Speaker 1: Happy Saturday. Our episode on the Dick and Metal had
Speaker 1: a brief mention of efforts to keep the UK free
Speaker 1: of rabies, and we also just got an email from
Speaker 1: listener Whitney on the subject of a mass rabies exposure
Speaker 1: in the news, and we have been working on plans
Speaker 1: for our trip to Morocco in November, which is a
Speaker 1: country considered to be a high risk for dog rabies. Basically,
Speaker 1: we're just thinking a lot about rabies right now, so
Speaker 1: seemed like a good time to replay our May ninth,
Speaker 1: twenty twenty two episode on the history of rabies. Enjoy
Speaker 1: Welcome to Stuff You Missed in History Class, a production
Speaker 1: of iHeartRadio. Hello, and welcome to the podcast. I'm Tracy V.
Speaker 1: Wilson and I'm Holly Frye. Foxes are one of many
Speaker 1: wild animals that share cities and other places with human beings,
Speaker 1: and in April, one of them made headlines after biting
Speaker 1: at least nine people around the US capital. When this
Speaker 1: story crossed my Twitter feed, I became incredibly invested in
Speaker 1: whether everybody who got bitten by this fox had gotten
Speaker 1: their raby shots. Afterward, news articles were not telling me
Speaker 1: the answer to this information some of them were talking
Speaker 1: about a specific reporter or a specific congress person, but
Speaker 1: I was like, no, everybody, everybody needs to get the
Speaker 1: raby shots because foxes can carry rabies. Rabies is virtually
Speaker 1: always fatal once people develop symptoms, once anyone develops symptoms,
Speaker 1: but today's rabies profile axis is almost one hundred percent
Speaker 1: effective at preventing that from happening. It is, I think,
Speaker 1: the most effective vaccine that we have in existence. So
Speaker 1: then when news broke that yes, this fox did have rabies,
Speaker 1: it was like just a big flashing, screaming sign in
Speaker 1: my brain, like raby shots, raby shots, Please tell me
Speaker 1: everyone got their rabies shots. Of course, then that made
Speaker 1: me want to do a podcast on rabies and the
Speaker 1: vaccine that prevents it, something that somehow I thought we
Speaker 1: already had stuff on. We don't, or if we do,
Speaker 1: I failed to find it. The vast majority of our
Speaker 1: listeners live in places where rabies deaths and humans are
Speaker 1: extremely rare. Some parts of the world are rabies free,
Speaker 1: and here in the United States there were only five
Speaker 1: human deaths from rabies and twenty twenty one that was
Speaker 1: the highest number of annual rabies deaths in the United
Speaker 1: States in a decade. There are also places, though, where
Speaker 1: rabies is still endemic, and globally about fifty six thousand
Speaker 1: people die from it every year. That is a not
Speaker 1: a like. That's a small number compared to something like
Speaker 1: the current pandemic, but they're fifty six thousand totally preventable deaths,
Speaker 1: like we have right what we need to prevent this,
Speaker 1: so I want to talk about that adds up though
Speaker 1: there's a lot of animal experimentation in this episode and deaths. Obviously,
Speaker 1: Rabi's is caused by Rabi's lyssavirus, which probably originated in
Speaker 1: Old World bats. This virus has existed on every continent
Speaker 1: except Antarctica and Australia for millennia, and although Australia is
Speaker 1: Raybi's free, it's home to a closely related virus called
Speaker 1: bat Lissa virus. But in spite of the virus's connection
Speaker 1: to bats, humanity's connection to Rabi's has mainly been through dogs.
Speaker 1: That connection shows up in the first written reference we
Speaker 1: have of rabies, that's in the Eshnuna code from roughly
Speaker 1: two thousand BCE. Eshnuno was a city in what's now Iraq,
Speaker 1: and some of its laws have survived on a pair
Speaker 1: of broken tablets that were found at an archaeological site
Speaker 1: near Baghdad. Here's one of the laws quote if a
Speaker 1: dog is mad, and the authority have brought the fact
Speaker 1: to the knowledge of its owner, if he does not
Speaker 1: keep it in, and it bites a man and causes
Speaker 1: his death, then the owner shall pay two thirds of
Speaker 1: a mina of silver. If it bites a slave and
Speaker 1: causes his death, he shall pay fifteen shekels of silver.
Speaker 1: The first written reference to rabies in China is from
Speaker 1: the Zuo tradition, sometimes called the Zoo Commentary. This is
Speaker 1: a commentary on the Spring and Autumn Annals, which chronicles
Speaker 1: a period of Chinese history stretching from seven twenty two
Speaker 1: to four eighty one BC. One passage in the Tzuo
Speaker 1: tradition describes people of the capital city of Sung chasing
Speaker 1: a rabid dog. The dog ran into the home of
Speaker 1: a minister named Huachen, and the people chased after it.
Speaker 1: Quachen was afraid and fled the city. In about the
Speaker 1: fourth century BCE, Aristotle wrote this in his History of Animals.
Speaker 1: Quote dogs suffer from three diseases, es, quincy, and sore feet.
