A Brief History of Rabies

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Stuff You Missed in History Class, a production
of I Heart Radio. Hello, and welcome to the podcast.
I'm Tracy V. Wilson. Now I'm Holly Fry. Foxes are
one of many wild animals that share cities and other

(00:21):
places with human beings, and in April, one of them
made headlines after biting at least nine people around the
US capital. When this story crossed my Twitter feed, I'm
became incredibly invested in whether everybody who got bitten by
this fox had gotten their rabies shots. Afterward, news articles

(00:41):
were not telling me the answer to this information. Some
of them were talking about a specific reporter or a
specific congress person, but I was like, no, everybody, everybody
needs to get the raby shots because foxes can carry rabies.
Rabies is virtually always is fatal once people develop symptoms,

(01:02):
once anyone developed symptoms, but today's rabies profile access is
almost a dent effective at preventing that from happening. It
is I think the most effective vaccine that we have
in existence. So then when news broke that yes, this
fox did have rabies, it was like just a big flashing,
screaming side in my brain, like raby shots raby shots.

(01:23):
Raby shots, Please tell me everyone got their rabies shots.
Of course, then that made me want to do a
podcast on rabies and the vaccine that prevents it, something
that somehow I thought we already had stuff on. We don't,
or if we do, I failed to find it. The
vast majority of our listeners live in places where Raby's

(01:44):
deaths in humans are extremely rare. Some parts of the
world are rabies free, and here in the United States
there were only five human deaths from rabies, and that
was the highest number of annual rabies deaths in the
United States in a decade. There are also places, though,
where rabies is still endemic, and globally about fifty six

(02:07):
thousand people die from it every year. That is not
like that's a small number compared to something like the
current pandemic, but they're fifty six thousand totally preventable deaths,
Like we have what we need to prevent this, So
I wanted to talk about that heads up though there's
a lot of animal experimentation in this episode and deaths. Obviously,

(02:32):
rabies is caused by rabies list of virus, which probably
originated in Old World bats. This virus has existed on
every continent except Antarctica and Australia for millennia, and although
Australia is Rabi's free, it's home to a closely related
virus called bat lists of virus. But in spite of

(02:52):
the viruses connection to Bat's humanity's connection to rabies has
mainly been through dogs. That connection show is up in
the first written reference we have of rabies, that's in
the Eshnuna code from roughly two thousand b c e.
Shnano was a city and what's now Iraq, and some
of its laws have survived on a pair of broken

(03:14):
tablets that were found at an archaeological site near Baghdad.
Here's one of the laws quote. If a dog is mad,
and the authorities have brought the fact to the knowledge
of its owner, if he does not keep it in,
and it bites a man and causes his death, then
the owner shall pay two thirds of amina of silver.
If it bites a slave and causes his death, he

(03:37):
shall pay fifteen shekels of silver. The first written reference
to rabies in China is from the Zoo tradition, sometimes
called the Zoo Commentary. This is a commentary on the
spring and Autumn Annals, which chronicles a period of Chinese
history stretching from seven twenty two to four eighty one
b C. One passage in the Two Tradition describes people

(04:00):
of the capital city of Sung chasing a rabid dog.
The dog ran into the home of a minister named
wat Chin, and the people chased after it. Wat Chin
was afraid and fled the city, and about the fourth
century BC, Aristotle wrote this and his History of Animals
quote dogs suffer from three diseases, rabies, quincy, and sore feet.

(04:25):
Rabies drives the animal mad, and any animal whatever, accepting man,
will take the disease if bitten by a dog so afflicted,
the disease is fatal to the dog itself and to
any animal it may bite man accepted. So this translation
makes it sound like Aristotle was saying that humans don't
get rabies, but it's also been interpreted as meaning that

(04:48):
people don't always develop rabies when bitten by a rabid dog,
and that is true, or that people don't always die
from the disease if they contract it, which is almost
never true. People will have known that rabies was essentially
always fatal for thousands of years, though Roman court physicians
Scribonious Largest described rabies as incurable in the first century CE.

