The strangest aspects of the human experience

Rabies

07/15/2022

CW: illness, death (including death of a child), animal attacks, animal and human harm

Nowadays, someone with a headache, fever, nausea, and vomiting is likely going to reach for a COVID test. Or try to remember if they had their flu shot. Those symptoms aren't unusual for a number of illnesses, after all.

But this is why rabies is so terrifying - because those early symptoms that mimic other conditions and viruses. And by the time those symptoms show up, it's likely too late. And then there are the later symptoms: agitation, anxiety, confusion, hyperactivity, difficulty swallowing, fear of water, fear of air being blown on the face. Then hallucinations, insomnia. Paralysis. Coma. Death.

Rabies is almost always fatal. And by the time symptoms start appearing, it's too late. The only way to truly save yourself is to get the rabies vaccine immediately after being bitten by any animal - wild or domestic. Doctors even recommend seeking immediate medical attention if you're near a bat; say, for example, it flew into your room at night. You don't know if you've been bitten, but why take the risk?

Roughly 59,000 people around the world die from rabies each year. But it's incredibly rare in the US due to the availability of the vaccine and rabies awareness programs for the public. In 2019 and 2020, the US recorded no deaths from rabies. But in 2021, there were 7. All of the cases involved exposure to bats.

Episode: File 0076: Rabid Pirate Dolphins of Tuared Pt. 2

Release Date: July 15 2022

Researched and presented by Halli

(Please be nice to bats, they're a part of our incredibly complex ecosystem. But take exposure to them seriously.)

From the Mayo Clinic: "Any mammal (an animal that suckles its young) can spread the rabies virus. The animals most likely to spread the rabies virus to people include:

Pets and farm animals

  • Cats

  • Cows

  • Dogs

  • Ferrets

  • Goats

  • Horses

Wild animals

  • Bats

  • Beavers

  • Coyotes

  • Foxes

  • Monkeys

  • Raccoons

  • Skunks

  • Woodchucks"

And we need to take rabies seriously. Here's what happened in one of the cases in 2021, a man in Illinois:
In one case, a man in Illinois who had a bat roost in his home awoke in August to find a bat on his neck, according to a statement from the Illinois Department of Public Health. The bat was captured and tested positive for rabies, but the man declined to take a vaccine because of a longstanding fear of vaccines. About a month after contact with the rabid bat, the man started experiencing neck pain, headaches, difficulty controlling his arms, finger numbness and difficulty speaking, before dying.

Yes, rabies can live in the bodies for months or even years before causing visible symptoms.

So that's all very scary and now we'll probably all look at our pets a little differently, if even for a moment. But there are rabies vaccines for those pets and farm animals, so please get your pets taken care of.

But we know a lot more now about this disease than in decades and centuries past. Humans have been living with domesticated dogs for over 14,000 years; some estimates put that at almost 32,000 years. We've also been familiar with diseases carried by these animals since around that time, and that awareness (and the spread of said illnesses, including rabies) only grew as people and domesticated animals moved from farm lands into villages, towns, and even cities. This goes back as far as Mesopotamia.

"The origin of the disease's name is either from the Sanskrit word rabhas (to do violence) or the Latin word rabere (to rage). In ancient Greece, it was known as lyssa (violence) and today the virus that causes rabies is classified in the genus Lyssa Virus. It has also been known as hydrophobia which refers to another symptom of rabies, fear of water."

If you listened to our episode on the Nibiru Conspiracy , I talked a lot in there about cuneiform, the language used in Ancient Mesopotamia. Curiously enough, cuneiform tablets were discovered in Bagdad and Iraq in the middle of the 20th century recounting the "Laws of Eshnunna, a Sumerian and later Akkadian city-state located in present Tell Asmar, Iraq"

This city was most prominent during the Isin-Larsa period, ca. 1950-1850 BCE and the tablet is dated ca. 1770 BCE...These describe Sumerian rules and regulations attesting to the fact that a causal link between the bite of a rabid animal and a human death from rabies was well recognized almost 4000 years ago."

Additionally:

"At least five old Mesopotamian "dog incantations" (ca. 1900-1600 BCE)...clearly reflect the notion of rabies being caused by something present in the saliva of the afflicted animal, akin to the poison transmitted by a snakebite or scorpion sting. An herb seems to have been used after a dog bite and the biting dog's movement was restricted. Dogs were thought more likely to become rabid when a lunar eclipse occurred at year's end."

Other tablets have been found specifically denoting the word "rabid" when talking about dogs.

And while herbalists, writers, and doctors were writing about care for rabies victims, there was little they could do for the paranoid, feverish, paralyzed people who had fallen victim to the virus. Interestingly, one of the first human-animal health precautions taken during this time involved shepherds cutting the tails off puppies when they were 40 days old, thinking this would help prevent the dogs getting rabies and spreading it to their herds or themselves. A few others tried to solve the problem:

"...Pedianus Dioscorides (ca. 40-90 A.D.), of Anazarba in Cilicia, founded by the Assyrians but a then Roman city, now in Adana Province of southern Turkey. A physician and a pharmacologist, he is said to have described rabies accurately...[and] proposed cauterization of the bitten part as prevention. But all attempts at treatment of clinically-declared rabies cases remained based on hopeful conjecture or were denounced as unnecessarily brutal..."

