This Podcast Will Kill You - Ep 14 Rabies: Don't dilute me, bro

Episode Date: November 27, 2018

After a long hiatus we are back with a much anticipated look at one of the most feared diseases of all time: rabies. We cover everything from its evolutionary history to its massive case fatality rate, from why it makes you slobber so much to how Pliny the Elder thought you should treat it (spoiler: don't try it at home, folks). Sit back with a foam-topped quarantini in hand and enjoy our first episode of season 2. See omnystudio.com/listener for privacy information.

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with built-in AI for real-time insights. Learn more at Intuit.com slash ERP. After the operation, he started mumbling loudly, then became hysterical. He was given a sedative which had no effect, and his body began to twist about and his legs thrash about in the air. He was moved to a side room.

But before he was moved, the patient thrashing about in agony bit a nurse who told how, after a routine operation, the patient began growling and howling, disturbing the whole hospital. Drugs had no effect, and he suffered convulsions, and he was violently sick. Saliva began foaming from his mouth, and he was unable to control his movements. He tried to hurl himself from the bed, and before she could catch him and stop his head hitting the floor, he bitter.

By then, six members of staff were trying to restrain him, and he appeared to be asking for water. When offered a glass, he spat water out and went mad. Hi. Hi. Long time to chat. Yeah. I mean, it's been a while. But guess what?

What? We're back. We are back. And it feels really good. Oh my gosh. I'm just the seat. It's like my butt never left it. I know, right?

It really does feel like no time has passed. That's true. It's kind of scary. I'm Aaron Welsh. And I'm Aaron Elman of Dyke. And you're listening to This podcast will kill you. Welcome. Welcome. We're so excited to have you. Yeah. Because there are so many more of you. Yeah. Then there used to be. Like a lot of thousands more. I got to admit, I'm a little nervous. Yeah.

But I think we're going to have a really fun time. I think this is going to be great. So let's just go right in. Yeah, let's. We have our microphones. Let's do this. We also have our very important quarantini. Quarantini. What do we have this week? Oh, well, this week, there's no question on what we're drinking. It's the hair of the rabid dog. Oh, what does that mean?

Does that mean that we're doing? Oh, yeah, that's right. Rabies. Rabies, baby. You asked for it, you got it. Okay, so we've got the hair of the rabid dog. Briefly, what's in it? Because we are going to post the complete recipe on Instagram, on Twitter, on Facebook, etc.

Yeah, so if you're not following us on social medes already, Make sure you do that. And that's where you can find, in addition to these delicious quarantini recipes, all of our other info about fun stuff. Links to old episodes, information about us, and also book lists. Back to the hair of the rabid dog. Right. What's in it? Let me tell you.

Gin, number one, of course. Great. Number two, grapefruit juice, because that's delicious. Mm-hmm. Number three, elder flower liqueur, because we fancy. And of course, the cardinal symptom of rabies is foaming at the mouth. So it's topped with a beautiful egg white foam. Oh, yes.

Oh, yes. Which also, as disease ecologists, drinking raw egg. You should have seen us trying to make it. We were like, ooh, is this a right amount? How do you, is this going to be safe for us to drink? We're taking one for the team here, guys. To make this cocktail, you mix some of the liquors together, and then you layer the egg white foam on top,

and then you're going to place some long strands of grapefruit peel on top so that it looks like little bits of hair, hence the hair of the rabidoc. I like to make things gross, though. And it's beautiful at the same time. It's fantastic. All right, rabies. When I started researching, my idea for this story was to kind of start with a, like, picture this, you're a little, like we did with tuberculosis. Yeah.

But Teabes was really endearing, and rabies is not. Mm-mm. It's a terrifying thing. Yeah. And so I didn't want to get too depressing right off the bat where, like, we start a story, and then everyone ends up dying in the story. So I'm sorry, which episode are we doing? Rabies, here we go. Let's just begin.

Here's where we're going to start. We're going to start at the beginning, which is, of course, with a bite. So you're bitten by, let's say, a dog. Okay. It doesn't have to be a dog. It could be a bat or a fox or a something. I don't know. Could be any number of animals.

but we're going to pretend like it's a dog. And in that dog's saliva are thousands of little viral particles. Okay. So that's our first point. Rabies is a virus. Okay. And if you remember from what we've talked about last season, viruses are basically just genetic material that's surrounded by protein. That's pretty much it.

