops only in nerve tissues. Virus can be found in the nerves of the side bitten, while the corresponding nerves on the opposite side are free from it. It can be ascertained that the virus is present in the medulla oblongata before the lower portion of the cord.

[248 MOTHERS' REMEDIES]

Comparative danger.--A wound of the hand after a delay of three weeks is as dangerous as a bite on the head exposed only a few days. There is always a possibility of an accumulative action and extension of the virus along the nerve trunk to the central nervous system during the interval of exposure, and this should be always borne in mind. It is stated by authority that the virus is not transmitted by the bite of a rabid animal until two days previous to the appearance of the first symptoms. It is with some difficulty that a decision is reached in advising patients who are bitten to take treatment early in the course of the disease. The symptoms are often so very obscure and slight that they are not recognized. If a dog which is not naturally vicious suddenly bites without any cause it should be tied securely and watched for seven days; and should it develop symptoms of the disease during this period the bite should be considered dangerous.

Immediate treatment of the wound.--A temporary measure is the cauterization of the wound; do not neglect this because a few hours have passed since the person was bitten, for wounds may be cauterized with advantage even after two or three days have elapsed. Of course the earlier it is done the better. If they are thoroughly laid open and scrubbed it is more effective. Nitric acid used freely is the best method to use. Wash the wound freely with boiled water after the acid has been applied; ninety-five per cent carbolic acid may be used if nitric acid cannot be obtained.

If carbolic acid is used it is necessary that it be washed from the wound by the free use of absolute alcohol, followed by boiled water and a dressing of bichloride of 1-7000. This prevents the ulceration of the wound by the carbolic acid. Cauterization thoroughly done destroys a part of the inoculated virus. Thorough cauterization is especially necessary with large wounds in which large quantities of the virus is inoculated.

When to send patients to an Institute.--Send them immediately, if there is good reason to believe the animal had rabies. It is not wise to wait until the animal dies; it is very important that treatment is begun as soon as possible, especially in severe bites.

What to send for examination.--The entire head may be sent by express, or better, the health officer should bring it in person. This saves time and relieves anxiety; or a portion of the brain may be removed under thoroughly clean conditions and placed in a sterilized twenty per cent solution of glycerin and water. In this way the virus retains its virulence and putrefaction is diminished. The first method is the best, taking the head directly. The head after it reaches the laboratory is examined microscopically for "negri bodies," and if there is no contamination the microscopic findings are verified by animal inoculations. The presence of negri bodies in a specimen is of great value owing to the rapidity with which a diagnosis can be made. In one case a positive diagnosis was reported within twenty minutes after the specimen entered the laboratory and within the next hour and a half the patient bitten by the dog the same day had begun her course of protective injections and was saved.

[BLOOD AND DUCTLESS GLANDS 249]

Protection.--To stamp out this disease city authorities, etc., can enact laws. All ownerless dogs should be killed, and the keeping of useless dogs should be discouraged by taxation. All dogs should be thoroughly muzzled where the disease prevails. This article is made up from an article written by an acknowledged authority on this disease, a man in charge of a Pasteur Institute.

Cities where Pasteur Institutes are located: Ann Arbor, Michigan. Baltimore, Maryland. Chicago, Illinois. Austin, Texas. Minnesota. Toronto, Ont. New York City.

DISEASES OF THE BLOOD AND DUCTLESS GLANDS.

Anaemia, or Anemia.--This may be defined as a reduction of the amount of blood as a whole or of its corpuscles, or of certain of its more important constituents, such as albumin and haemoglobin. Primary or essential anemia includes chlorosis and pernicious anemia; secondary anemia results from hemorrhages, poor nourishment or intoxications, poisons. Chlorosis, a primary anemia chiefly of young girls, characterized by marked relative decrease of haemoglobin.

Causes.--It usually occurs in blondes of from twelve to twenty years of age and most often from fourteen to seventeen years of age, when the menstrual function is being established and during which time they are rushed with their school work. There may be a family history of chlorosis or tuberculosis. Poor food, hard, unhealthy work, confinement in close unventilated rooms are other causes.