Speaker 1: Rabies drives the animal mad, and any animal whatever, excepting man,
Speaker 1: will take the disease if bitten by a dog so afflicted,
Speaker 1: the disease is fatal to the dog itself and to
Speaker 1: any animal it may bite. Man accepted. So this translation
Speaker 1: makes it sound like Aristotle was saying that humans don't
Speaker 1: get rabies, but it's also been interpreted as meaning that
Speaker 1: people don't always develop rabies when bitten by a rabid dog,
Speaker 1: and that is true, or that people don't always die
Speaker 1: from the disease if they contract it, which is almost
Speaker 1: never true. People have known that rabies was essentially always
Speaker 1: fatal for thousands of years, though Roman court physicians Scribonius
Speaker 1: largest described rabies as incurable in the first century CE.
Speaker 1: In addition to being lethal, rabies progresses in a way
Speaker 1: that can be really terrifying. The exact symptoms can vary,
Speaker 1: but there are two broad categories, both of which end
Speaker 1: in coma and death. Paralytic rabies involves lethargy, weakness, and paralysis,
Speaker 1: and furious rabies involves agitation, aggression, and hyperactivity. The word
Speaker 1: rabies reflects this latter type that comes from the Latin
Speaker 1: for two rage, which may have roots in a Sanskrit
Speaker 1: word meaning to do violence. Lisavirus has a similar root.
Speaker 1: It comes from a Greek word meaning frenzy or madness,
Speaker 1: which was used to describe rabies as well as to
Speaker 1: describe irrational rage. Rabi shows up a lot in popular culture,
Speaker 1: and that goes back thousands of years as well, including
Speaker 1: the use of rabies or rabid dogs as a metaphor
Speaker 1: for being mad or uncontrollable. For example, in the Iliad,
Speaker 1: which was written in about the eighth century BCE, Homer
Speaker 1: describes Hector as a rabid dog. Rabies can also cause
Speaker 1: paralysis and spasms in the throat that make it impossible
Speaker 1: to swallow water. That's why it's also known as hydrophobia.
Speaker 1: In the second century CE, Roman philosopher Celsus used the
Speaker 1: word hydrophobia in his description of the disease. Celsus also
Speaker 1: recognized that something was present in saliva that transmitted this illness,
Speaker 1: and he recommended a range of techniques to draw this
Speaker 1: substance out of wounds. Like the connection between Rabi's and
Speaker 1: aggressive rage, the connection between rabies and hydrophobia made its
Speaker 1: way into literature centuries ago. For example, in about the
Speaker 1: year five hundred, Kayleius Aurelianus suggested that Homer's description of
Speaker 1: Tantalus in the Odyssey might have been inspired by rabies,
Speaker 1: since Tantalus is tormented by water that he cannot drink.
Speaker 1: It's also possible that rabies influenced ancient Greek depictions of Cerberus,
Speaker 1: the multi headed dog that guarded the underworld, and that
Speaker 1: those depictions of a mad beast with poisoned frothing from
Speaker 1: its jaws circled back to influence people's perceptions of rabies.
Speaker 1: So through these and other written references, we know that
Speaker 1: rabies had spread from wherever it originated, all through India, China,
Speaker 1: the Middle East, Greece, Rome, and Egypt by about fifteen
Speaker 1: hundred years ago, but we don't really know how wide
Speaker 1: spread the disease was in any of these places, or
Speaker 1: how many deaths it caused among humans and other animals.
Speaker 1: That starts to change in the medieval period, when people
Speaker 1: started documenting large outbreaks of the disease within specific animals.
Speaker 1: These accounts primarily focused on outbreaks among dogs and other canids,
Speaker 1: including wolves and foxes. For example, an outbreak of wolf
Speaker 1: raybies struck Franconia in twelve seventy one. A massive outbreak
Speaker 1: among red foxes spread over parts of Europe between fifteen
Speaker 1: seventy one and fifteen eighty one, leading people to try
Speaker 1: to stop the disease by culling them. Sometimes these outbreaks
Speaker 1: could spread to other animals, including infecting people when they
Speaker 1: were bitten. At this point, we haven't mentioned rabies in
Speaker 1: the Americas, and that's because while rabies existed in the
Speaker 1: Americas through all this, rabid dogs probably did not, based
Speaker 1: on genetic studies of the virus itself. Before European colonization,
Speaker 1: rabies in the America's primarily infected bats and skunks. There's
Speaker 1: some evidence that indigenous peoples in ancient Central and South
Speaker 1: America regarded both bat bites and snake bites as potentially
Speaker 1: dangerous and treated bat bites with washing and cauterization with
Speaker 1: hot coals to try to prevent disease. Spanish colonists were
Speaker 1: reported being bitten by bats in the early fifteen hundreds,
Speaker 1: and in fifteen fourteen, Fernandez de Oviedo wrote about several
Speaker 1: soldiers dying after being bitten by vampire bats. Dog rabies
Speaker 1: is one of many diseases that Europeans introduced to the Americas,
Speaker 1: and after that introduction it spread to other animals and
Speaker 1: became far more likely to infect people, but that process
Speaker 1: did not happen nearly as quickly with rabies as it
Speaker 1: did with diseases like smallpox. Rabies typically has an incubation
Speaker 1: period of roughly three to eight weeks, although it can
Speaker 1: occasionally be much longer. Once symptoms appear, rabies is virtually
Speaker 1: always fatal within about ten days. When Europeans first started
Speaker 1: sailing to the Americas, the voyage often took more than
Speaker 1: two months, so any dogs or other animals that had
Speaker 1: been infected before setting sail usually developed symptoms and died
Speaker 1: or were killed while still at sea. So that meant
Speaker 1: introducing dog rabies to the Americas required a voyage that
Speaker 1: was short enough for infected dogs to survive. It also
Speaker 1: required a large enough population of dogs and other mammals
Speaker 1: within a colony for the disease to keep circulating that
Speaker 1: had been introduced. The first recorded outbreak of dog rabies
Speaker 1: in the Americas was reported in Mexico City in seventeen
Speaker 1: oh nine, and by the end of the eighteenth century,
Speaker 1: dog rabies was widespread in most of the places in
Speaker 1: the Americas that Europeans had colonized. This in turn spread
Speaker 1: the disease to the continent's native animals, with some of
Speaker 1: those exposures leading to new strains of the virus that
Speaker 1: were adapted to specific species. We'll talk about how a
Speaker 1: vaccine was developed to prevent rabies after a sponsor break.