(05:11):
In addition to being lethal, rabies progresses in a way
that can be really terrifying. The exact symptoms can vary,
but there are two broad categories, both of which end
in coma and death. Paralytic rabies involves lethargy, weakness, and paralysis,
and furious rabies involves agitation, aggression, and hyperactivity. The word

(05:36):
rabies reflects this latter type that comes from the Latin
for to rage, which may have roots in a Sanskrit
word meaning to do violence. Lissa virus has a similar root.
It comes from a Greek word meaning frenzy or madness,
which was used to describe rabies as well as to
describe irrational rage. Raby shows up a lot in popular

(05:59):
cult sure, and that goes back thousands of years as well,
including the use of rabies or rabid dogs as a
metaphor for being mad or uncontrollable. For example, in the Iliad,
which was written in about the eighth century b c. E.
Homer describes Hector as a rabid dog. Rabies can also
cause paralysis and spasms in the throat that make it

(06:22):
impossible to swallow water. That's why it's also known as hydrophobia,
and the second century CE Roman philosopher Celsus used the
word hydrophobia in his description of the disease. Celsus also
recognized that something was present in saliva that transmitted this illness,
and he recommended a range of techniques to draw this

(06:45):
substance out of wounds. Like the connection between rabies and
aggressive rage, the connection between rabies and hydrophobia made its
way into literature centuries ago. For example, in about the
year five hundred, Klias A lean Is suggested that Homer's
description of Tantalus in the Odyssey might have been inspired

(07:06):
by rabies, since Tantalus is tormented by water that he
cannot drink. It's also possible that rabies influenced ancient Greek
depictions of Cerberus, the multi headed dog that guarded the underworld,
and that those depictions of a mad beast with poison
frothing from its jaws circled back to influence people's perceptions

(07:26):
of rabies. So through these and other written references, we
know that rabies had spread from wherever it originated, all
through India, China, the Middle East, Greece, rome in Egypt
by about fifteen hundred years ago, but we don't really
know how widespread the disease was in any of these places,

(07:46):
or how many deaths it caused among humans and other animals.
That starts to change in the medieval period, when people
started documenting large outbreaks of the disease within specific animals.
These account it's primarily focused on outbreaks among dogs and
other canids, including wolves and foxes. For example, an outbreak

(08:07):
of wolf rabies struck Franconia in twelve seventy one. A
massive outbreak among red foxes spread over parts of Europe
between fifteen seventy one and fifteen eighty one, leading people
to try to stop the disease by culling them. Sometimes
these outbreaks could spread to other animals, including infecting people
when they were bitten. At this point, we haven't mentioned

(08:30):
rabies in the America's and that's because while rabies existed
in the Americas through all this, rabid dogs probably did not.
Based on genetic studies of the virus itself. Before European colonization,
rabies and the America's primarily infected bats and skunks. There's

(08:50):
some evidence that Indigenous peoples in ancient Central and South
America regarded both bat bites and snake bites as potentially dangerous,
treated bat bites with washing and cauterization with hot culls
to try to prevent disease. Spanish colonists were reported being
bitten by bats in the early fifteen hundreds, and in

(09:12):
fifteen fourteen, Fernandez de Oviedo wrote about several soldiers dying
after being bitten by vampire bats. Dog rabies is one
of many diseases that Europeans introduced to the America's, and
after that introduction, it spread to other animals and became
far more likely to infect people, but that process did

(09:33):
not happen nearly as quickly with rabies as it did
with diseases like smallpox. Rabies typically has an incubation period
of roughly three to eight weeks, although it can occasionally
be much longer. Once symptoms appear, rabies is virtually always
fatal within about ten days. When Europeans first started sailing

(09:53):
to the America's, the voyage often took more than two months,
so any dogs or other animals that had been infect
did before setting sale usually developed symptoms and died or
were killed while still at sea, so that meant introducing
dog rabies to the America's required a voyage that was
short enough for infected dogs to survive. It also required

(10:16):
a large enough population of dogs and other mammals within
a colony for the disease to keep circulating once it
had been introduced. The first recorded outbreak of dog rabies
in the Americas was reported in Mexico City in seventeen
o nine, and by the end of the eighteenth century,
dog rabies was widespread in most of the places in

(10:37):
the Americas that Europeans had colonized. This in turn spread
the disease to the continent's native animals, with some of
those exposures leading to new strains of the virus that
were adapted to specific species. We'll talk about how a
vaccine was developed to prevent rabies after a sponsor break.

(11:06):
By the eighteenth and nineteenth centuries, outbreaks of rabies were
spread across a lot of the world and domesticated dogs
and in wild animals. In North America, rabies became so
widespread in skunks that they were nicknamed Phoebe cats like
hydrophoby and phoebe tents were advertised as a way for
cowboys to avoid being bitten by them in their sleep.