Symptoms.--Rounded fleshy appearance may continue. There is some difficulty of breathing, palpitation of the heart on slight exertion, from a fright or from excitement, tendency to faint feeling or even fainting, headache, a tired feeling, hard to stir or do anything, irritable temper, poor or changeable appetite, the digestion is disturbed, there is constipation, coldness of the hands and feet, difficult menstruation, irregular menstruation, leucorrhea, amenorrhea, and sometimes there is a slight fever. The color is often of a yellowish-green tinge, and this is more noticeable in the brunette type, though the cheeks may be flushed; the whites of the eyes bluish white in color. The heart sounds are not right. The blood is pale in color. The red cells are diminished, but usually are not below eighty per cent of the normal; the haemoglobin is greatly reduced, sometimes to thirty-five or forty per cent. The age, greenish tint of pallor, bluish whites of the eyes, poor nutrition, etc., aid in making the diagnosis.

[250 MOTHERS' REMEDIES]

Treatment.--Fresh air, good food, care of the bowels and rest if the symptoms are severe. When it is not so severe, plenty of outdoor exercise is necessary and beneficial. That takes them away from their cramped sedentary life and gives the sunshine, good pure air, and change of the scene. Horseback riding is a very good form of exercise, but it should be slow riding. "Tending" the horse is also good, and sleeping in the open air is excellent. Automobile riding is too straining and should not be indulged in.

1. Blaud's pills are very much used. The formula follows:

Dried Sulphate of Iron 2 drams Carbonate of Potash 2 drams Syrup Sufficient

Mix thoroughly, and make forty-eight pills. Take one to three pills, three times a day after meals.

2. Fowler's solution of arsenic is also very good remedy; three to four drops three times a day. It must be watched for bad symptoms and should only be taken under a physician's supervision.

Diet.--This should be good and varied to suit the special taste, and as the stomach and bowels are usually disordered such food should be chosen as will best agree. Diet plays a very important part.

PERNICIOUS ANAEMIA.--This is characterized by great decrease of the red cells of the blood with a relatively high color index and the presence of large number of germs. The causes are unknown.

Condition.--The body is not emaciated. A lemon color of the skin is usually present. The muscles are a dark red, but all the other organs are pale and fatty. The heart is large and fatty. The liver and spleen are normal in size, or only slightly enlarged with an excess of iron in the pigment. The red cells may fall to one-fifth or less of the normal number. The rich properties of the blood are fearfully decreased.

Symptoms.--Stomach and bowels, dyspepsia, nausea and vomiting, or constipation, may precede other symptoms or they may last throughout the case. The onset is gradual and unknown, with gradually increasing weary feeling, paleness and some difficulty in breathing and palpitation of the heart on exertion. There is paleness of the skin and the mucous membranes, the lips look pale, no color. The paleness becomes extreme, the skin often having a lemon yellow tint. The muscles are flabby; the ankles are swollen, you can see the arteries beat. Hemorrhages may occur into the skin, mucous membrane and retina of the eye. Nervous symptoms are not common. The pallor and weakness become extreme, sometimes with intervals of improvement and death usually occurs. The following is Addison's description given by Dr. Osler:

[BLOOD AND DUCTLESS GLANDS 251]

It makes its approach in so slow and insidious a manner that the patient can hardly fix a date to the earliest feeling of that languor which is shortly to become extreme. The countenance gets pale, and white of the eyes become pearly, the general frame flabby rather than wasted. The pulse perhaps larger, but remarkably soft and compressible, and occasionally with a slight jerk, especially under the slightest excitement. There is an increasing indisposition to exertion, with an uncomfortable feeling of faintness or breathlessness in attempting it; the heart is readily made to palpitate; the whole surface of the body presents a blanched, smooth and waxy appearance; the lips, gums and tongue seem bloodless, the flabbiness of the solid increases, the appetite fails, extreme languor and faintness supervene, breathlessness and palpitation are produced by the most trifling exertion, or emotion; some slight oedema (swelling) is probably perceived about the ankles; the debility becomes extreme. The patient can no longer rise from the bed; the mind occasionally wanders; he falls into a prostrate and half torpid state and at length expires; nevertheless, to the very last, and after a sickness of several months' duration, the bulkiness of the general frame and the obesity (fat) often present a most striking contrast to the failure and exhaustion observable in every other respect. The disease is usually fatal.