Speaker 1: By the eighteenth and nineteenth centuries, outbreaks of rabies were
Speaker 1: spread across a lot of the world, in domesticated dogs
Speaker 1: and in wild animals. In North America, rabies became so
Speaker 1: widespread in skunks that they were nicknamed phobe Cats like
Speaker 1: hydrophobe and phobe hens were advertised as a way for
Speaker 1: cowboys to avoid being bitten by them in their sleep,
Speaker 1: and eighteen oh three, an outbreak among wild foxes in
Speaker 1: France spread to dogs, pigs, and people. Bites from rabid
Speaker 1: wolves tended to be particularly lethal, in part because attacking
Speaker 1: wolves often bit people's faces or necks, meaning the virus
Speaker 1: was way closer to their brain, while rabid dogs usually
Speaker 1: bit people's hands or arms. There was no cure for
Speaker 1: rabies and no way to tell whether a person would
Speaker 1: develop it after being bitten, and estimates of how many
Speaker 1: people developed rabies after a bite stretch all the way
Speaker 1: from five percent to fifty percent. Some of this is
Speaker 1: just because of imprecise record keeping, but it's also connected
Speaker 1: to how people responded to the disease. In many places,
Speaker 1: there was a widespread assumption that any animal that bit
Speaker 1: had rabies, and during outbreaks, people tended to hunt down
Speaker 1: and kill animals that they thought might be spreading disease.
Speaker 1: So a dog that bit someone in the midst of
Speaker 1: all of this might be rabid, or it might just
Speaker 1: be scared and cornered and trying to defend itself. Around
Speaker 1: the world, people tried various herbs and medical preparations to
Speaker 1: prevent or cure rabies, and because it was so lethal,
Speaker 1: many of these also relied on the idea of divine intervention.
Speaker 1: For example, Hubertus, also called Saint Hubert, is the patron
Speaker 1: saint of hunting, and one of his reported miracles involved
Speaker 1: curing somebody who had been bitten by a rabid dog.
Speaker 1: So in much of Europe, people used a piece of
Speaker 1: iron called Saint Hubert's key to cauterize bite wounds. As
Speaker 1: part of this treatment, a priest would also make a
Speaker 1: shallow cut over a person's forehead, place a black bandage
Speaker 1: over that, and the person wore that bandage for nine days.
Speaker 1: Some people even carried one of these keys around with
Speaker 1: them for protection. Long before the development of the germ
Speaker 1: theory of disease, people recognized that when someone was bitten
Speaker 1: by a rabid animal, something in the animal's saliva was
Speaker 1: going into the wound and potentially causing rabies. So some
Speaker 1: of the other treatments for bites involved washing the wound,
Speaker 1: applying caustic chemicals to it, or cauterizing it, whether it
Speaker 1: was with a Saint Hubertus's key or with some other implement.
Speaker 1: If these treatments were done immediately after a person was bitten,
Speaker 1: they may have helped reduce the chance of developing rabies
Speaker 1: by washing away the animals infected saliva. Thoroughly washing the
Speaker 1: wound is still step one in rabies prevention today, but
Speaker 1: none of this was enough to totally prevent the chance
Speaker 1: of developing the fatal disease. People also tried to prevent
Speaker 1: rabies by reducing the numbers of animals that could carry
Speaker 1: it and transmit it to humans and to other animals.
