MICROSCOPICAL EXAMINATIONS FOR ANIMAL PARASITES MADE AT THE THREE BACTERIOLOGICAL LABORATORIES OF THE STATE BOARD OF HEALTH DURING 1911

The "mad dog" incident in the state for the past year has occasioned deep concern to the executive office, both on account of the seriousness of the situation as well as the cost of preventive measures which in the way of serum administration is necessary to escape the horrible agony of a death from hydrophobia.

The state statutes would seem to impose upon the State Health Officer the duty of preventing both a spread as well as an introduction of hydrophobia in the state of Florida, but when rabid animals became numerous in Duval county during the past summer, and when some action on the part of the State Health Officer seemed demanded, and to longer put off radical measures, such as muzzling all dogs running loose or destroying roaming animals.

to suppress the disease, would be a failure to perform an important duty, the State Health Officer was confronted with this fact: that he would have to describe by metes and bounds the infected territory in any orders to be given the sheriff, as the statute prescribes, to be legally effective, a condition which he found it was then impossible and impracticable to meet or reasonably or rationally carry into effect. And here a pause is made, to say that unless certain discretionary authority is vested in the State Health Officer to manage or control many disease conditions arising in the state from time to time, which could not have been anticipated or thought of by the legislature or made mention of specifically when the statute providing for the control of communicable diseases was framed and passed, the very purpose of health government and sanitary supervision in Florida will be considerably embarrassed, if not altogether defeated.

In caring for persons-citizens of the state-who are indigent. and who have been bitten by rabid animals, the State Board of Health has offered gratuitously the Pasteur treatment to those financially unable to purchase this vaccine-a method of immunization gradually produced-by which the virus of rabies can be destroyed and the patient saved from horrible agony and death from hydrophobia. Some doubt has been expressed as to the legal authority of the Board to expend funds in the control or management of any disease not especially provided for or mentioned by legislative enactment; but here again arises a question of great moment to the state and her citizenship: whether the executive officer shall sit quietly by, know of, and perhaps see, conditions existing which threaten both the health and peace and comfort of the citizens, and do nothing, because the state statutes dealing with health matters do not particularly state and lay down a rule of action for every exigency which may arise, or whether he shall assume such authority, trusting to the approval of the Board or the courts should such action be questioned. The people must decide this important matter, for after all it is but the expression and wishes of the people which are concreted into laws. To wait for specific statutory authority has a parallel in the oft-cited incident where the man on the dock would offer no assistance to the man in the water likely to be drowned, because he had not been formally presented and introduced to the unfortunate about to lose his life; and the State Health Officer demurs to a strict observance of the letter of the

law and ignoring or lightly considering the spirit of the exigency or exigencies, for it seems to him that the spirit of the law should be made the magnetic needle in directing sanitary assistance to the people of Florida.

From correspondence and from interviews there can be no doubt of this fact: the people of Florida, reposing confidence in the organization which by constitutional enactment they have created, suppose that their health and all that pertains to it is placed in the hands of the State Board of Health to manage and direct, and when reasonable requests looking to that end are met by answers of lack of statutory authority, dissatisfaction is naturally expressed toward a system whereby seemingly indispensable measures are held up or refused because of absence of or ill-defined wording of the statute.

Deaths from Hydrophobia:

During 1911 four deaths from hydrophobia, in humans, were reported to the State Board of Health. The case records are of value and two facts are established beyond the shadow of a doubt by these instances and when it is remembered that 66 other persons bitten by animals demonstrated to have been rabid, either by clinical manifestations or by microscopic examination, or both, and that 48 other persons exposed to animals supposedly rabid, were all successfully treated with anti-rabic vaccine to prevent the development of rabies: that is, that there is a disease, hydrophobia, which may affect the human as well as the lower animals; and, second, the prompt administration of anti-rabic vaccine after a person has been exposed to rabies, will, in most cases, prevent a development of the disease.

Case Records:

Case No. 1, male, white, age 83, residence Otter Creek, Levy county, Florida. Bitten January 6, 1911, by dog. Dog killed and brain sent to laboratory of the State Board of Health at Jacksonville. Examination unsatisfactory, and physician submitting head for examination so informed. Animal inoculation made at laboratory, but after three months the three animals inoculated had shown no symptoms of rabies.

On March 17th, p. m., patient, as stated by the attending physician, Dr. J. W. Turner, was

"taken with a difficulty of swallowing and it soon developed into spasms of the pharyngeal region and glottis, every time he attempted to swallow or put anything about his head or face. Within 12 hours from the time these symptoms developed, he was delirious, restless and could not swallow. His movements were almost continuous; would lie down and get up, walk the floor, sit on a chair, go out of the room and back, all over the same thing. When he would doze off with slumber, he would lose his breath and wake right up. He would beg for water and wish that he knew how he could get it inside him without swallowing it. The last 18 hours he lived he was perfectly insane but never had a convulsion. He died about sixty hours (Monday, March 20th) after exhaustion. He never had an elevation of temperature."

