Rabid (4 page)

Western histories of medicine tend to favor the Greeks—and understandably so, given the legacy of Hippocrates (ca. 400
B.C.
) and the generations of medical authors who expanded on his wisdom in the centuries that followed. But arguably the most impressive description of rabies from the ancient world appears in the
Sus´ruta samhita,
a classic text of Ayurveda, the Indian system of traditional medicine. By and large, authorship of this tome is attributed to its namesake, Sus´ruta, who practiced medicine in the city of Varanasi, on the banks of the Ganges. Most contemporary historians place Sus´ruta in the first or second century
A.D.
, though some put him far earlier, and that is merely the beginning of our complications in affixing a date to the work. On the one hand, the text was edited, apparently heavily, by a later disciple named Nāgārjuna, who lived sometime between the fifth and the tenth centuries
A.D.
On the other hand, the
Samhita
is said to collect wisdom from Sus´ruta’s hallowed ancestor, Divodāsa Dhanvantari, who by all accounts lived in 1000
B.C.
or earlier.

Regardless, the
Samhita
is a stunning medical compendium for its
time. Sus´ruta is best known to medical historians as the father of surgery, and indeed the
Samhita
documents a staggering array of procedures, from the nose job to the cesarean section. For the eye alone, Sus´ruta’s text includes eighteen chapters laying out some fifty-one different operations, many of them quite sophisticated in the details.

The
Samhita
devotes nearly a thousand words to rabies, and based on the versions of the text that have been handed down, it correctly identifies many aspects of the disease. It recognizes that humans contract the disease and can be said to display comparable symptoms: “A person bitten by a rabid animal barks and howls like the animal by which he is bitten,” causing him to lose the “functions and faculties of a human subject.” The ancient Ayurvedans also claim the honor of being the first early medical scholars to isolate the phenomenon of hydrophobia itself and to recognize that a human illness progressing to that phase is invariably fatal: “If the patient in such a case becomes exceedingly frightened at the sight or mention of the very name of water, he should be understood to have been afflicted with Jala-trása [water-scare] and be deemed to have been doomed.” (The
Samhita
goes a bit too far, however, by claiming that Jala-trása is fatal even in patients who are merely frightened by
reports
of Jala-trása.)

Although the disease is presented as an interaction of the “wind” of the human and the “phlegm” of the animal—Vāyu and Kapha, respectively, concepts that live on today in the practice of Ayurveda—the
Samhita
recognizes that rabies is fundamentally neurological in nature, and it also provides a fairly reliable description of rabies as it manifests in animals:

Among the vaunted Greeks, the medical understanding of
lyssa
was not nearly so sophisticated. Reference to the disease does not appear explicitly in Hippocrates. Aristotle does address rabies directly in his treatise
History of Animals,
though he flubs it in nearly every respect. Dogs, he wrote with an odd confidence, suffer from only three diseases:
lyssa,
or rabies;
cynanche,
severe sore throat or tonsillitis; and
podagra,
or gout.
*
The philosopher also held the belief that rabies could not be contracted by humans: “Rabies drives the animal mad, and any animal whatever, excepting 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 excepted.” (Aristotle added that the elephant, generally thought then to be immune to disease, “is occasionally subject to flatulency.”)

In the first two centuries
A.D.
, during roughly the same period that Sus´ruta (if the consensus estimates are true) was practicing his surgical wonders, the Greco-Roman tradition of medicine did begin to develop a comparably sophisticated understanding of rabies. This awareness begins with Aulus Cornelius Celsus, believed to have been born in around 25
B.C.
and to have written during the early part of the first century. Almost nothing is known of Celsus’s life, in a civilization that took great pains to document the lives of men it considered sufficiently worthy. Pliny the Elder, the first-century historian and naturalist, believed that Celsus lived in the southern part of France, based on his reference to a vine that was native to that region. Celsus seems to
have been not a physician but an encyclopedist who compiled his
De medicina
largely from the Greeks. But while his notes on hydrophobia go well beyond the silence of Hippocrates and the complete misapprehension of Aristotle, they are hardly more incisive. He does recognize the existence of hydrophobia (“a most distressing disease, in which the patient is tortured simultaneously by thirst and by dread of water”) and pays at least lip service to the fact that “in these cases there is very little help for the sufferer.” His description of the malady ends there, though, and the balance of his account is given over to an elaborate and darkly amusing series of treatments—more on which later.

It was a hundred years or so after Celsus that a school of scientific thought emerged to spur the classical tradition toward a better understanding not just of rabies but of medicine as a whole. Hoping to escape the intellectual strictures of the empiricists—who rejected not only experimentation but all theoretical approaches to medicine, holding that physicians should work based only on what they could perceive with the naked eye—these scholars called themselves the methodists, and they put forward a positive theory of how the human body functioned. That their theory (which involved conceiving of diseases as “affections” and considering their effects holistically) strikes the contemporary mind as largely nonsensical seems to have been beside the point. The methodists’ focus on improving therapy invigorated the whole enterprise of writing and thinking about human health.

The founder of the methodist school, Themison (first century
B.C.
), and one of his disciples, Eudemus, were both said to have survived attacks by rabid dogs; and either might have been the original author of an anonymous methodist text, usually dated to the first century
A.D.
, that touches on rabies at length. More impressive still are the notes on hydrophobia made by Soranus, a methodist physician (first or second century
A.D.
) from Ephesus, on the western shore of what is now Turkey. Best known today for his prescient thoughts on gynecology, Soranus also left behind—in his treatises on acute and chronic
diseases, which survive in a full Latin translation made by Caelius Aurelianus during the fifth century—a few fairly lengthy sections on hydrophobia and its treatment. Unlike most of his predecessors, Soranus recognized that contact with rabid animals is the only means by which hydrophobia spreads. He even gives a seemingly far-fetched example that in fact might be possible, given what we know today about the disease:

One gathers that Soranus is drawing upon close observation of quite a few rabies sufferers, given his thorough and plausible list of symptoms, which includes not just revulsion at water but rapid and irregular pulse, fever, incontinence, shaking, and—noted for the first time—involuntary ejaculation. He correctly rebukes an earlier writer for having claimed the disease can sometimes progress over the course of years. He even rebuffs Eudemus, Themison’s successor, for his idea that melancholy and hydrophobia were one and the same. “The victims of hydrophobia die quickly,” Soranus writes, “for it is not only an acute disease but one that is unremitting.”