Speaker 1: For example, in eighteen sixty seven, the UK passed the
Speaker 1: Metropolitan Streets Act. Among other things, this act empowered police
Speaker 1: to collect and muzzle stray dogs, are dogs that were
Speaker 1: determined to be dangerous. This reportedly led to a drop
Speaker 1: in human cases of rabies in British cities. Also in
Speaker 1: the eighteenth and nineteenth centuries, researchers were learning about rabies
Speaker 1: and working on ways to prevent it spread. During the
Speaker 1: earlier part of this time, researchers didn't yet know what
Speaker 1: a virus was. But trying to talk around that got
Speaker 1: really clunky. So we are still going to call it
Speaker 1: a virus in our discussion today. Yeah, it was a
Speaker 1: lot of incredibly stilted sentences before I was like, we're
Speaker 1: just calling it a virus, regardless of whether that individual
Speaker 1: researcher knew what a virus was. So in seventeen sixty nine,
Speaker 1: Italian anatomist and pathologist John MORGANI observed that rabies traveled
Speaker 1: via the nerves rather than traveling through the bloodstream. He
Speaker 1: made this connection because some patients reported a feeling of
Speaker 1: pins and needles or other neurological disturbances around the site
Speaker 1: of their original bite wound. MORGANNYU was correct. Once it
Speaker 1: enters the body. The rabies virus moves along the nerves
Speaker 1: until it gets to the brain and the rest of
Speaker 1: the central nervous system. After it gets to the brain,
Speaker 1: the rabies virus makes its way to the salivary glands,
Speaker 1: where it can cause excessive salivation. And although eighteenth century
Speaker 1: researchers didn't quite have that part figured out, they did
Speaker 1: know that the disease was spread through saliva. In seventeen
Speaker 1: ninety three, Scottish surgeon John Hunter speculated that it would
Speaker 1: be possible to use a lancet to intentionally introduce an
Speaker 1: infected animal saliva into another animal, but it's not clear
Speaker 1: whether he tried this in practice. We also don't know
Speaker 1: whether German naturalist George Gottfried Zinka was familiar with Hunter's work,
Speaker 1: but in eighteen oh four he brushed saliva from a
Speaker 1: rabbit dog onto a cut he had made in the
Speaker 1: leg of a health the dog. This previously healthy dog
Speaker 1: contracted rabies. He did the same thing with other healthy mammals,
Speaker 1: demonstrating that it was possible for the bite of an
Speaker 1: infected dog to infect animals of other species. In eighteen
Speaker 1: twenty one, French neurophysiologist Francois Magendi reported that he had
Speaker 1: infected a previously healthy dog with saliva from a person
Speaker 1: who had contracted rabies. Victor Gaultier was a professor at
Speaker 1: the National Veterinary School in Lyon, France, and he started
Speaker 1: experimenting with rabies in eighteen seventy nine. He found that
Speaker 1: it was possible to transmit rabies from a dog to
Speaker 1: a rabbit, and then from that rabbit to another rabbit.
Speaker 1: Rabbits were smaller and easier to keep than dogs, and
Speaker 1: they were less dangerous research subjects than rabbit dogs were.
Speaker 1: Gaultier also found that the rabbits had a shorter incubation
Speaker 1: period of about eighteen days rather than a month or
Speaker 1: more that you might see in a dog. Gualtier did
Speaker 1: various experiments with infected animal's saliva, attempting to see whether
Speaker 1: he could find some way of using this infectious material
Speaker 1: to prevent rabies. In eighteen eighty one, he injected rabies
Speaker 1: virus into the jugular veins of sheep and they didn't
Speaker 1: develop rabies, And then when he exposed one of them
Speaker 1: to saliva from a rabid dog later on, it seemed
Speaker 1: like it was immune to the disease. French chemist and
Speaker 1: microbiologist Louis Pasteur started working on rabies at about this
Speaker 1: same time, and he was inspired by Gautier's success. Pastor
Speaker 1: already had an extensive background in this kind of work.
Speaker 1: In the eighteen fifties, he had studied yeast and alcohol fermentation,
Speaker 1: as well as the ability for microorganisms to contaminate fermenting beverages.
Speaker 1: This had contributed to both the germ theory of disease
Speaker 1: and the development of pasteurization. In the eighteen sixties, he
Speaker 1: had identified a microorganism that was devastating the French silk
Speaker 1: in day, and in the eighteen seventies he studied animal
Speaker 1: diseases like anthrax and chicken cholera, including developing an anthrax vaccine.
Speaker 1: While Pasteur had lots of experience in this kind of research,
Speaker 1: he had pretty much no experience in medicine or the
Speaker 1: clinical treatment of patience, so he relied on other people
Speaker 1: for this knowledge, including French physician and bacteriologist Emil Roux.
Speaker 1: A whole team of other scientists and doctors were involved
Speaker 1: in this work as well, including Chiles Chamberlain, Emil Duclaux,
Speaker 1: Luis Jullier, and Joseph Granche. This is definitely not a
Speaker 1: solo effort, and Pasteur was not always excited about crediting
Speaker 1: other people for their involvement in it. There are even
Speaker 1: some historians who have accused him of stealing other people's ideas.
Speaker 1: Much of Pastor's previous work had involved culturing bacteria and
Speaker 1: working from those cultures, and he started out trying to
Speaker 1: do the same thing with Rabi's. Since Rabi's is caused
Speaker 1: by a virus rather than a bacterium, Pastor's efforts to
Speaker 1: replicate his earlier process failed. He started working directly with
Speaker 1: the saliva of infected animals and then moved on to
Speaker 1: working with central nervous system matter. He found that if
Speaker 1: he exposed a healthy rabbit to rabies, it developed rabies.