(11:29):
In eighteen o three, and outbreak among wild foxes in
France spread to dogs, pigs, and people. Bites from rabid
wolves tended to be particularly lethal, in part because attacking
wolves often bit people's faces or necks, meaning the virus
was way closer to their brain, while rabid dogs usually

(11:50):
bit people's hands or arms. There was no cure for
rabies and no way to tell whether a person would
develop it after being bitten, and estimates of how many
people developed rabies after a bite stretch all the way
from five percent to Some of this is just because
of imprecise record keeping, but it's also connected to how

(12:11):
people responded to the disease. In many places, there was
a widespread assumption that any animal that bit had rabies,
and during outbreaks, people tended to hunt down and kill
animals that they thought might be spreading disease. So a
dog that bits someone in the midst of all of
this might be rabid, or it might just be scared

(12:31):
and cornered and trying to defend itself. Around the world,
people tried various herbs and medical preparations to prevent or
cure rabies, and because it was so lethal, many of
these were also relied on the idea of divine intervention.
For example, Hubertus, also called St. Hubert Is the patron

(12:51):
saint of hunting, and one of his reported miracles involved
curing somebody who had been bitten by a rabid dog.
So inch of Europe people used a piece of iron
called St. Hubert's key to cauterize bite wounds. As part
of this treatment, a priest would also make a shallow
cut over a person's forehead, place a black bandage over that,

(13:15):
and the person wore that bandage for nine days. Some
people even carried one of these keys around with them
for protection. Long before the development of the germ theory
of disease, people recognize that when someone was bitten by
a rabid animal, something in the animals saliva was going
into the wound and potentially causing rabies. So some of

(13:35):
the other treatments for bites involved washing the wound, applying
caustic chemicals to it, or cauterizing in whether it was
with a Saint Hubertists key or with some other implement.
If these treatments were done immediately, after a person was bitten.
They may have helped reduce the chance of developing rabies
by washing away the animals infected saliva. Thoroughly washing the

(13:58):
wound is still step one in rabies prevention today, but
none of this was enough to totally prevent the chance
of developing the fatal disease. People also tried to prevent
rabies by reducing the numbers of animals that could carry
it and transmit it to humans and to other animals.
For example, in eighteen sixty seven, the UK passed the

(14:20):
Metropolitan Streets Act. Among other things, this act empowered police
to collect and muzzle stray dogs, are dogs that were
determined to be dangerous. This reportedly led to a drop
in human cases of rabies in British cities. Also in
the eighteenth and nineteen centuries, researchers were learning about rabies

(14:40):
and working on ways to prevent it spread. During the
earlier part of this time, researchers didn't yet know what
a virus was. But trying to talk around that got
really clunky. So we are still going to call it
a virus in our discussion today. Yeah, it was a
lot of incredibly stilted sentences before I was like, we're
just it a virus, regardless of whether that individual research

(15:03):
or knew what a virus was. So in seventeen sixty nine,
Italian anatomist and pathologist John Morganni observed that rabies traveled
via the nerves rather than traveling through the bloodstream. He
made this connection because some patients reported a feeling of
pins and needles or other neurological disturbances around the site

(15:25):
of their original bite wounds. Morgan was correct. Once it
enters the body, the rabies virus moves along the nerves
until it gets to the brain and the rest of
the central nervous system. After it gets to the brain,
the rabies virus makes its way to the salivary glands,
where it can cause excessive salivation, and although eighteen century

(15:47):
researchers didn't quite have that part figured out, they did
know that the disease was spread through saliva. In seventeen
ninety three, Scottish surgeon John Hunter speculated that it would
be possible to use a lancet to intentionally introduce an
infected animals saliva into another animal, but it's not clear
whether he tried this in practice. We also don't know

(16:09):
whether German naturalist George Gottfried Zinca was familiar with Hunter's work,
but in eighteen o four he brushed saliva from a
rabid dog onto a cut he had made in the
leg of a healthy dog. This previously healthy dog contracted rabies.
He did the same thing with other healthy mammals, demonstrating

(16:31):
that it was possible for the bite of an infected
dog to infect animals of other species. In eighteen twenty one,
French neurophysiologist Francois Magendie reported that he had infected a
previously healthy dog with saliva from a person who had
contracted rabies. Victor Gautier was a professor at the National

(16:53):
Veterinary School in Lyon, France, and he started experimenting with
rabies in eighteen seventy nine. He found that it was
possible to transmit rabies from a dog to a rabbit,
and then from that rabbit to another rabbit. Rabbits were
smaller and easier to keep than dogs, and they were
less dangerous research subjects than rabbid dogs were. Gaultier also

