At the time of onset of the first symp toms of hydrophobia these local meas ures may properly again be resorted to should any evidences of irritation of the wound be present. The patient should be kept in a darkened room and free from any sources of irritation or annoy ance. Restraint of any kind is not necessary, there being, contrary to com mon belief, little or no tendency on the part of the patient to injure others, and there is no danger of those in attendance contracting the disease. The patient should not be forced to make attempts at swallowing food or drink. Nutrient enemata should be employed, and large quantities of water be given by the rec tum.
Local applications of cocaine to the fauces and pharynx are said to prevent spasm and enable the patient to swallow.
During the violent spasms chloroform may be used by inhalation, and the ad ministration of bromides and chloral by the mouth and of morphine hypodermic ally are followed by some amelioration of the acute symptom. Curare, in to doses every half-hour until muscular relaxation occurs, is lauded by sonic. All such remedies are, however, merely palliative and exert no influence over the course of the disease.
Preventive Inoculation. — The work of Pasteur in developing the treatment of rabies by preventive inoculation con stitutes by far the most important ad dition to our knowledge of the nature of the affection and the possibilities of its cure which has been made since the disease was first recognized. Pasteur found that the toxin in the spinal cords of rabbits which had been killed by rabies inoculation gradually lost its viru lence if the cords were kept for some days under antiseptic precautions; so that after about two weeks the cord was no longer poisonous, inoculations from it failing to produce the disease. This fact offered then a method of gradually establishing an immunity, by inoculat ing the infected animal with cords which had, to a certain degree, lost their viru lence through preservation in this way. The production of artificial immunity is the now widely and successfully em ployed Pasteur treatment for rabies, persons bitten by mad dogs being ried through a series of inoculations with the spinal cords of rabbits. The inoculation is begun with cord which has been kept for 14 days; the second day cord 13 days old is employed; the third day 12-day-old cord, and so on until cord 5-clay-old is reached, when a new series of inoculations is commenced with the cord of the ninth or tenth day.
In the "intensive" method the tion of the morning of the first day is from cords 14 and 13 days old rubbed up together, cords of the 12th and 11th days being used the same evening, cords of the 10th and 9th days the following morning, and cords of the 8th and 7th the same afternoon. On the third day cord 6 days old is used; on the fourth day cord 5 days old, on the fifth day cord 4 days old, on the sixth day cord 3 days old; then a new series is begun with cord 5 days old. After from one to several weeks of this treatment the patient is regarded as immune, and the subsequent development of rabies is but slightly to be dreaded.
Instead of using Pasteur's method of protective "vaccination" for the animals from which the serum is to be obtained, according to personal method, the virus that is to be used is attenuated by a process of peptic digestion. The activity of the virus is thus so far modified that considerable doses may be injected at a comparatively early stage of the process; the animals that have been so injected withstand the action of the more viru lent virus within a comparatively short period. When an inoculation with a lethal dose of the poison is made, a com paratively small quantity of the serum serves to neutralize its effect if injected at once, and even if delayed until the end of the first half of the incubation period the amount required to be given has only to be multiplied some six or eight times. It is possible, by drying, to prepare a "permanent" form of this serum which will, if kept from air and light, remain active for a long period. It is very portable, is readily dissolved, and may be used by anyone who is ca pable of sterilizing a subcutaneous inject ing needle and syringe. The treatment, therefore, can be commenced almost as soon as the patient has received the bite, as it is not necessary that he should leave his home or his own medical at tendant, with the result that the patient at once receives a quantity of the anti toxic material, which under the Pasteur method could only be manufactured in the body of the patient himself, and then in quantities sufficient to neutralize the infective material, say, after the sec ond half of the incubation-period. Tiz zoni and Centanni (Atti della Reale Accad. defile Sci. dell' Inst. di Bologna, Feb. 10, '95).