Rabid (2 page)

Today, we understand that more than half our new diseases (60 percent, by a recent tally in
Nature
) are “zoonotic”—that is, originating in animal populations—and our widespread fear of the worst of these (swine flu, AIDS, West Nile, Ebola) has been colored by our knowledge of their bestial origins. It is hardly an exaggeration to say that nothing has made humans sicker than our association with animals. Not only our emerging diseases today but the major killers throughout the ages—smallpox, tuberculosis, malaria, influenza—evolved from similar diseases in animals. This is what Jared Diamond has called “the lethal gift of livestock,” a major shaper of human destiny; the very fact that the farmer won out over the hunter-gatherer is due in part, Diamond argues, to the fact that the former “breathed out nastier germs.” Through their close contact with animals, early farmers built up immunity to illnesses that would readily kill unexposed populations, a dynamic that still holds for emerging infectious diseases today.

Yet until the twentieth century, humans had no idea that so many of their illnesses derived from nonhuman hosts. During those years when the most catastrophic zoonosis in history struck—the fourteenth-century Black Death, or bubonic plague, which spreads to humans via fleas living on the backs of rats and other rodents—scholars blamed nearly everything else, from demonic forces and bad air to astronomical happenings and even human malefactors. For centuries, rabies was
the only illness in which the animalistic transfer, or more like a transformation, was evident. No microscope was required to see the possession take place. A mad animal bit; a mad man appeared; each would die a terrible death. The madness could lurk within any mammal, even in—especially in—the most domesticated and loyal of all, the dog.

As the lone visible instance of animal-to-human infection, rabies has always shaded into something more supernatural: into bestial metamorphoses, into monstrous hybridities. When Greek myth beholds Lycaon, king of Arcadia, as he transforms into a slavering wolf, his countenance is “rabid,” his jaws “bespluttered with foam.” In fifteenth-century Spain, witch-hunters called
saludadores
were reputed, also, as healers of rabies, a convergence that made eminent sense given the widely held association between witches and their demonic canine “familiars.” Between the fifteenth and the eighteenth centuries, Europe gestated two enduring legends whose part-human, part-animal villains bite their victims, thereby passing along their own degraded conditions—namely, the werewolf and the vampire, both of whom haunt the Western imagination to the present day. The essayist Susan Sontag noted that even as late as the nineteenth century, when viruses were becoming well understood and a rabies vaccine lay within reach, the true source of the rabies panics in France was not the fatality of the disease but rather the “fantasy”—though one might accurately say the
fact
—“that infection transformed people into maddened animals.”

Paradoxically, during the twentieth century, after Pasteur’s invention of a rabies vaccine provided a near-foolproof means of preventing its fatality in humans, our dark fascination with rabies seemed only to swell. The vaccine itself became as mythologized as the bug, such that even today many Americans believe that treatment requires some twenty (or is it thirty?) shots, delivered with a foot-long syringe into the stomach. (In fact, today’s vaccine entails four shots, and not particularly deep in the arm.) Even as vaccination of dogs in the United States was reducing the infection rate in that species
down to negligible levels, a generation of children learned to scrutinize their pet pooches for the slightest signs of madness, thanks in part to the lamentable influence of
Old Yeller,
a Walt Disney film about a frontier-era boy who falls in love with a yellow dog that becomes rabid. Twenty-four years later, a novel called
Cujo
(and its subsequent film adaptation) taught a whole new generation to fear rabies, albeit a bit more forthrightly: no one finished the book or left the theater surprised by what became of that nice dog.