(17:15):
found that the rabbits had a shorter incubation period of
about eighteen days rather than a month or more that
you might see in a dog. Gaultier did various experiments
with infected animals saliva, attempting to see whether he could
find some way of using this infectious material to prevent rabies.
In eighteen eighty one, he injected rabies virus into the

(17:37):
jugular veins of sheep and they didn't develop rabies, and
then when he exposed one of them to saliva from
a rabbit dog later on, it seemed like it was
immune to the disease. French chemist and microbiologist Louis Pasteur
started working on rabies at about this same time, and
he was inspired by Gaultier success. Pastor already an extensive

(18:00):
background in this kind of work. In the eighteen fifties,
he had studied yeast and alcohol fermentation, as well as
the ability for micro organisms to contaminate fermenting beverages. This
had contributed to both the germ theory of disease and
the development of pasteurization. In the eighteen sixties, he had
identified a micro organism that was devastating the French silk industry,

(18:24):
and in the eighteen seventies he studied animal diseases like
anthrax and chicken colera, including developing an anthrax vaccine. While
Pasteur had lots of experience in this kind of research,
he had pretty much no experience in medicine or the
clinical treatment of patients, so he relied on other people
for this knowledge, including French physician and bacteriologist Emile Roux.

(18:49):
A whole team of other scientists and doctors were involved
in this work as well, including Charles Chamberlin, Emile Duclox,
Louis Dulier, and Joseph grane A. This is definitely not
a solo effort, and Pasteur was not always excited about
crediting other people for their involvement in it. There are

(19:09):
even some historians who have accused him of stealing other
people's ideas. Much of Pastor's previous work had involved culturing
bacteria and working from those cultures, and he started out
trying to do the same thing with rabies. Since rabies
is caused by a virus rather than a bacterium, Pastor's
efforts to replicate his earlier process failed. He started working

(19:32):
directly with the saliva of infected animals and then moved
on to working with central nervous system matter. He found
that if he exposed a healthy rabbit to rabies, it
developed rabies. Then if he used that rabbit's central nervous
system matter to expose another rabbit, that second rabbit also
developed rabies, and the second rabbits infection seemed to be

(19:55):
more virulent than the first. If he did this a
third time, the third rabbit's infection was also more virulent
than the seconds had been. He continued this serial passage
of the virus from rabbits to rabbit until he had
a strain of it that he described as fixed. It
was consistent and how virulent it was, and it had

(20:18):
an incubation period that was set at six or seven days.
From there, Pastor air dried the spinal cords of rabbits
that had died of that highly virulent fixed strain. The
longer they dried, the weaker the virus became. That's a
process called attenuation. When he exposed other animals to a
small amount of this attenuated virus, they seemed to develop

(20:41):
a resistance to rabies rather than becoming ill. From there,
Pastor started to wonder whether it was possible to make
an animal more resistant to rabies after it had already
been bitten. Preventing it from developing the disease. Having successfully
tested out this idea in dogs, he tried at it
on two people, but he didn't publish on either of

(21:03):
these attempts, so they were not known about until much later.
One of these was a man who had been bitten
by a dog, and while this man survived, it's also
likely that he had not actually been exposed to rabies.
The other was an eleven year old girl who had
been bitten in the face by a puppy, and she
had already started developing rabies symptoms. She died the day

(21:25):
after she was given the treatment. On July four, nine
year old Joseph Meister was repeatedly bitten by a dog
in Alsace. The dog was believed to be rabid, and
two days later the child was brought to Pestor for help.
Emil Ru had been heavily involved in Pestor's research up
to this point, and he refused to be involved in

(21:46):
the boy's treatment because of ethical concerns. Pastor expressed some
reluctance as well, but Joseph Granche and Alfred Vopien of
the Academy to Medicine encouraged him to try with granch
admit us during the treatment. Since Pastor was not a doctor,
Joseph was given a series of inoculations over the span

(22:07):
of ten days, starting with a very weak preparation and
working up through ones that were less and less attenuated.
Three months later, he had no sign of rabies. Another
attempt was started with another patient shortly after Joseph Meister
was declared to be in the clear. That was Jean
Baptiste Jupel, a fourteen year old shepherd who had been

(22:29):
mauled while saving a group of younger boys from a dog.
Pastor reported his results to the French Academy of Science
on October eighteen eighty five, while Dupeel's treatment was still ongoing.
Told about his success with Joseph Meister and the fact
that he had successfully inoculated fifty dogs against rabies before