Treatment.--The patient should remain in bed and should use a light nourishing diet, taking food in small amounts and at stated intervals. Rest in bed is essential. Dr. Osler treated a case in the following way: I usually begin with three minims (drops) of Fowler's solution of arsenic three times a day and increase the dose to five drops at the end of the first week; to ten at the end of the second week; to fifteen at the end of the third week, and if necessary go up to twenty or twenty-five. Symptoms of an overdose are rare; vomiting and diarrhea occur. Then the medicine must be discontinued for a few days.

SECONDARY ANEMIA. Causes.--Hemorrhage form (bleeding). (a) Rapid bleeding from the rupture of an aneurism, from a blow, or eating into the blood vessels by an ulcer. (b) Slow bleeding as from nose-bleed, flow from the womb, piles or in "bleeders" people who bleed readily.

2. Inanition form.--Not nourished because of interference in taking food or assimilating food, from cancer of the gullet, or disease of the stomach.

3. Toxic poison cases; from acute and chronic diseases, such as typhoid fever, tuberculosis, rheumatism, syphilis, malaria, nephritis; or chronic lead poisoning, mercury, arsenic, and copper poisoning.

Symptoms.--There is pallor, dizziness, headache, palpitation and dyspnoea, difficult breathing on exertion; there is weakness, tendency to fainting, poor appetite, dyspepsia and constipation. The red blood cells are diminished, also the haemoglobin. Death may occur from a single hemorrhage.

[252 MOTHERS' REMEDIES]

Treatment.--Remove the cause and rest. Good fresh air, good easily digested food. The bowels must be kept regular. Iron and arsenic are good remedies if necessary. It is not possible to give special directions. A person in this condition needs a good physician. There is no time to waste. Iron and arsenic are good remedies, but they must be used intelligently and in proper doses. Blaud's pill is good in some cases. It contains iron. Also Fowler's solution of arsenic.

LEUKAEMIA.--An affection characterized by persistent increase in the white blood corpuscles, associated with changes, either alone or together, in the spleen, lymphatic glands and bone-marrow.

1. Spleen and Bone-Marrow, (Spleen-Medullary) type.--The changes are especially localized in the spleen and in the bone-marrow while the blood shows a great increase in elements which are derived especially from the latter tissue.

2. Lymphatic Type.--The changes in this type are chiefly localized in the lymphatic apparatus, the blood showing an especial increase in those elements derived from the lymph glands.

Causes--Unknown. It is most common before middle age.

Symptoms.--Either type may be acute or chronic. The invasion may be gradual, sometimes with disturbance of the stomach and bowels, or nose-bleed. (a) The first type is the common one. The spleen generally becomes enlarged; it is sometimes tender and painful, it may occupy over half of the abdominal cavity and varies in size after a hemorrhage, diarrhea or after a meal. There may be paleness of the face, etc., early and late nausea, vomiting, diarrhea, and dysentery are common, as is also ascites (dropsy in the abdomen). The pulse is rapid, full and soft. Fever is usual. Hemorrhages occur in the skin, retina, pleura, peritoneum, etc. Headache, dizziness, short breathing, and fainting may occur from the anemia. The liver may be enlarged. The blood shows a great increase in the white cells. Sometimes they are more numerous than the red blood cells. (b) Lymphatic type is rare, various groups of the lymph glands are enlarged, usually separate, but sometimes matted together; others, such as the tonsils may become large. The blood shows an increase of the white cells, but less than in the other form. The spleen is usually somewhat enlarged. Recovery is rare; the lymphatic cases may last only six or eight weeks. The course is usually progressive for two or three years.

Treatment.--The same as for Pernicious Anaemia.

FALSE LEUKAEMIA. (Pseudo-Leukaemia).--Also called Hodgkin's disease, malignant lymphoma, and general lymphadenoma. This is a progressive anemia and enlargement of the lymph glands and the skin, with secondary lymphoid growth in the liver, spleen and other organs.

Causes.--Males are more affected than females, and usually young persons. Continual local irritation causes a local enlargement of the gland, but the actual cause is unknown.