Speaker 1: Then if he used that rabbit's central nervous system matter
Speaker 1: to expose another rabbit, that second rabbit also developed rabies,
Speaker 1: and the second rabbit's infection seemed to be more virulent
Speaker 1: than the first. If he did this a third time,
Speaker 1: the third rabbit's infection was also more virulent than the
Speaker 1: seconds had been. He continued this serial passage of the
Speaker 1: virus from rabbit to rabbit until he had a strain
Speaker 1: of it that he described as fixed. It was consistent
Speaker 1: and how virulent it was, and it had an incubation
Speaker 1: period that was set at six or seven days. From there,
Speaker 1: mastor Air dried the spinal cords of rabbits that had
Speaker 1: died of that highly virulent fixed strain. The longer they dried,
Speaker 1: the weaker the virus became. That's a process called attenuation.
Speaker 1: When he exposed other animals to a small amount of
Speaker 1: this attenuated virus, they seemed to develop a resistance to
Speaker 1: rabies rather than becoming ill. From there, Pastors started to
Speaker 1: wonder whether it was possible to make an animal more
Speaker 1: resistant to rabies after it had already been bitten, preventing
Speaker 1: it from developing the disease. Having successfully tested out this
Speaker 1: idea in dogs, he tried it on two people, but
Speaker 1: he didn't publish on either of these attempts, so they
Speaker 1: were not known about until much later. One of these
Speaker 1: was a man who had been bitten by a dog,
Speaker 1: and while this man survived, it's also likely that he
Speaker 1: had not actually been exposed to rabies. The other was
Speaker 1: an eleven year old girl who had been bitten in
Speaker 1: the face by a puppy, and she had already started
Speaker 1: developing rabies symptoms. She died the day after she was
Speaker 1: given the treatment. On July fourth, eighteen eighty five, nine
Speaker 1: year old Joseph Meister was repeatedly bitten by a dog
Speaker 1: in Alces. The dog was believed to be rabid, and
Speaker 1: two days later the child was brought to Pest for help.
Speaker 1: Emil rou had been heavily involved in Pester's research up
Speaker 1: to this point, and he refused to be involved in
Speaker 1: the boy's treatment because of ethical concerns. Pastor expressed some
Speaker 1: reluctance as well, but Joseph Groanche and Alfred Vaupien of
Speaker 1: the Academy de Medcent encouraged him to try, with Granche
Speaker 1: administering the treatment since Pastor was not a doctor, Joseph
Speaker 1: was given a series of inoculations over the span of
Speaker 1: ten days, starting with a very weak preparation and working
Speaker 1: up through ones that were less and less attenuated. Three
Speaker 1: months later, he had no sign of rabies. Another attempt
Speaker 1: was started with another patient shortly after Joseph Meister was
Speaker 1: declared to be in the clear. That was Jean Baptiste Jupelee,
Speaker 1: a fourteen year old shepherd who had been mauled while
Speaker 1: saving a group of younger boys from a dog. Pastor
Speaker 1: reported his results to the French Academy of Science on
Speaker 1: October twenty sixth, eighteen eighty five, while Jupeel's treatment was
Speaker 1: still ongoing. Told about his success with Joseph Meister and
Speaker 1: the fact that he had successfully inoculated fifty dogs against
Speaker 1: rabies before trying this process on a human. We're going
Speaker 1: to talk more about what happened with all of this
Speaker 1: after we paused for a quick sponsor break. As a
Speaker 1: word of Pastor's success at preventing rabies started to spread,
Speaker 1: people started flocking to him for treatment. By the start
Speaker 1: of eighteen eighty six, he had treated at least three
Speaker 1: hundred and fifty people. They came from all over Europe
Speaker 1: and from the United States. In early December of eighteen
Speaker 1: eighty five, a dog bit at least seven other dogs
Speaker 1: and six children in Newark, New Jersey. Word of Pastor's
Speaker 1: work had made it to the US, and a local
Speaker 1: doctor published an appeal for funds to send the boys
Speaker 1: to Paris for treatment. Four of the boys were sent
Speaker 1: to Paris by steamer. The other two were determined to
Speaker 1: not have sufficient injuries to need treatment. American news coverage
Speaker 1: of these boys tripped to Paris and then their return
Speaker 1: to the United States turned rabies vaccine into just a
Speaker 1: media sensation, and three of the boys were displayed at
Speaker 1: the Globe Museum in the Bowery in New York after
Speaker 1: they all got home. Not everyone agreed with what Pasture
Speaker 1: and his team were doing. Anti vivisectionists objected to the
Speaker 1: use of animals in this research, and as we've said,
Speaker 1: not everyone who is bitten by a rabid animal contracts rabies,
Speaker 1: and not every animal who bite someone is rabbid. Since
Speaker 1: there was still not a test for rabies, determining whether
Speaker 1: an animal had it usually involved just waiting to see
Speaker 1: if it died, but that wasn't really possible if it
Speaker 1: had already been killed, or if it just couldn't be found.
Speaker 1: You could also expose a healthy animal to the brain
Speaker 1: or saliva of an animal who had bitten someone, but
Speaker 1: by the time the healthy animal showed any symptoms, it
Speaker 1: was just likely to be too late for the human patient.
Speaker 1: So critics made the point that Pasteur was potentially exposing
Speaker 1: people to rabies for no reason, and that his inoculation
Speaker 1: might cause somebody who had been bitten by a non
Speaker 1: rabid dog to then develop rabies because of their treatment.