When we move on to the Middle Ages, not much changed. Dogs became seen as unclean, so they were often avoided or killed. Medical practioners advised cleaning the bites and saw rabies as a "poison" that would spread through the body until ultimately taking the patient's life.

"...a miracle cure was deemed to be found at several specialized religious sites, such as the church of the village of Andage, renamed Saint-Hubert, where Louis I the Pious, one of Charlemagne's sons and his successor, authorized the transfer of the eponymous saint's thighbones in 826 CE. This abbey located near Liège, Belgium became a specialized center for rabies prevention. At the time, prevention before a bite took the form of applying a white-hot Key of Saint Hubert to dogs so they would not contract the disease..."

But in humans, the key wasn't the method chosen at this abbey.

"In humans, the preferred method of rabies prevention after a bite was based on incision of the forehead and implantation of threads from the Saint's supposedly miraculous stole, accompanied by prayers and fasting."

During the Renaissance, some scientists made good attempts at understanding the disease, the causes, and the treatments. Julien Le Paulmier (1520-1588) wrote seven medical textbooks in all, one specifically on rabies. 

Bezoards, or gallstones, were thought to keep rabies at bay, particularly if you wore one around your neck. And in a case of WTF, a Polish-Lithuanian artillery general Kazimierz Siemienowicz (c. 1600-c. 1651), made an early attempt at biological warfare, by firing hollow shells containing saliva of rabid dogs in 1650. 

By the mid 19th century, documentation of rabies cases and victims had grown - largely because governing powers ordered it to be done. Cases like a plague of rabies-infected mongooses in the Caribbean (because the mongooses were introduced to kill the rat populations in the sugar cane fields) led to colonial powers realizing rabies was a real issue. Fear of dogs in Europe bled away, leading toward better domestic animal care, including rules and regulations around aggressive dogs, documenting dog bite victims, and elimination of stray dogs.

The understanding of rabies as a disease grew slowly, but there was almost no better understanding during this time of the prevention of post-bite rabies. This stumped scientists, researchers, and doctors. Many treatments after a bite remained "faith-based" or other strange superstitions like apply the hair of the dog to the bite (literally where we get the phrase "hair of the dog"). And even more confusing to those researching rabies was that not every animal bite led to the illness. And the cruelty of treatments continued as well:

"In 1830s London, children bitten by potentially rabid dogs still underwent surgery or cauterization of the wound...Patients with clinically declared rabies were plunged into cold water or hot oil...or were later euthanized by being stifled between mattresses or made to bleed to death."

Thankfully these inhuman treatments of rabies patients slowly came to an end, starting with Louis Pasteur's work.

"Rabies virus attenuation was first validated by experiments which Pasteur and his team reported in 1884, documenting survival of dogs vaccinated by live, attenuated (a vaccine created by reducing the virulence of a pathogen, but still keeping it viable) vaccine before viral challenge. The prototypal vaccine against rabies was first used as salvage therapy in humans presenting signs of declared clinical rabies, with rapid documented failure in at least one instance: that of the child Antoinette Poughon in late June 1885. The vaccine, however, was to meet resounding success in patients exposed to rabies virus but with yet no signs of declared infection."

The first person to receive Pasteur's live, attenuated rabies vaccine was a 9-year-old schoolboy, Joseph Meister. The little boy was attacked and bitten 14 times by Mr. Théodore Vonné's dog while on an errand in Maisonsgoutte (Meissengott), in then German-occupied Alsace, on 4 July 1885. Joseph Meister suffered deep bites to the right hand and to the thighs and leg. The owner of the dog received one bite to the arm before the dog was shot by the police. The dog's owner was bitten through cloth and didn't leave a wound, so he didn't fall ill.

This little kid went through an ordeal. After the initial vaccine, he received 12 more injections over the course of 10 days. He survived. Another successful vaccine delivery was made in 1885 when a 15 year old shepherd was bit by a rabid dog. And by August 1886, Pasteur reported that of over 1235 recipients of the vaccine, only 3 (or 0.2%) had died.

Many more scientists in the following decades and centuries made incredible discoveries on the study of rabies and the rabies vaccine. And the invention of the electron microscope in the 1960s only furthered these developments; that was the first time that rabies, along with many other bacteria and viruses, were observed at such a detailed level.

And yet...

"Our understanding of the mechanisms and primary and secondary prevention of rabies in animals and in humans has profoundly changed since the Laws of Eshnunna were introduced by one of the earliest known civilizations. Yet despite this, and great progress in symptomatic management of encephalitic patients, clinicians caring for animals or patients with symptomatic rabies remain as powerless today as they were 4000 years ago. Rabies remains today the most lethal disease known to man and...modern medicine has offered no tangible improvement. We wait in hope for researchers to identify antiviral agents capable of controlling progression of clinically-declared rabies.

Rabies became a neglected disease when it was eliminated from Europe and North America. It is emerging in some island territories and remains uncontrolled in most of the developing world, where surveillance of dog bites, rabies exposures (syndromic or laboratory-confirmed) or rabies deaths, is poor. The prevention of human rabies deaths in the 21stC still rests on tools and strategies developed in the 19thC... While we strive for all dogs to be vaccinated, a major effort is urgently needed to make the time-proven and well-tolerated vaccine (and immunoglobulin) geographically and financially accessible in a timely way to those people who remain the most vulnerable to rabies: the rural populations of developing countries."

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