Rabies (Lyssa) is an acuteinfectious viral disease of the nervous system transmitted by the saliva of infected animals, particularly dogs. The animals most liable to be afflicted with rabies are dogs; but cats, wolves, foxes, etc, are also subject to it.
The early symptoms of rabies in the dog are such as restlessness and general uneasiness, irritability, sullenness, an inclination for indigestible and unnatural food, and often a propensity to lap its own urine. As the disease proceeds the eyes become red, bright, and fierce, with some degree of strabismus or squinting; twitch-ings occur round the eye, and gradually spread over the whole face. After the second day the dog usually begins to lose perfect control over the voluntary muscles. He catches at his food, and either bolts it almost unchewed, or, in the attempt to chew it, suffers it to drop from his mouth. This want of power over the muscles of the jaw, tongue, and throat increases until the lower jaw becomes dependent, the tongue protrudes from the mouth, and is of a dark, and almost black colour. A peculiar kind of delirium also comes on, and the animal snaps at imaginary objects. His thirst is excessive, although there is occasionally a want of power to lap. His desire to do mischief depends much on his previous disposition and habits. He utters also a peculiar howl, and his bark is altogether dissimilar from his usual tone. In the latter stages of the disease a viscid saliva flows from his mouth, and his breathing is attended with a harsh, grating sound.
The loss of power over the voluntary muscles extends, after the third day, throughout his whole frame, he staggers in his gait, and frequently falls. On the fourth or fifth day of the disease the dog dies, sometimes in convulsions, but more frequently without a struggle.
With regard to man the rabid virus seems to be more violent when it proceeds from wolves than from dogs. It appears to be contained solely in the saliva of the animal, and does not produce any effect on the healthy skin. But if the skin is deprived of the epidermis, or if the virus is applied to a wound, the inoculation will take effect. The development of the rabid symptoms is rarely immediate; it seldom takes place before the fortieth or after the sixtieth day, but in some cases has occurred after six months or even longer. It begins with a slight pain in the scar of the bite, sometimes attended with a chill; the pain extends and reaches the base of the breast, if the bite was on the lower limbs, or the throat, if on the upper extremities. The patient becomes dejected, morose, and taciturn. He prefers solitude, and avoids bright light; frightful dreams disturb his sleep;
the eyes become brilliant; pains in the neck and throat ensue. These symptoms precede the rabid symptoms two or three days. They are followed by a general shuddering at the approach of any liquid or smooth body, attended with a sensation of oppression, deep sighs and convulsive starts, in which the muscular strength is much increased. A foamy, viscid slaver is discharged from the mouth; the deglutition of solid matters is difficult; the respiration hard; the skin warm, burning, and afterwards covered with sweat; the pulse strong; the fit is often followed by a syncope; the fits return at first every few hours, then at shorter intervals, and death takes place generally on the second or third day. The treatment for rabies at the start of the 20th century consisted in preventing its development, which may be effected by applying a ligature, where possible, to impede the circulation from the wound, by sucking it, and thoroughly cauterizing it either with nitrate of silver or with iron heated to a white heat, the pain of cautery being less as the temperature is greater. If these means are not available, any burning substance and most acids were used.
Louis Pasteur put forward a method of preventing the development of the disease by a system of successive inoculations with rabid virus of greater and greater intensity; the inoculation being made the first day with marrow which has been extracted from the rabid animal 12, 10, and 8 days; then the second day with marrow extracted 6, 4, and 2 days; the third day with one day's marrow, etc. Louis Pasteur's method was favourably reported on by an English commission (1886-1887), but there is doubt regarding the number of cures really performed. As a contemporary critic of the Pasteur system remarked, every one who is bitten and inoculated is counted in the list of cures, though there is nothing to prove that he ever contracted the rabies. Despite the lack of scientific proof, Pasteur's dubious innoculation are still in use 100 years later, and there is still no cure for rabies though with careful medical attention patients have survived. Research Rabies
There are several methods of controlling bleeding during surgical operations. 1. When an incision is made, much of the bleeding comes from the skin edges and from subcutaneous tissue: small towels are often used, clipped to the edges of the wound to protect the cut surface, and prevent the repeated rubbing away of clot which would otherwise occur. These are called variously 'side-towels','skin towels' or 'tetra towels'. The latter term arose as these towels are commonly attached with four- pronged forceps ('tetra forceps'). 2. By pressure. As the surgeon makes his incision, he or his assistant applies a gauze swab to the raw area. Capillary and most venous bleeding stops almost immediately, and does not re-start unless the surface is rubbed. 3. Pressure forceps (arteryforceps) are applied to the cut ends of arteries, as little of the surrounding tissue as possible being included in the jaws of the forceps.