Speaker 1: Critics also noted that some of Pasteur's patients did die.
Speaker 1: By November of eighteen eighty six, seventeen hundred patients had
Speaker 1: received rabies injections and ten of them had died. The uncertainty,
Speaker 1: combined with the death to spark a huge amount of
Speaker 1: debate within the medical community about whether what Pasteur was
Speaker 1: doing was ethical or even medically necessary. The Academy de
Speaker 1: Mensa held a meeting on the subject on January eleventh,
Speaker 1: eighteen eighty seven. Although Pastor's critics were vocal, his supporters,
Speaker 1: led by doctor Joseph Gronchet, successfully defended his work. The
Speaker 1: Institute Pasteur was established on June fourth, eighteen eighty seven,
Speaker 1: and it opened on November fourteenth of that year. It
Speaker 1: focused on disease research and on providing rabies vaccine. By
Speaker 1: eighteen ninety eight, more than twenty thousand people had been
Speaker 1: treated at the Pasteur Institute after a possible rabies exposure,
Speaker 1: and only ninety six of them had died, or less
Speaker 1: than half of a percent of patients. To be clear,
Speaker 1: there was a lot about this early version of the
Speaker 1: vaccine that was inherently unsafe. It was basically made from
Speaker 1: animal brain or spinal cordtish. There could for sure be complications,
Speaker 1: but this was still a dramatic improvement over an untreatable
Speaker 1: fatal disease. Discoveries about the rabies virus continued after this point.
Speaker 1: In nineteen oh three, Italian pathologist Aldecci Negri discovered round
Speaker 1: and oval regions in the brains of animals that had
Speaker 1: died of rabies, which he called Negri bodies. At the time,
Speaker 1: he thought they were some kind of parasite, but they
Speaker 1: actually arise as part of the reproductive cycle of the virus.
Speaker 1: This paved the way for the first rabies tests. While
Speaker 1: there are newer methods for detecting rabies in brain matter today,
Speaker 1: negribodies are still sometimes used when those methods are not available.
Speaker 1: The most reliable tests do still involve examining an animal's brain,
Speaker 1: which is why living animals have to be euthanized to
Speaker 1: be tested for rabies. Refinements in the vaccine were also
Speaker 1: in the works. Pastors' methods didn't always produce a consistently
Speaker 1: potent vaccine, and if it was too potent, it could
Speaker 1: cause somebody to contract rabies in the early twentieth century,
Speaker 1: researchers started using phenol to kill the virus rather than
Speaker 1: attenuating it through air drying. Viruses were cultured in tissues
Speaker 1: in nineteen thirty six, which led to tissue cultured vaccines
Speaker 1: rather than using brain matter to make them. Today's rabies
Speaker 1: vaccines are mostly cultured in human cells or in chick
Speaker 1: embryos or some other cellular matter. Although some of Pastor's
Speaker 1: colleagues speculated about whether it would be possible to mass
Speaker 1: vaccinate dogs or other animals and lower the spread of
Speaker 1: rabies to people, serious efforts to do that didn't start
Speaker 1: until decades later, but efforts like that have led to
Speaker 1: the successful eradication of rabies in some parts of the world.
Speaker 1: There are too many rabies free countries today for us
Speaker 1: to try to name them all. They include many islands,
Speaker 1: including many Caribbean islands, the Canary Islands, the Falkland Islands,
Speaker 1: the Galapagos Islands, the UK, Iceland, Japan, and New Zealand.
Speaker 1: Several nations in continental Europe are also considered rabies free,
Speaker 1: including much of Western Europe. We should note, though, that
Speaker 1: rabies free often means rabies free in terrestrial animals. There
Speaker 1: can still be rabies or other lissaviruses in bats, specifically,
Speaker 1: so even if you are somewhere that is considered rabies free,
Speaker 1: being bitten by a bat still warrants medical attention. Just
Speaker 1: in general. Don't touch bats with your bare hands. You
Speaker 1: don't need to be afraid of bats. They're generally pretty
Speaker 1: shy and they're not gonna mess with you if you
Speaker 1: don't mess with them. But like, don't go grab one
Speaker 1: with your hand, which is so hard because they're so cute.
Speaker 1: Not for me because I see one. Like if I
Speaker 1: see a bat somewhere that I don't expect to see
Speaker 1: a bat, I'm like, that bat is definitely a problem.
Speaker 1: I Am not going anywhere near it. I will tell
Speaker 1: a bat story in our behind the scenes. Ok. As
Speaker 1: we said at the top of the show, Rabies is
Speaker 1: still endemic in some parts of the world, including parts
Speaker 1: of Asia and Africa. About forty percent of human rabies
Speaker 1: deaths occur each year in India, with the vast majority
Speaker 1: of those exposures coming from dogs, and some serious outbreaks
Speaker 1: among wild animals started long after the rabies vaccine was developed.
Speaker 1: For example, rabies was identified in North American raccoons in
Speaker 1: nineteen thirty six, and there is an ongoing epidemic of
Speaker 1: rabies among raccoons all along the East Coast. There are
Speaker 1: efforts to get these and other outbreaks in wild animals
Speaker 1: under control, using things like oral rabies vaccine baits. Yeah,
Speaker 1: there are also mass vaccination campaigns, a lot of work
Speaker 1: on this. A lot of the deaths that occur around
Speaker 1: the world happen in children who'd like just wanted to
Speaker 1: pet a dog and got bitten, so it is very sad.