Of eight children also bitten by the same dog, three were given the Pasteur treatment with no untoward development.

Case No. 2, C. L., male, white, age 32, residence Jacksonville, Duval county, Florida. On March 22nd, 1911, was bitten by his pet dog on the nose, near the left eye, an upper incision being close to the supraorbital foramen, and possibly close to a cranial nerve. The animal inflicting the wounds not only gave clinical evidence of hydrophobia, but the Negri bodies were demonstrated by the microscope. Patient was advised to have the Pasteur treatment administered, and consented several hours afterward to do so. Anti-rabic vaccine was thereupon ordered by telegraph from Marietta, Pa. The first three doses, as usual, were administered on March 25th. The subsequent history of the case is given as follows in a letter from Dr. Frederick Bowen, the attending physician:

"State Health Officer,

Sir:

City.

"April 11, 1911.

I regret to report the case of C. L., who was bitten by a dog on March 22nd, has terminated fatally. The man began treatment March 25th, receiving his first dose of vaccine on that date....

The man proceeded for the first seven days without symptoms. The 8th, 9th and 10th doses produced marked induration, which subsided about three days later.

On April 6th the patient complained of general drowsiness, telling me that he had fallen asleep in his buggy once. On Friday (7th) he complained of the same with the addition of pain in his head, which he said radiated from the top of his head over the location of the wound received from the dog. The wound had entirely healed over by the ninth day.

Treatment was continued until Sunday when symptoms of pain in the throat, headache, dryness of the throat and fear of cold liquids induced me to stop treatment.

On Monday morning, in company with Dr. Hiram Byrd, Assistant State Health Officer, I went to the residence of the patient, and found him suffering from great nervousness, pain in the head, spasmodic contraction of the

throat, inability to swallow cold liquids, convulsive seizures and inability to sleep.

I ordered morphine in the amounts of one-half to one grain to be repeated at frequent intervals until quiet. At the end of twenty-four hours he had taken twenty grains of morphine hypodermatically, twenty-four grains of sodium bromide and about one-half ounce of chloral hydrate by rectum, but these sedatives had produced only short intervals of sleep, but with little or no relief from the convulsive seizures.

The man's condition become steadily worse, until Tuesday, April 11, when general paralysis set in and the patient died."

It may be said in explanation for the sudden termination of this case that the virus which entered through the wound produced by the animal which bit him was extremely virulent and progressed faster than the preventive treatment could retard. The City Health Officer of Jacksonville, as well as the attaches of the executive office and the Jacksonville laboratory, have several times during the year remarked upon the seeming extreme virulence of the type of rabies prevailing in Duval county.

Case No. 3. The history of this case, as follows, is abstracted from "Rabies in a Human Being, with Post Mortem," by Henry Hanson, A. B., M. D., Senior Bacteriologist, State Board of Health Laboratories of Florida, Jacksonville, Florida., published in the Journal of the American Medical Association, December 23, 1911, vol. lvii, pp. 2064-2068. Dr. R. L. May of Jacksonville was the attending physician in the case.

Patient.-March 12, 1911, Dr. May was called to see a boy with severe throat symptoms and inability to swallow. It was at first thought that possibly this might be due to some of the commoner throat affections, probably diphtheria. On examination of the throat, however, nothing definite was revealed and the forcible depression of the tongue during the examination seemed temporarily to enable the patient to swallow a bit of medicine which the doctor administered. When the boy tried to drink some water it was forcibly expelled through the nose and mouth and a general convulsion was noted. Aside from this the patient's condition did not seem very serious and the doctor left, stating that he would call again.

History. A few hours after leaving the patient, Dr. May received a hurry call and on return found the patient very much worse. The boy was more nervous, the respiration was interfered with, and the muscles of deglutition were paralyzed. This aroused the doctor's suspicion and he began to inquire about the possibility of the boy's having been bitten by a dog, and learned that some three weeks previous a stray dog had made its appearance about the premises and the boy had captured it, intending to keep it as a pet. The dog seemed somewhat vicious at times and, when the boy was tying it up, bit him severely on the calves of both legs. The father, in attempting to help the boy tie the dog up, was bitten on the wrist but not very severely. Two other children were also bitten by the same dog but so far nothing had come of it. Shortly after this the dog escaped and nothing further was known of it. Three

*The father and one of the children were afterward given the Pasteur treatment, commencing March 20th, with no untoward developments.