These bleeding points are dealt with at some later stage in the operation in one of four ways. (i) The arteryforceps are simply removed. Bleeding does not recur as the crushed end of the vessel has sealed itself off. (ii) Surgical diathermy current is applied to the pressure forceps, thus coagulating the end of the blood vessel. (iii) A surgical ligature is tied round the tissue included in the forceps which are then removed. (iv) A stitch is inserted and tied round the tissue held in the forceps in order to secure more firmly the end of the cut vessel. 4. The surgical diathermy is used to make the incision through the muscle and deep tissue layers. This technique is used especially in the treatment of cancer and particularly in the removal of vascular structures such as the breast. Small blood vessels are thus sealed as the tissue is divided. 5. The application of gauze soaked in adrenaline solution. This drug constricts the ends of the vessels and is particularly useful in the nose.
Where extensive bleeding may be expected - such as in plastic operations on the face - the operation area is sometimes infiltrated with a saline solution of adrenaline. By the time the effect of the adrenaline has passed off, the divided vessels have become blocked by clots. 6. The application of hot packs. The combination of pressure and heat speeds the clotting process and the retraction of the cut ends of vessels. 7. Thromboplastin released by enzymes from damaged tissue is essential to start the clotting process. There is very little damage in a clean surgical incision and thromboplastin formation can be brought about by the surgeon taking a small piece of muscle, and pulping it by repeated crushing with pressure forceps. This ' muscle graft' is applied to the bleeding area. Purified thrombin is supplied in powder in sterile ampoules ready to mix with sterile water: the solution is then applied with a swab or a spray and is particularly useful under skin grafts where it acts as a kind of glue. Fibrin foam is another preparation used extensively in neurosurgery where even a small amount of bleeding into the brain or nerve, may do irreparable damage. Gelatin 'sponge' supplied in small biscuit-like strips, can be used in bleeding cavities or tied to the surface of a bleeding organ. The sponge acts as an artificial network in which clotting occurs and the substance is itself absorbed.
Oxycel (oxidised cellulose) acts in a similar way and promotes rapid clotting. It is used in such sites as the prostatic cavity and can be tied around the catheter which is left in place at the end of operation. Calciumalginate is a similar preparation and is manufactured from sea-weed. The raw oozing surface is moistened with one solution which is then activated by spraying with a second solution containing calcium. All these artificial coagulants are only of use for 'low pressure' bleeding - that is from capillaries or small veins. Research Surgical Haemostasis
A clarinet (clarionet) is a single-reed woodwind musical instrument of the reed kind invented by Johann Denner in Nuremberg around 1690, and perfected and installed within the symphonyorchestra during the late 18th century by the work of Ludwig van Beethoven. The clarinet is comprised of five parts making up a cylindrical tube which ends in a flared bell at the lower part, and at the upper part terminates in a cone-shaped, tapering mouthpiece, which is bevelled to a thin edge on one side, and has a flattened longitudinal portion on the other, upon which the reed is laid and kept in position by a ligature containing two screws. Clarinets are made in various ranges including the small soprano clarinet, the bass clarinet and the largest, rare, contrabass clarinet. Research Clarinet
Abbreviations
Research Rabies