It’s almost as if the very anachronism of rabies, to the Western mind, has rendered it even more intriguing to us. Like the vampire, rabies carries with it the musty whiff of a centuries-old horror, even as it still terrifies us in the present day. Lately, TV comedians have taken to seizing on it for a laugh: two animated series created by Mike Judge,
King of the Hill
and
Beavis and Butt-Head,
have done episodes on rabies, as did the long-running medical comedy
Scrubs
. In the U.S. version of
The Office,
Michael Scott (the bumbling boss played by Steve Carell) tries to paper over the fact that he has hit an employee with his car by organizing a charity “race for the cure.” The disease he chooses is rabies. He soon becomes perplexed, though, at how few donations are forthcoming:

Contrary to what your television may have told you, there are most assuredly still rabies doctors, and humans still die in the tens of thousands from the disease every year (fifty-five thousand, in the estimate of the World Health Organization). But few of these deaths happen in
the United States or in western Europe. The dead hail overwhelmingly from Asia and Africa, from countries where vaccination is too expensive or too difficult to procure. And the course of their suffering is every bit as grim, and as inevitably fatal, as that endured by victims throughout the millennia.

Indeed, other than the wide availability of sedatives, which can subdue the final agonies of the disease, the sequence of horrors faced by a typical rabies patient today is hardly different from those experienced by the man who was probably the most eminent rabies victim in history: Charles Lennox, fourth Duke of Richmond, who for the two years leading up to his death in 1819 served as governor-general of Canada, the top post in what was then still a colonial government. The duke was a famous lover of dogs; a portrait of Lennox as a boy shows the young nobleman reclining against a tree stump as an adoring spaniel paws at his finery. Ironically, it was not a dog but rather a fox, the ostensibly tame pet of a soldier whose garrison the duke had occasion to inspect in Quebec, whose jaws were to blame for his demise. When the fox tangled with the duke’s own dog—Blucher, so named in honor of Gebhard Leberecht von Blücher, the Prussian general who had recently bested Napoleon at Waterloo—Lennox manfully stepped in to separate the two. The mad fox seized this chance to insult the visiting dignitary, chomping down hard on the base of his thumb.

After a bite, the rabies virus binds quickly into the peripheral nerves but then makes its course with almost impossible sloth, usually requiring at least three weeks and often as long as three months to arrive at and penetrate the brain. On rare occasions a full year, or even five years, can elapse before the onset of symptoms. During this time the wound will heal over, and the victim may even forget about his scrape with a snarling beast. But healed or no, as the virus enters the brain, the wound will usually seem to return, as if by magic, with some odd sensation occurring at the site. This sensation can take many forms: stabbing pain, or numbness; burning, or unnatural cold;
tingling, or itching; or even a tremor. At roughly the same time, these soon-to-be-doomed patients typically display general signs of influenza, with a fever and perhaps a sore throat or some mild nausea. In the case of the Duke of Richmond, it began one day with shoulder pains and a sore throat, then progressed the following day to insomnia and fatigue.

All this is merely prelude to the illness itself, whose most notable symptom in humans—unique, as far as physicians know, to rabies among all diseases—is a terrifying condition called hydrophobia. As the term suggests, hydrophobia is a fear of water, though the word “fear” does not do justice to the eerie and fully physical manner in which it manifests. Present the hydrophobic patient with a cup of water and, desperately though he wants to drink it, his entire body rebels against the consummation of this act. The outstretched arm jerks away just as it is about to bring the cup to the parched lips. Other times the entire body convulses at the thought. Just beholding the water can make the diaphragm involuntarily contract, causing patients to gag and retch. On YouTube one can find video from a 2007 sufferer in Vietnam, showing the travails of a middle-aged construction worker as he attempts to consume some dark beverage from a clear plastic cup. He brings the vessel two-thirds of the distance to his lips before his hands begin to tremble uncontrollably. He stares at the fluid, mouth agape, his twitching hands sloshing it over the sides. Finally he forces himself to bring the tiniest sip into his mouth and, overcoming the revulsion in his gullet, to swallow it.

For the Duke of Richmond, though the chronology remains in some dispute, the hydrophobia seems to have struck first on the evening of August 26, 1819. At dinner with his officers, he found that his glass of claret disagreed with him. “I don’t know how it is,” he is said to have remarked to Colonel Francis Cockburn, one of his retinue, “but I cannot relish my wine tonight as usual. I feel that if I were a dog I should be shot for a mad one!”

