Just over a month ago I came face to snout with rabies, one of the world’s oldest identifiable diseases and one of the most dreaded.

Dreaded, because rabies—which is transmitted via saliva when a person (or animal) is bitten by an infected animal, such as a dog, bat, raccoon, skunk, or fox—has one of the highest case-fatality ratios of any of the infectious viruses. (Ebola is one of the viruses that is even more virulent.) According to the Centers for Disease Control and Prevention, only three individuals in the U.S. are known to have survived rabies without having received the post-exposure vaccine.

Doing a bit of research, I learned that raccoon bites account for 44% of all cases. Skunk bites for 29%. Bat bites for 13% and fox bites for 6%. Shockingly, in 6% of all cases, there’s no traceable evidence of a bite at all.

The gap between rabies fatalities in the U.S. and worldwide is shocking as well. Prior to the twentieth century, rabies fatalities in the U.S. were approximately one hundred per year. Today the number has been reduced to two to three per year, due to a long-term, aggressively promoted national campaign of control and vaccination begun in the 1940s and continued in the 2000s  with widespread oral rabies vaccinations.

Sadly, the American success story is not shared worldwide. The World Health Organization reports that the number of rabies deaths worldwide, particularly in Asia and Africa, remains at crisis levels. Each year there are 55,000 reported deaths, mostly resulting from dog bites.

How did rabies intersect with my daily routine? It was mid-morning when I spotted a middling-sized raccoon on my driveway, weaving its way toward me. My first thought was that the animal’s unsteady gait seemed to indicate an injured leg. However, the longer I observed the animal’s movements, the more concerned I became. For although I’d never encountered a rabid animal before, I knew that the raccoon’s confused and oblivious behavior, coupled with the fact that a nocturnal animal was wandering about in the light of day, were signs that something might be seriously wrong.

I quickly went inside to call my local health department to seek guidance. The voice on the phone confirmed that the behavior I described sounded like symptoms of early-stage rabies. To my surprise the voice recommended that I call 911 in order to inform the state troopers and/or local sheriff’s office of the situation. The police? I was more than surprised to learn that they—rather than a public-health organization—would be my frontline defense against a public-health threat.

A few minutes after the 911 dispatcher signed off on my call, a police car pulled into the driveway. A young man dressed in a dark blue uniform ambled toward me. I noted that as the officer approached, his right hand was cupped over his holstered pistol—a sign that I took to mean that he was at the ready to un-holster if the need should arise.

I felt myself stiffening a bit—not out of fear but because I realized in that moment that in any encounter with enforcement officers my behavior, the tone of my voice, and my general demeanor would be sized up from the moment an officer caught sight of me. In short, even though this call was about something as potentially non-threatening as a brown furry animal wandering my property, the officer was sizing me up.

As my spouse continued tracking the raccoon’s erratic path, the young officer calmly informed me that, taking into account the behavior I had reported, he believed the animal to be rabid. His conclusion, he continued, was based on his experience as a hunter (but not, I noted, as someone trained in diagnosing wildlife diseases). He informed me that the only action he was authorized to take would be to shoot the animal. Observing what must have been an undisguised look of shock on my face, he kindly reminded me in his soft-spoken way that rabies is a terrible disease and that infected animals (I noticed he didn’t mention humans) suffer horribly in the disease’s later stages.

To make a long story short, the young officer shot and killed the raccoon. To my surprise, it took three volleys to put the animal down. (Three, because, as the young officer explained, the animal could not take a shot to the head where the virus resides.) With my abhorrence and fear of guns, the sound of those nearby shots is not something I’ll soon forget.

But here’s where the story really goes off the rails. Not only was it up to an individual trained in law enforcement and not wildlife management or veterinary medicine to make the call about a rabid animal, but once the animal was dead, the officer informed us that he was not authorized to remove the animal from our property. Disposal would be our responsibility. I learned that our local health department, lacking money and personnel, would not pick up suspected rabid animals for testing unless there had been direct human contact—meaning a bite or a scratch (so much for keeping accurate statistics on one of the world’s most virulent viruses).

I’m still trying to wrap my mind around what I learned that day. An infected animal, potentially posing a serious threat to humans, other wildlife, and domestic animals, was to be disposed of by individuals untrained in appropriate practices.

What did I do in the face of no information, no protocols, no guidance? I went to my computer, of course. Fortunately, the website of the New York State Department of Environmental Conservation gave clear instructions about the safe disposal of a dead animal. Besides detailed instructions on disposal, I read that the rabies virus remains alive in the body of a dead animal either for a few hours in warm weather or for months in freezing temperatures. I also learned that cats and dogs may contract rabies from a dead animal through an open wound (the raccoon on my property had three) or by chewing on the carcass. I concluded that proper disposal was vital not only for the health and safety of my outdoor cat but also for the other domestic and wild animals in the area and, of course, my neighbors.

This first (and, I hope, last) encounter with rabies was instructive in many ways. Of course, I am now better informed about a highly dangerous disease. But beyond that, the most important was observing firsthand what it means to live in a small community in a rural area where government budgets and personnel are limited, and where making do with the resources at hand is a day-to-day challenge.