Speaker 1: It's also possible for one animal to spark a huge
Speaker 1: exposure scenario, even in places where rabies is relatively well controlled.
Speaker 1: For example, on October fifth, nineteen ninety four, a family
Speaker 1: bought a kitten from a pet store in New Hampshire,
Speaker 1: and then about three weeks later, this kitten developed seizures
Speaker 1: and died. After its death, it was determined to have
Speaker 1: had rabies. This kitten had been examined by a veterinarian
Speaker 1: and had a certificate of health before it was sold,
Speaker 1: but the pet store didn't have clear records of when
Speaker 1: animals had arrived there or been sold, so in the end,
Speaker 1: six hundred and sixty five people received post exposure prophylaxis
Speaker 1: or PEP for rabies. These were people who had come
Speaker 1: into contact with that kitten, or who had bought other
Speaker 1: animals that had probably had contact with the kitten at
Speaker 1: the store, or people who had contact with those animals,
Speaker 1: people who worked at the store, people who visited the
Speaker 1: store and handled the animals. Really just on and on.
Speaker 1: The probable initial source for this whole thing was a
Speaker 1: raccoon that may have come into contact with three feral
Speaker 1: kittens that were then captured and sold at the store.
Speaker 1: As a side note, you may have heard that Raby's
Speaker 1: prophylaxis is a horrifying series of incredibly painful shots directly
Speaker 1: into the stomach with a gigantic and terrifying needle. It
Speaker 1: is not. Older versions of Raby's PEP did involve a
Speaker 1: long series of fourteen to twenty one shots, usually given
Speaker 1: in the abdomen, but that's just because the abdomen offered
Speaker 1: a lot more surface area to work with, not because
Speaker 1: the injections went into the stomach through a huge needle. Still,
Speaker 1: I mean to be clear, that is a lot of
Speaker 1: shots into a tender area, and the vaccine that was
Speaker 1: in use at the time could have a range of
Speaker 1: unpleasant side effects. Yeah, I would not want to get
Speaker 1: fourteen to twenty one shots all around my abdominati think
Speaker 1: like it was not a gigantically long needle going into
Speaker 1: people's actual stomachs. It's also not what is in use today.
Speaker 1: The current recommendation is that a person gets one dose
Speaker 1: of human rabies immune globulin and one dose of rabies
Speaker 1: vaccine shortly after the bite. The immune globulin is typically
Speaker 1: injected near the bite location, and then the vaccine typically
Speaker 1: goes into the deltoid region of the arm, where lots
Speaker 1: of other vaccines go. Then the person gets three more
Speaker 1: doses of vaccine that are spread out in the days
Speaker 1: that follow, again as injections into the shoulder area. Also
Speaker 1: using a vaccine that is like cultured in tissues and
Speaker 1: a lot safer than what was being used in the past.
Speaker 1: This process can be a little bit different for children,
Speaker 1: or if a person is immuno compromised, or if a
Speaker 1: person has been previously vaccinated for rabies. That's something that's
Speaker 1: typically only done based on a person's risk for being
Speaker 1: exposed to rabies. As another side note, we have been
Speaker 1: really really focused on bites here because the overwhelming majority
Speaker 1: of rabies exposures come from bites or possibly scratches. There
Speaker 1: are some other ways to contract the disease, but they're
Speaker 1: extraordinarily rare, like through the eyes or mucous membranes. If
Speaker 1: someone is exposed to aerosolized rabies virus in some way,
Speaker 1: or because rabies can closely resemble various types of encephalitis,
Speaker 1: it is sometimes missed as a diagnosis when doctors don't
Speaker 1: know that the person was bitten by an animal. This
Speaker 1: has led to an extremely small number of rabies transmissions
Speaker 1: through organ transplants, although the risk of this is extremely remote.
Speaker 1: After their first report of it happening, many organ procurement
Speaker 1: organizations started including screening questions to try to rule out
Speaker 1: this possibility. Circling back around to rabies in pop culture,
Speaker 1: this was actually a plot line on the TV show Scrubs.
Speaker 1: Its sounds truly horrifying, but also like the disease process
Speaker 1: that rabies causes, like in the umbrella of encephalitis, and
Speaker 1: if a doctor doesn't know that a person was bitten
Speaker 1: by an animal or picked up a bat or whatever,
Speaker 1: like it's most doctors have never seen a case of
Speaker 1: rabies in their career, and it's not the thing that
Speaker 1: first comes to mind. In two thousand and four, fifteen
Speaker 1: year old Gena Geezy and her medical team made headlines
Speaker 1: after she became the first person known to survive rabies
Speaker 1: after starting to develop symptoms. She had picked up and
Speaker 1: been bitten by a bat, and although her wound was
Speaker 1: cleaned with hydrogen peroxide, she wasn't taken in for further treatment.
Speaker 1: She started developing symptoms about a month later, and then,
Speaker 1: about six days into her illness, reported having been bitten
Speaker 1: by the bat. Doctors placed Geezy in a medically induced
Speaker 1: coma and gave her anti viral drugs and other treatments.