The next day, the duke ate and drank almost nothing and remained in bed. By the evening, he found he could not drink at all. The following morning, a doctor prescribed a gargle, but this, too, had a “convulsive” effect on his throat. He could not even accept his customary shave, so repelled was he by the water in the basin. This day he dragged himself from his bed. He was scheduled to tour the swamps around the Ontario town of Richmond, recently renamed as such in his honor. But his body rebelled as he stepped into the boat. In terror he jumped back to the shore. Taken to the closest house, he begged to be moved farther inland: the very sound of running water had become unbearable to him. He was moved to a barn and laid down on a deathbed of straw.

Fevers spike high during this final phase of the disease. The mouth salivates profusely. Tears stream from the eyes. Goose bumps break out on the skin. Cries of agony, as expressed through a spasming throat, can produce the impression of an almost animal bark. In the throes of their convulsions, patients have even been known to bite. They also hallucinate. The eminent French physician Armand Trousseau, who practiced in the middle part of the nineteenth century, noted that “the patient is seized with sudden terror; he turns abruptly round, fancying that somebody calls to him.” He cited the account of a colleague, one Dr. Bergeron, whose rabies patient “heard the ringing of bells, and saw mice run about on his bed.”

Not uncommonly, male patients succumb to an even more lurid sort of abandon. The virus’s action on the limbic system of the brain can cause them to exhibit hypersexual behavior: increased desire, involuntary erections, and even orgasms, sometimes occurring at a rate of once per hour. If the Duke of Richmond evidenced this symptom, his companions were too gallant to set it down for posterity. But other case reports from history describe up to thirty ejaculations in a single day. The Roman physician Galen, in his own remarks on rabies, describes the case of an unfortunate porter who suffered such emissions for three full days leading up to his death. Commenting on this
grim fate the eighteenth-century Austrian physician Gerard van Swieten soberly noted, “
Semen et animam simul efflavit
”: “His seed and his life were lost at the same time.”

And yet, despite all the horrors of hydrophobia, arguably the most tragic aspect is the fact that the attacks will often subside, for a time, allowing sufferers periods of terrible, poignant lucidity: they are given the opportunity to fully contemplate what their condition portends. Before his death, the duke dictated a lengthy letter to his eldest daughter and also gave instructions that his beloved Blucher be handed over to her. “It will make her cry at first,” he said, “but turn him in when she is alone and shut the door.”

By now it should be apparent that this book is not for the squeamish or weak-kneed. Encounters with rabies have ever been thus. Louis Pasteur and his assistants, in order to develop their vaccine, had to corral dogs at the apex of their madness and extract deadly slaver from their snarling jaws. Axel Munthe, a Swedish physician, once saw Pasteur perform this trick with a glass tube held in his mouth, as two confederates with gloved hands pinned down a rabid bulldog. Some members of his team soon established a ghoulish fail-safe for these procedures. “At the beginning of each session a loaded revolver was placed within their reach,” recalled Mary Cressac, the niece of Pasteur’s collaborator Emile Roux. “If a terrible accident were to happen to one of them, the more courageous of the two others would put a bullet in his head.”

We cannot claim so much bravado for this volume, on either our account or yours. A better analogy, perhaps, is the difficult process by which veterinarians submit suspect pets for rabies testing—another case study in how this diabolical disease causes nothing but agony for those who behold it. Even today, vets do not use a blood test for rabies in animals; it’s not a pinprick and wait-and-see affair. Only a sampling from the brain will suffice. Therefore the animal must be killed, with its head removed and shipped off to authorities for study.

The first part of that process—capturing and humanely dispatching
a deranged animal—is fairly standard stuff for your local vet. But carrying out a decapitation, even of a smallish creature, is much harder than they make it look in slasher pics. This is true not just for the obvious emotional reason: that in many cases the vet had been trying to save the life of this beloved pet just hours beforehand. It is also an ordeal in the purely practical sense. The cadaver is laid out on its back, contorted face canted skyward. With a scalpel the vet slices readily through the soft tissue around the animal’s neck: fur and skin, muscles and vessels, esophagus and trachea.