I now understand and appreciate that law-enforcement offices in small communities like mine are full-service agencies, and that the duties of their officers go well beyond the usual duties we expect and take for granted—duties like enforcement of vehicle and traffic laws; crime prevention and enforcement; responding to, investigating, and de-escalating domestic incidents; locating missing children; and responding to assaults, burglaries, robberies, homicides, and natural and man-made disasters.

After the deed was done with the raccoon, the officer stuck around for a while and shot the breeze with my spouse. In our low-crime area there was no immediate call for him to rush off. It was obvious to me that he too was a bit shaken by the necessity to fire off those three shots. When he eventually walked back to the patrol car and turned back to look at us, I noticed a certain resigned look on his face. It seemed to say, “All in a day’s work.”

The post What I learned from a rabid raccoon appeared first on Occasional Planet.

Today’s battle between science and willful ignorance is not new. Scientists have always had to struggle against entrenched, non-empirical beliefs, as well as resistance to change. One battle that reason eventually won was the war on medical infections. Here’s how it unfolded:

In 1840s Vienna, a young physician named Ignac Semmelweis made a world-changing observation. Aware that childbed (“puerperal”) fever was killing as many as 25 percent of women in the days following childbirth, Semmelweis found it curious that the deaths occurred almost exclusively among women who delivered their infants in hospitals. Those who delivered at home, and those who self-delivered in alleys and streets, rarely contracted the fatal condition.

Further investigation led Semmelweiss to see a link between the standard medical-school curriculum and maternal deaths. Each day, medical students and professors discussed several cadavers, often between patient rounds. Although the concept of germs was as yet undiscovered, “Semmelweis concluded that the transmission of what he called ‘invisible cadaver particles’was the cause of childbed fever,” says Sherwin B. Nuland, MD, in Doctors, the Biography of Medicine. “The transmitting source of the ‘cadaver particles’ was to be found in the hands of the students and attending physicians.”

Fearing the terrible truth

Semmelweis then instituted the simple measure of washing hands in a chlorine solution. His hygienic practices dramatically reduced the number of deaths caused by childbed fever. But his theory met strong resistance from established physicians, who were offended by the abrasive upstart and slow to acknowledge the terrible truth that their own entrenched procedures may have caused so many deaths, writes Nuland. Semmelweis did not publish his results for another 15 years.

In the 1860s, British physician Joseph Lister broadened the battle to include post-surgical infections, which were almost universal and frequently fatal. Lister was an early adopter of Louis Pasteur’s recently postulated germ theory. Learning that a nearby city had eliminated a stench in its sewers by pouring carbolic acid down the drains, he reasoned that the chemical had killed microorganisms like those identified by Pasteur. Applying this conclusion to surgery, he then devised a wound dressing soaked in carbolic acid. Later, he added a sprayer to drench the entire surgical area in a mist of carbolic acid solution.

Soon, Lister began applying it to his hands and instruments. Lister’s first report on this treatment was published in The Lancet in 1867, the year now regarded as the birth date of antisepsis.

“Listerism” changes everything

As “Listerism” gradually gained acceptance, its principles of cleanliness caught on. The surgeon’s traditional black frock coat, elegantly tailored, stained with blood and rarely laundered, began to be covered by a rubber apron designed to protect the coat from disinfectant.

Then in the 1870s and 1880s, surgeons began to move beyond Lister’s antiseptic approach. Through new aseptic procedures, surgeons attempted to exclude infectious bacteria by boiling or heating instruments, sutures, towels and sponges. Increasingly convinced that their own clothing might be a source of infection, some surgeons began to wear loose-fitting gowns over their street clothes. Some, but not all, anesthetists, assistants and spectators also replaced their street coats with special sterilized cotton or linen coats.An elaborate ritual of hand washing became the norm, and in 1893, William Halsted became the first surgeon to wear sterile rubber gloves while performing an operation.

By 1910, surgical caps and gloves had become widely accepted. Few surgeons, however, welcomed the advent of face masks. “Early masks, which became quickly saturated with moisture from breathing and talking, irritated surgeons, especially those with beards,” writes James M. Edmunson, inSurgical Garb. “For these reasons many surgeons preferred to enforce a rule of silence during operations, rather than don a cumbersome and largely ineffective mask.”

Aseptic techniques even influenced operating room décor. By the 1920s, white gowns, starched white linens, and the sparkling white operating room symbolized the modern concept of healing.

No one, however, has yet found a way to completely eliminate hospital-based (“nosocomial”) infections. In the 1950s and 60s, a nationwide pandemic of staphylococcal infections spurred a movement toward systemic infection control in hospitals. As a result, infection control has emerged as a medical specialty, and several national organizations dedicate themselves to standard-setting education and enforcement.

Today, statistics published by the Centers for Disease Control and Prevention reveal that nosocomial infections affect about 1.7 million patients each year and contribute to 99,000 deaths.

Clearly, more than a century after the early concepts of infection control began to unfold, many challenges remain. We’re waiting for the emergence of the Semmelweises and Listers of our times. And let’s hope their new ideas are accepted.

[Adapted, updated and reprinted by permission of the American Hospital Association, who published the original article, by Gloria Shur Bilchik, in 100 Faces of Healthcare.]

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