(22:49):
trying this process on a human. We're gonna talk more
about what happened with all of this after we paused
for a quick sponsor break. As a word of Pastor's
success that preventing rabies started to spread, people started flocking

(23:12):
to him for treatment. By the start of eighteen eighties six,
he had treated at least three hundred and fifty people.
They came from all over Europe and from the United States.
In early December of eighteen eighty five, a dog bit
at least seven other dogs and six children in Newark,
New Jersey. Word of Pastor's work had made it to

(23:34):
the US, and a local doctor published an appeal for
funds to send the boys to Paris for treatment. Four
of the boys were sent to Paris by steamer. The
other two were determined to not have sufficient injuries to
need treatment. American news coverage of these boys tripped to
Paris and then they returned to the United States turned

(23:56):
rabies vaccine into just a media station, and three of
the boys were displayed at the Globe Museum in the
Bowery in New York after they all got home. Not
everyone agreed with what Pastor and his team were doing.
Anti vivisectionists objected to the use of animals in this research.

(24:17):
And as we've said, not everyone who is bitten by
a rabid animal contracts rabies, and not every animal who
bites someone is rabid. Since there was still not a
test for rabies, determining whether an animal had it usually
involved just waiting to see if it died. But that
wasn't really possible if it had already been killed, or
if it just couldn't be found. You could also expose

(24:40):
a healthy animal to the brain or saliva of an
animal who had bitten someone, but by the time the
healthy animal showed any symptoms, it was just likely to
be too late for the human patient. So critics made
the point that Pasteur was potentially exposing people to rabies
for no reason, and his inoculation caused somebody who had

(25:01):
been bitten by a non rabid dog to then develop
rabies because of their treatment. Critics also noted that some
of pasteurs patients did die. By November of eighteen eighty six,
seventeen hundred patients had received rabies injections, and ten of
them had died. The uncertainty combined with the deaths to

(25:23):
spark a huge amount of debate within the medical community
about whether what Pasteur was doing was ethical or even
medically necessary. The Academy Demnsen held a meeting on the
subject on January eleventh, eighteen eighty seven. Although Pastor's critics
were vocal, his supporters, led by Dr Joseph Granche, successfully

(25:44):
defended his work. The Institute Pasteur was established on June fourth,
eighteen eighty seven, and it opened on November fourteenth of
that year. It focused on disease research and on providing
rabies vaccine. By eight more than twenty thousand people had
been treated at the Pastier Institute after a possible rabies exposure,

(26:06):
and only nine six of them had died, or less
than half of a percent of patients. To be clear,
there was a lot about this early version of the
vaccine that was inherently unsafe. It was basically made from
animal brain or spinal corn tissue. There could for sure
be complications, but this was still a dramatic improvement over

(26:29):
an untreatable fatal disease. Discoveries about the rabies virus continued
after this point. In three, Italian pathologist al Deci Negri
discovered round and oval regions in the brains of animals
that had died of rabies, which he called negribodies. At
the time he thought they were some kind of parasite,

(26:50):
but they actually arise as part of the reproductive cycle
of the virus. This paved the way for the first
rabies tests. While there are new methods for detecting rabies
in brain matter, Today, negribodies are still sometimes used when
those methods are not available. The most reliable tests do
still involve examining an animal's brain, which is why living

(27:14):
animals have to be euthanized to be tested for rabies.
Refinements in the vaccine were also in the works. Pastor's
methods didn't always produce a consistently potent vaccine, and if
it was too potent, it could cause somebody to contract rabies.
In the early twentieth century, researchers started using phenol to

(27:35):
kill the virus rather than attenuating it through air drying.
Viruses were cultured in tissues in NY six, which led
to tissue cultured vaccines rather than using brain matter to
make them. Today's rabies vaccines are mostly cultured in human
cells or in chick embryos or some other cellular matter.

(27:58):
Although some of Pastor's colleagues speculated about whether it would
be possible to mass vaccinate dogs or other animals and
lower the spread of rabies to people, serious efforts to
do that didn't start until decades later, but efforts like
that have led to the successful eradication of rabies in
some parts of the world. There are too many rabies

(28:20):
free countries today for us to try to name them all,
but they include many islands, including many Caribbean islands, the
Canary Islands, the Falkland Islands, the Galapagos Islands, the UK, Iceland, Japan,
and New Zealand. Several nations in continental Europe are also
considered rabies free, including much of Western Europe. We should note, though,