Throughout this vast expanse of history, the constant threat of rabies—rare yet tinged with horror—served as merely another wrinkle in early civilization’s intimate, complex relationship with the dog. By this point dogs had been domesticated (or had domesticated themselves, as most scholars now believe) for at least ten thousand years, and yet their role in society was profoundly dissonant. Based on findings of teeth and bones around Mesopotamian sites, archaeologists have concluded
that semi-feral dogs roamed cities as scavengers, feeding on trash. Yet many dogs were companions, for whose actions a human was responsible, as the Laws of Eshnunna attest. Alongside the other attendant advances of civilization, such as the city and the written word, reliable breeding of dogs first emerged during this period: remains of sight hounds—a purebred line of dogs that persists to this day in such graceful runners as greyhounds, whippets, and salukis—have been found in the region dating back as far as 3500
B.C.
Dogs also figured prominently in the spiritual symbology of early Mesopotamia. In a curious connection to our joke, the dog seems to have been most invoked as the symbol of Gula, the spirit of healing; when archaeologists excavated her temple at Isin, the very same one over which the high priest is said to have presided, they found it studded with dog figurines. Later, King Nebuchadnezzar II, writing in roughly 600
B.C.
, records that dog statuettes made of precious metals were left at Gula’s temple in Babylon.

And so dogs occupied the lowest and yet also the highest rungs in the bestiary of early man: pitiful scavenger of garbage but also huntmate, totem, friend. It is a dual nature that persists into the present day, as one can vividly witness on the streets of any developing-world city, where the collared and the bathed uneasily coexist with the unkept and the unkempt. It is also a bifurcation that dates all the way back to the beginning of dog history, to the very first creatures to earn the name
Canis familiaris
. Scientists theorize that the indispensable hearth of domestication was the human garbage pile, with the wolves that scavenged there some fifteen thousand years ago becoming gradually more tame. By studying the mitochondrial DNA of various dogs from around the world, geneticists have tracked the site of this domestication to southern China—which means that, based on local traditions and archaeological records, the first dogs may have been bred for use as food. Dog bones found by archaeologists in that region are often scarred with knife marks.

Nevertheless, the dog almost immediately became something
more. The uncanny ability of dogs to pick up on human moods and needs is almost certainly instinctive rather than bred, so we can imagine the slow courtship of human and beast as it would have played out over centuries. Without even having to be captured or trained, some tamed dogs would have begun to function as guard animals, alerting humans to potential intrusion, protecting food and other possessions from outside assault. Soon, with training, these ur-pets would have been hunting, pulling sleds, and, eventually, herding livestock—man and dog, creating civilization as one.

Yet the hand that feeds the dog has forever been not merely bitten by it but, on occasion, devoured. In rabies, after all, every dog has a dark side lurking behind the soulful eyes; and even a healthy dog seldom hesitates to feast on the corpse of a dead human, even that of a former friend or master. In ancient India, the ambivalence toward dogs was eloquently expressed in one sacred text called the
NisīhaCuū,
which says that gods “come to the world of men in the shape of
yaksas,
dogs, that is. They are worshipped when they do good, and not, when they do not.” Indian literature itself is rife with images of dogs as battlefield scavengers; in one sacred text, hell is portrayed as a place where malign rulers are devoured by 720 dogs with fangs of steel. And yet dogs were kept as pets and bred by the elite, and the favors of a dog were sometimes auspicious. “If a dog comes face-to-face with [a man] in a joyous mood,” noted one ancient work, “frolicking and rolling on the ground in front of him, then…there will be a great gain of wealth [when he] starts on a journey.”

Nowhere was the dichotomy in the dog starker than among the ancient Egyptians, whose highest god was the dog god Anubis and who bred graceful sight hounds—the lithe form of which is believed by some to survive to the present day in our pharaoh hounds. An excavated tomb at Abydos, dating to 3300
B.C.
, built during the pre-pharaonic Upper Kingdom for an unknown ruler, shows evidence of the ritual burial of dogs, which would become a common practice in Egypt. A tomb at Hierakonpolis from approximately the same time
(discovered during the late nineteenth century but then lost) was illustrated in full color with a hunting scene, complete with hounds, and contained the remains of multiple domesticated dogs; excavation of the tomb of Queen Herneith, who ruled a few hundred years later, found the skeleton of her dog stretched across the entrance to her tomb, guarding her home in the afterlife. In art, hounds were often depicted on leashes and as widely present in human society; ancient Egypt was a dog’s paradise, a place where (if we are to believe Herodotus) the death of a pet dog would prompt its owner to shave not just his head but his entire body.

And yet even in Egypt, semi-feral dogs posed a constant threat in the streets of towns and villages; in
The Book of the Dead,
dogs are alluded to in one appeal by the deceased narrator to Ra, the sun deity, against a force that “carries off souls, who gulps down decayed matter, who lives on carrion, who is attached to darkness and dwells in gloom, of whom the feeble are afraid.” References to dogs as scavengers in Egypt are found not just in the Hebrew Bible’s accounts but in papyri documenting the Roman era there.