[BLOOD AND DUCTLESS GLANDS 253]

Symptoms.--The lymph glands of the neck, arm-pit or groin are enlarged and without any pain, followed by anemia, loss of strength and slight fever. The glands enlarge slowly or rapidly, forming large masses, while the growth extends to other regions. The spleen may be felt; the skin may be bronzed. In cases with involvement of deep seated nodes the first symptoms may be those of pressure on blood vessels, nerves, trachea, bronchial tubes or other structures.

Treatment.--Cut them out if they are small and localized. Arsenic, quinine, cod-liver oil are good medicines.

PURPURA.--This is not strictly a disease, but a symptom. This includes a group of affections characterized by hemorrhages into the skin.

Symptoms.--There are hemorrhages into the skin, and this takes the form of small blood spots underneath the skin, (petechia) and spots like the bursting of a blood vessel shows vibices or ecchymoses. The first are in small minute points and appear, as a rule, in the hair follicles and unlike the erythemas (redness) do not disappear upon pressure. Another kind occurs as streaks, while the ecchymoses are larger, but similar in nature to the first kind. They may be larger than a split pea, and they range from a deep red to a livid bluish tint. They assume a yellowish brown, then a yellow color, as they fade away and finally disappear. This eruption appears in a series of crops and the legs are the usual seat.

1. Symptomatic Purpura. (a) Infectious. Occurs in typhus fever, endocarditis, cerebro-spinal meningitis, typhoid fever, etc. (b) Toxic; from snake bites, iodide of potash, quinine, copaiba, bella donna, ergot, etc., and with jaundice. (c) Cachectic; with cancer, tuberculosis, leukaemia, false leukaemia, scurvy, etc. (d) Neurotic; with hysteria, neuralgia, and some organic disease. (e) Mechanical; due to violent effort and poor venous circulation.

2. Type arthritic purpura. (a) Simple Purpura. A mild form usually occurring in children, sometimes with pains in the joints, rarely any fever. There is anemia, disturbance of the stomach and purpuric spots on the legs, often on the arms and trunks. (b) Rheumatic purpura; this usually occurs in men from twenty to forty years old. There is usually pain and swelling of several joints, temperature 101 to 103 degrees, purpuric eruption chiefly on the legs and about the affected joints, often with hives and digestive disturbances: (c) Henoch's purpura; usually in children and is sometimes fatal. There are recurrent joint pains and swelling, disturbances of the stomach and bowels, skin troubles resembling it, and hemorrhage from mucous membrane.

[254 MOTHERS' REMEDIES]

PURPURA HAEMORRHAGIC.--This is a severe form, usually seen in delicate girls. The cause is unknown.

Symptoms.--Weakness, extensive purpuric spots (small blood spots in the skin), eruption, hemorrhages from the mucous membranes which may cause secondary anemia, slight fever, slow clotting of the blood. The duration is from ten to fourteen days. Death may occur within a day in cases marked by profuse bleedings into the skin and prostration.

Treatment.--Remove the causes. Fresh air, food and tonics, etc. This disease is serious and needs careful treatment from a physician.

HAEMOPHILIA. "Bleeders."--This is a hereditary disorder characterized by a tendency to persistent bleeding, spontaneously or even after a slight injury.

Causes.--Usually hereditary through many generations. It is transmitted through daughters, themselves usually not "bleeders," to their male children. It is found most often in the Anglo-German races.

Condition.--The blood vessel walls are thin; the skin is delicate, clotting of the blood is usually retarded.

Symptoms.--It comes spontaneously or after only slight wounds; the person is extremely delicate. The bleedings occur from the skin, or mucous membrane, or from wounds, but rarely during menstruation or confinement. They vary from small spots to bleeding which may end fatally, or in recovery with marked anemia. There may be pain and swelling of the joints, etc., and this may leave deformities resembling deformed arthritis. The result is worse the earlier the disease shows itself. They may live to old age.

Treatment.--Avoid, as much as possible, wounds and operations in "bleeding" families. Marriage of the women should be discouraged. For bleeding: rest, ice, tannic or gallic acid or adrenalin locally if the bleeding points can be reached. Plug the nostrils for nose-bleed both behind and in front.

SCURVY. (Scorbutus).--A constitutional disease characterized by weakness, anemia, sponginess of the gums and tendencies to bleeding.