(28:42):
that rabies free often means rabies free and terrestrial animals.
There can still be rabies or other lists of viruses
in bats, specifically, so even if you are somewhere that
is considered rabies free, being bitten by a bat still
warrants medical attention. Just in general, don't touch baths with

(29:05):
your bare hands. You don't need to be afraid of bats.
They're generally pretty shy and they're not gonna mess with
you if you don't mess with that. But like, don't
go grab one with your hands, which is so hard
because they're so cute, not for me because I see one.
Like if I see a bat somewhere that I don't
expect to see a bat, I'm like that bat is
definitely a problem. I'm not going anywhere near it. I

(29:26):
will tell a bat story and are behind the scenes.
As we said at the top of the show, rabies
is still endemic in some parts of the world, including
parts of Asia and Africa. About of human rabies deaths
occur each year in India, with the vast majority of
those exposures coming from dogs, and some serious outbreaks among

(29:47):
wild animals started long after the raby's vaccine was developed.
For example, rabies was identified in North American raccoons in
nineteen thirty six, and there is an ongoing epidemic of
rabies among rec coons all along the East Coast. There
are efforts to get these and other outbreaks in wild
animals under control, using things like oral rabies vaccine baits. Yeah,

(30:10):
they're also mass vaccination campaigns. A lot of work on this.
A lot of the deaths that occur around the world
happen in children who just wanted to pet a dog
and got bitten, so it is very sad. It's also
possible for one animal to spark a huge exposure scenario
even in places where rabies is relatively well controlled. For example,

(30:34):
on October a family bought a kitten from a pet
store in New Hampshire and then about three weeks later,
this kitten developed seizures and died. After its death, it
was determined to have had rabies. This kitten had been
examined by a veterinarian and had a certificate of health
before it was sold, but the pet store didn't have

(30:55):
clear records of when animals had arrived there or been sold,
so in the end, six hundred sixty five people received
post exposure prophylaxis or PEP for rabies. These were people
who had come into contact with that kitten, or who
had bought other animals that had probably had contact with

(31:17):
the kitten at the store, or people who had contact
with those animals, people who worked at the store, people
who visited the store and handled the animals. Really just
on and on. The probable initial source for this whole
thing was a raccoon that may have come into contact
with three feral kittens that were then captured and sold

(31:38):
at the store. As a side note, you may have
heard that Raby's prophylaxis is a horrifying series of incredibly
painful shots directly into the stomach with a gigantic and
terrifying needle. It is not Older versions of Raby's PEP
did involve a long series of fourteen to twenty one
shots usually given in the abdomen. But that's just because

(32:01):
the abdomen offered a lot more surface area to work with,
not because the injections went into the stomach through a
huge needle. Still, I mean to be clear, that is
a lot of shots into a tender area, and the
vaccine that was in use at the time could have
a range of unpleasant side effects. Yeah, I would not
want to get fourteen to twenty one shots all around

(32:22):
my abdominat it. It was not a gigantically long needle
going into people's actual stomachs. It's also not what is
in use today. The current recommendation is that a person
gets one dose of human rabies immune globulin and one
dose of rabies vaccine shortly after the bite. The immune

(32:44):
globulin is typically injected near the bite location, and then
the vaccine typically goes into the deltoid region of the arm,
where lots of other vaccines go. Then the person gets
three more doses of vaccine that are spread out in
the days that follow, again as injections into the shoulder area.
Also using a vaccine that is like cultured and tissues

(33:06):
and a lot safer than what was being used in
the past. This process can be a little bit different
for children or if a person is um you know, compromised,
or if a person has been previously vaccinated for rabies.
That's something that's typically only done based on a person's
risk for being exposed to rabies. As another side note,

(33:27):
we have been really really focused on bites here because
the overwhelming majority of rabies exposures come from bites or
possibly scratches. There are some other ways to contract the disease,
but they're extraordinarily rare, like through the eyes or mucous membranes.
If someone is exposed to aerosolized rabies virus in some way,
or because rabies can closely resemble various types of encephalitis,

(33:51):
it is sometimes missed as a diagnosis when doctors don't
know that the person was bitten by an animal. This
has led to an extremely small a number of rabies
transmissions through organ transplants, although the risk of this is
extremely remote. After their first report of it happening, many
organ procurement organizations started including screening questions to try to

(34:13):
rule out this possibility. Circling back around to rabies and
pop culture, This was actually a plot line on the
TV show Scrubs. Its sounds truly horrifying, but also like
the disease process that rabies causes, like in the umbrella
of encephalitis, And if a doctor doesn't know that a
person was bitten by an animal or picked up a

