Rabid

Authors: Bill Wasik and Monica Murphy

Background

This book narrates an exceptionally gripping history of rabies, ‘the most fatal virus in the world’, and it does this alongside an uplifting account of the scientific advances that led to the development of its vaccine. Noting that the virus is befittingly ‘shaped like a bullet‘, the authors illustrate how, ‘like almost no other virus known to science’, it slowly creeps through the nervous system to the brain where it ‘works slowly, diligently, fatally to warp the mind‘. Whilst the gloomy shadow of the deadly virus permeates the text, the book also shines a light on the generally successful efforts to contain it, and on such emerging therapeutic prospects as RNA interference (RNAi). And just as it dissects the extremely distressing clinical manifestations of rabies, the book also explores the diverse cultural, mythological, and artistic portrayals of the disease. The book therefore turns out to be both an enlightening scientific sketch of rabies, and a vivid portrait of its depiction in society, arts and literature (pages 3 and 17).

 

Synopsis

The theme that dominates the book’s narrative is its elucidation of the clinical picture of rabies. For example, the authors noted that the illness usually follows the bite of an infected animal such as a dog, a bat, or a raccoon, and that the virus then ‘makes its course with almost impossible sloth‘ to the brain – the reason for its long incubation period of between three weeks and five years. In depicting the almost uniquely terrifying symptoms of rabies, the book refers to such manifestations as the fear of water or hydrophobia, hypersexual behaviour including priapism and nymphomania, and the interspersed ‘periods of terrible, poignant lucidity‘. In a brilliantly effective method of illustrating the destructive ferocity of the virus, the authors narrated riveting historical anecdotes, one of which was that of Charles Lennox, Governor-General of Canada; referring to Lennox as ‘probably the most eminent rabies victim in history’, the authors described how, after he was bitten by a mad fox, he found even ‘the very sound of running water‘ unbearable (page 7-10, 111 and 225-228).

The most uplifting theme of the book is arguably its biographical portrayal of Louis Pasteur and the rigorous and meticulous experiments he carried out to develop the first effective rabies vaccine. The text noted that Pasteur had already established a track record of scientific breakthroughs after he ‘exploded the stubborn myth of spontaneous generation‘, and after he successfully produced vaccines against cholera and anthrax. The authors described how Pasteur, with the assistance of Emile Roux, set out to induce immunity in animals using rabid dogs as the source of the infection. They noted that he first developed ‘a strain of rabies that behaved more reliably than the natural infection’, and with the virus ‘finally under his control‘, they said he serially attenuated the strength of the virus ‘in order to induce immunity without causing disease‘. In its vivid portrait of Pasteur’s character, the book described how he demonstrated perseverance and ‘intellectual flexibility‘ in the face of ‘the ever-present risk of contracting rabies’; how he countered the challenges of the antivivisectionists; and how he overcame the scepticism of fellow scientists by dramatically demonstrating the effect of his vaccine on nine-year-old Joseph Meister – the first human experimental subject (pages 120-145).

Amongst the most fascinating stories in the book are the anecdotes of those who unexpectedly survived the deadly infection. In a graphic illustration of one such compelling example, the authors described the illness of Jeanne Giese, a fifteen-year-old girl who contracted rabies after she was bitten on a finger by a bat. The book recounts how her physician, Rodney Willoughby, became ‘struck with a novel idea‘ of inducing her into a coma until she recovers, his rationale being the observation that the virus did not cause significant neuronal damage, and that her immune system will pick up after the phase of supposed neurotransmitter dysfunction. It is heart-warming that Giese eventually pulled through on the treatment that became known as the Milwaukee protocol – a combination of ketamine, amantadine, midazolam, and ribavirin. Other survivor stories in the book were of six-year-old Matthew Winkler who recovered spontaneously following a furious dog bite, and eight-year-old Precious Roberts who survived after he was bitten by a feral cat (pages 183-200).

One of the major epidemiological themes of the book is what the authors referred to as the ‘combustible‘ relationship between rabies, dogs, and humans. The authors stressed ‘the special role of dogs in spreading rabies’, arguing that the virus ‘coevolved to live in the dog, and the dog coevolved to live with us’, and asserting that the bond between dogs and humans is written through their entire history. The authors pointed out that dog bites are ‘responsible for 90 percent of human exposures to rabies worldwide and more than 99 percent of human deaths’, and stressing that this is most evident in ‘places where government has broken down’. To emphasise the link between rabies and stray dog populations, the authors cited the case of the invasion of Bali by the virus – an event that unfolded when an unvaccinated dog turned rabid and broke the island’s rabies-free record. Arguing that ‘Bali serves as an instructive story about how quickly any gain in rabies control can be reversed’, they used the tragedy to emphasise the importance of vaccinating dogs against the disease – a much cheaper and more humane approach than the ruthless, expensive, and ineffectual strategy of mass dog culling that the Bali authorities adopted (pages 203-212 and 223).

The place of rabies in mythology and the arts was a theme that the book explored rather extensively and this looked into how the disease may have been the source of such myths as vampires and werewolves. In this regard, the place of rabies in literature featured prominently with such examples as The Iliad and The Canterbury Tales. However, the most relevant literature the authors cited was Their Eyes Were Watching God, the fictional work written by Zora Neale Hurston. Just as the authors speculated on ‘how Hurston came to use rabies as a plot in the first place’, they also pointed out the intriguing clues in the text, and they noted the determining role rabies played in the denouement. The book also reviewed rabies in the context of Greek, Egyptian, Indian, Christian, and Islamic religions (pages 65-66, 16-57, and 155-160).

Opinion

This book takes a comprehensive approach to a disease that is as fascinating as it is sinister. Couched in mystery and mythology, the book explored the twin cultural and scientific dimensions of the subject, a goal that was probably only achievable by the dual perspectives of the authors, a journalist and a veterinarian. The most helpful aspect of the book is the scientific review of rabies and the inspiring work of Louis Pasteur. Whilst the cultural and mythological history was interesting, it was however over-dramatised in a rather journalistic and wordy narrative. Some of the themes in the book, such as the extensive review of animal related horror movies, were not related to the book’s subject. The content is however thorough and replete with educational and enlightening material.

Overall assessment

Rabies is a disease of legend and science, of myth and of reality. This book brings to light the impact of the disease in history, noting the breakthroughs that enabled scientists to control it, but also highlighting failures in government and health policy that still leave a vast swathe of the world vulnerable to its deadly effects. The lessons of the book are relevant to health care, and I recommend it to all doctors.

Book details

Publisher, Place, Year:  Penguin Books, London, 2012
Number of chapters: 8
Number of pages: 275
ISBN: 978-0-14-312357-6
Star rating: 5
Price: £9.99