Speaker 1: These treatments continued until tests suggested that her body was
Speaker 1: fighting off the virus, and at that point she was
Speaker 1: brought up of the coma. She survived this experience, and
Speaker 1: news outlets have continued to report on her life into
Speaker 1: the year twenty twenty one. At the time, this seemed
Speaker 1: like a hopeful sign that what came to be known
Speaker 1: as the Milwaukee Protocol would make it possible to cure
Speaker 1: people after they started showing symptoms of rabies, but efforts
Speaker 1: to replicate that success have been largely unsuccessful. One paper
Speaker 1: in the Journal of the Brazilian Society of Tropical Medicine
Speaker 1: traced thirty eight published uses of the Milwaukee protocol, including
Speaker 1: one use of a similar protocol called the Recifi protocol.
Speaker 1: Only eleven of those patients survived, with all but five
Speaker 1: of them having moderate to severe complications afterward. This is
Speaker 1: certainly an improvement over a disease with an essentially one
Speaker 1: hundred percent fatality rate, but these numbers may be deceptively optimistic.
Speaker 1: Three of the people who were described as having survived
Speaker 1: did make it through the most critical part of the illness,
Speaker 1: but they still died. At least one of the patients
Speaker 1: may not have actually had rabies, and there's been no
Speaker 1: coordinated method for tracking when this protocol has or hasn't
Speaker 1: been attempted. It's likely that anyone who tried it and
Speaker 1: succeeded would publish their results, but it's also possible that
Speaker 1: people who tried it and failed have not yet. There
Speaker 1: are some papers like Opinion Commentary written by teams of
Speaker 1: doctors that are like this does not work and we
Speaker 1: need to stop focusing our effort on it, and others
Speaker 1: that are a little bit more like this may need
Speaker 1: some other refining before it could work. Aside from all that, though,
Speaker 1: all the patients described in these publications spent at least
Speaker 1: a month in the hospital with extensive care throughout their stay,
Speaker 1: so it's extremely unlikely that this protocol could really be
Speaker 1: put into use in the places where human deaths from
Speaker 1: rabies are the most prevalent. These places tend to be
Speaker 1: rural and poor without a lot of health care infrastructure.
Speaker 1: Places where people don't have access to rabies profile axis
Speaker 1: are likely to also be places where people don't have
Speaker 1: access to a hospital that could support this kind of treatment. Also,
Speaker 1: it's extremely clear at this point that coordinated programs of
Speaker 1: public education and dog vaccinations and sometimes vaccinations in particular
Speaker 1: wild animals, can lower the number of human rabies deaths enormously,
Speaker 1: and places that don't have the resources to support those
Speaker 1: kinds of programs and initiatives are really likely not to
Speaker 1: have the resources to support hundreds or thousands of people
Speaker 1: with long term hospital stays and medically induced comas. It's
Speaker 1: like even if this worked, it would really be working
Speaker 1: for the wealthiest countries in the world and not the
Speaker 1: places where treatment is most needed. So all of that said,
Speaker 1: the global cost of rabies is roughly eight point six
Speaker 1: billion dollars per year, and more than fifteen million people
Speaker 1: per year receive Raby's PEP. This protocol can be really expensive.
Speaker 1: In the United States, it can cost between twelve hundred
Speaker 1: and sixty five hundred dollars. Yeah, that's like one estimate
Speaker 1: that I can sew that I saw. I saw some
Speaker 1: that were even higher than that. September twenty eighth of
Speaker 1: every year is World Raby's Day. That's also the anniversary
Speaker 1: of the death of Louis Pasteur. Well, that's a basic
Speaker 1: history of rabies, raybees. My hope is that in the
Speaker 1: future will at least get to the point where the
Speaker 1: places in the world that have lots of free roaming
Speaker 1: dogs also have those dogs vaccinated, because that's really where
Speaker 1: like so much feeding back into the greater environment and
Speaker 1: so much feeding into human cases of rabies, Like it's
Speaker 1: all interconnected with the dogs. Yeah. I think we mention
Speaker 1: it at the top of our episode on the history
Speaker 1: of Veterinary Medicine that one of the vets at my
Speaker 1: practice participates in a program where she goes to countries
Speaker 1: where the dog population is not well vaccinated and tries
Speaker 1: to just do as many vaccinations as they can in
Speaker 1: a short period of time. Yeah, they had gone to Malawi,
Speaker 1: I think, and Malawi's target is like seventy percent of
Speaker 1: the dog population vaccinated, which would do a lot to
Speaker 1: reduce the number of human deaths, but still would like
Speaker 1: there would still be a reservoir of circulating rabies among
Speaker 1: dog populations. There are a lot of sad parts to that,
Speaker 1: but one of the saddest parts is like a lot
Speaker 1: of a lot of the people who die of rabies
Speaker 1: or like just a kid that wanted to pet a dog. Yeah,
Speaker 1: thanks so much for joining us on this Saturday. If
Speaker 1: you'd like to send us a note, our email addresses
Speaker 1: History Podcast at iHeartRadio dot com, and you can subscribe
Speaker 1: to the show on the ihea radio app, Apple Podcasts,
Speaker 1: or wherever you listen to your favorite shows.