(34:33):
bat or whatever, like it's most doctors have never seen
a case of rabies in their career, and it's not
the thing that first comes to mind. In two thousand four,
fifteen year old Gina Geezy and her medical team made
headlines after she became the first person known to survive
rabies after starting to develop symptoms. She had picked up

(34:55):
and been bitten by a bat, and although her wound
was cleaned with hydrogen per beside, she wasn't taken in
for further treatment. She started developing symptoms about a month later,
and then about six days into her illness reported having
been bitten by the bat. Doctors placed ge Zy in
a medically induced coma and gave her anti viral drugs

(35:15):
and other treatments. These treatments continued until tess suggested that
her body was fighting off the virus, and at that
point she was brought out of the coma. She survived
this experience, and news outlets have continued to report on
her life into the year one. At the time, this
seemed like a hopeful sign that what came to be
known as the Milwaukee Protocol would make it possible to

(35:38):
cure people after they started showing symptoms of rabies, but
efforts to replicate that success have been largely unsuccessful. One
paper in the Journal of the Brazilian Society of Tropical
Medicine traced thirty eight published uses of the Milwaukee Protocol,
including one use of a similar protocol called the Recipe

(35:59):
proto Call. Only eleven of those patients survived, with all
but five of them having moderate to severe complications afterward.
This is certainly an improvement over a disease with an
essentially fatality rate, but these numbers may be deceptively optimistic.
Three of the people who were described as having survived

(36:21):
did make it through the most critical part of the illness,
but they still died. At least one of the patients
may not have actually had rabies, and there's been no
coordinated method for tracking when this protocol has or hasn't
been attempted. It's likely that anyone who tried it and
succeeded would publish their results. But it's also possible that

(36:41):
people who tried it and failed have not yet. There
are some papers like Opinion Commentary written by teams of
doctors that are like this does not work and we
need to stop focusing our effort on it, and others
that are a little bit more like this may need
some other refining before it could work. Aside from all that, though,

(37:03):
all the patients described in these publications spent at least
a month in the hospital with extensive care throughout their stay,
so it's extremely unlikely that this protocol could really be
put into use in the places where human deaths from
rabies are the most prevalent. These places tend to be
rural and poor without a lot of health care infrastructure.

(37:24):
Places where people don't have access to Raby's profile axis
are likely to also be places where people don't have
access to a hospital that could support this kind of treatment. Also,
it's extremely clear at this point that coordinated programs of
public education and dog vaccinations and sometimes vaccinations in particular

(37:46):
wild animals, can lower the number of human Raby's deaths enormously,
and places that don't have the resources to support those
kinds of programs and initiatives are really likely not to
have the resources to support hundreds or thousands of people
with long term hospital stays and medically induced comas. It's like,

(38:09):
even if this worked, it would really be working for
the wealthiest countries in the world and not the places
where treatment is most needed. So all of that said,
the global cost of rabies is roughly eight point six
billion dollars per year, and more than fifteen million people
per year received rabies PEP. This protocol can be really expensive.

(38:31):
In the United States, it can cost between twelve hundred
and sixty hundred dollars. Yeah, that's like one estimate that
I can saw that I saw. I saw something that
were even higher than that. September twenty eight every year
is World Raby's Day. That's also the anniversary of the
death of Louis Pasteur. Well, that's a basic history of rabies. Rabies.

(38:54):
My my hope is that in the future will at
least get to the point where the places in the
world that have lots of free roaming dogs also have
those dogs vaccinated, because that's really where like so much
feeding back into the greater environment and so much feeding

(39:17):
into humans cases of rabies, Like it's all interconnected with
the dogs. Yeah. I think we mentioned it at the
top of our episode on the history of veterinary medicine
that one of the vets at my practice participates in
a program where she goes to countries where the dog
population is not well vaccinated and tries to just do

(39:37):
as many vaccinations as they can in a short period
of time. Yeah, they had gone some mallowe I think.
And Malawi's target is like se of the dog population vaccinated,
which would do a lot to reduce the number of
human deaths, but still would like there would still be
a reservoir of circulating rabies among dog populations. There are

(39:58):
a lot of sad parts to that, but one of
the saddest parts is like a lot of the a
lot of the people who die of rabies are like
just a kid that wanted to pet a dog. So anyway, uh,
I haven't a listener mail it's about animals, um, it's
not about rabies. It's from Kaylee, And it followed our

(40:20):
episodes on Shackleton. Kaylee rode in and said, Hi, Holly
and Tracy, I'm a huge fan of yours. I've been
listening to your podcast for years. I finally have something
to write to you about. I just listened to the
Endurance episodes. I can't wait for your behind the scenes
episodes about it. I'm a children's librarian in Maine, and
it's my job to try to read as many books

(40:41):
in our children's collection in order to give recommendations. Well,
a twenty nineteen book called Fearless Felines thirty True Tales
of Courageous Cats came across my desk a few months back,
and as an avid cat lover, I opened up the
book and immediately started reading. The first story I happened
to see was about Mrs Chippy, the explorer cat aboard

(41:03):
the Endurance. According to this children's book and other research,
I found, Mrs Chippy would climb in the rigging and
walker along the narrow ship rails, even in bad weather.
There was one episode where Mrs Chippy jumped through the
porthole and the crew had to rescue him after he
spent ten minutes in the water. When I read the
part about the ship getting stuck in shackleton, making tough

(41:25):
decisions and this meant no more Mrs Chippy, I absolutely
lost it and hit in the library basement, bawling my
eyes out. As a highly sensitive person, sometimes I wonder
if I can make it as a children's librarian from
all the books I've read that have caused tears. Fast
forward to more recent weeks than I was driving to
work and listening to NPR and the story of the
Endurance wreckage being discovered came on. A descendant of Shackleton

(41:48):
was talking about how their great grandfather was a hero
and brave and all I could do was hell but
he killed Mrs Chippy at the radio, listening to your
episodes about Shackleton and the Endurance gave me another perspective.
Though Shackleton clearly cared about his crew, from their health
to the morale. Their situation was dire, and I'm glad
Mrs Chippy, along with the puppies and dogs, didn't starve

(42:10):
to death. You probably found this in your research. But
mc nish, the carpenter on the Endurance, held a grudge
against Shackleton after the whole Mrs Shippy Ordeal McNish died
penniless and was buried in an unmarked grave. In nineteen thirty.
The New Zealand Antarctic Society gave him a headstone in
nineteen fifty nine, and then in two thousand four, a
life size bronze statue of Mrs Chippy was built on

(42:33):
his grave. Visiting his grave and the Mrs Chippy memorial
is now on my bucket list and if I make it,
I'll be sure to send a picture. But in the meantime,
here's a picture of my cat family I rescued last summer.
Past regards from a librarian considering joining Peter Cayley, thank
you so much for this email. You are not the
only person who commented in some way about being angry

(42:57):
at Shackleton about Mrs Chippy. Like when we put the
episode on our on our social media, there were various
comments that said things like he killed Mrs Chippy, he's
a monster of and it uh, it reminded me a
little bit um. Some years ago, we were having a
conversation about potential future episode topics and suggestions on our

(43:20):
Facebook page or somewhere, and there were a lot of
people who were asking for LM. Montgomery, who wrote Ann
of Green Gables, who was definitely on my to do
list for an episode. And there was one particular person
who had been apparently traumatized by a scene in one
of the later books that involves a cat being killed,

(43:41):
and then was like commenting in reply to every single
person who suggested that topic with like how horrible the
cat death was, And I was like you, clearly, this
is something that really upset you as a child. But
attitudes about animals were very different at the time, and
like what people thought of as the humane way to

(44:03):
treat animals not the same as we think of now
when we think of pets as family members. A very
different situation, and I understand how upsetting it can be.
But like Kaylee, I'm glad that the animals who were
with Shackleton, although we could have a whole argument about

(44:24):
whether they should have been there in the first place,
glad that they did not face some of the dire
situations of of hunger and cold and all of that
that the that the men faced. Um, so thank you
for this email and the picture. And the story is

(44:45):
about Mrs Chippy. I didn't put a lot about Mrs
Chippy in the episode itself because I didn't want to
make the end of Mrs Chippy even sadder than it
already was. Like part of me didn't even want to
put the name Mrs Chippy in there, but some how
that made it harder. Um, so thank you for giving
me the chance to share some Mrs Chippy stories. You

(45:07):
would like to write to us about this or any
other podcasts for a history podcast at iHeart radio dot com.
And we're all over social media at MS in history
That's Real Fight or Facebook, Twitter, Pinterest, and Instagram. And
you can subscribe to our show on the iHeart Radio
app or wherever you like to get your podcasts. Stuff

(45:29):
you Missed in History Class is a production of I
heart Radio. For more podcasts from I heart Radio, visit
the iHeart Radio app, Apple Podcasts, or wherever you listen
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Holly Frey

Tracy Wilson

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