In the case of rabies virus, which is also called elisivirus, that's the genus of virus. We're talking about five different proteins and one strand of RNA. That's the whole thing. That's all it is. Okay. All this mess is going to come from five proteins and a little strand of RNA. Okay. So these viral particles happen to be shaped like little bullets, which is crazy.

Like people are like, oh, they look like bullets. But then you look at a picture of them, they actually look like a bullet, like what's in a gun. That's crazy. Yeah. It's nuts. So you've been bitten. And the saliva is now in your large gaping wound. Oh, my God.

Let's say this wound is on your calf. Okay. That seems like a reasonable place where a dog would bite you. So you have a large gaping wound on your calf. It's bleeding everywhere. And it's covered in dog saliva. And the saliva is filled with a little bullet-shaped viruses. Uh-oh.

So what happens next? Do I want to know? Oh, you want to know. So what happens is the virus actually binds to these receptors on your muscle cells. They're called acetylcholine receptors, which basically is a receptor that your nerves use to transmit signals. So that's like the normal way that your nerve would talk to your muscle is through these receptors. So the virus binds to those and then it squirms its way into your muscle cells and it starts to replicate. And because it's inside of your cell, most of the time, if you get a giant gaping bite wound,

your immune system comes over and it's like, oh my God, we need to clean us up. There's saliva everywhere. And it does a really good job of cleaning up what's going on in that large gaping wound. But this virus, it's already inside your muscle cells. Your immune system is basically useless because it can't attack your own muscle cells. It doesn't even know that anything's in there. right? Ooh, that's so sinister.

It's great. So it just sort of hangs out in your muscle cells for a while, replicating itself and building up its own little army. Then, once it's got its own little bullet army, it bloops its way out of your muscle cells. It travels across the space between your muscle and your neuron that we know is right there. And then it weasles its way into the neuron using the same receptors that were on the muscle. muscle cell. Okay. So it's the same receptor on both the nerve and the muscle, and it just goes

broop, broop. So it just makes this easy little transfer. Just a little jump. Yeah. Just a little jump. And then it travels up the nerve. So it travels from your calf up your nerve all the way to your central nervous system, to your spinal cord.

That sounds really bad. And then it travels all the way up your spinal cord to your brain. And that is how you get rabies. And it does this kind of slowly. I mean, I got actually very mixed results when I was trying to figure out exactly how fast it's traveling up your nerve. Like the first source that I found was like, oh, it travels at a rate of one to three millimeters a day. And I was like, that's wicked slow. That's like very slow.

Yeah. And then the next one was like 12 to 100. And I was like, that's an insane amount of very, that's not 100. what, 12. So the WHO expert on rabies says 8 to 20, so I'm going to go with that. That sounds good. Okay. So what that means is it takes about one to three months most of the time for it to make its way all the way to your central nervous system. So the incubation period for this virus is on average one to three months. But if you get bit somewhere like your face, where A, you've got a bunch of nerves there that it could travel on, and B,

nerves are real close to your brain, then the incubation period could be a lot shorter. Okay, that makes sense. Yeah, but isn't that crazy? Like, this virus hitches a ride inside of your neuron. Right. Let's talk about how crazy that is. It's ridiculous. Because, like, what is the blood-brain barrier?

Okay. So the blood-brain barrier, it basically prevents crazy infections from getting into your brain. There's not a ton of other pathogens that, that, that, do this, that make their way into our nervous system. There are some, something like herpes virus, something like varicella or chickenpox. Those viruses are also very good at hiding out in our nervous system, which is a great way for your body to not be able to recognize it because our body doesn't want to attack our nervous system because we need that, especially our central nervous system. If something goes wrong there, we're really, really screwed. And so even your

own immune cells have a hard time making it into your nervous system to be able to fight off invaders. Most of the time, the blood-brain barrier keeps those invaders out to begin with. Okay. So it's already there. Like, it's ridiculous. And it just, it traveled there on your nerve. And so then it's basically there. Like, once it's in your central nervous system, there's not really much that you can do. There happened to be five main phases of infection with, rabies virus. Incubation, which is what we pretty much just talked about. It's that period that on average lasts one to three months, but it honestly can be from like a couple of weeks to years. That's terrifying. It's terrifying. And it really depends on how many viruses get into your system

from the very beginning. So if you got bit on the calf by a dog full of saliva that's full of viral particles, then the incubation period is probably going to be shorter, even if you got bit on your calf, because it's not going to spend as much time in your muscle cells. It's just going to be able to hop straight into your nerves more quickly. Whereas if you maybe got bit and you had like two viral particles, then it could lay latent for a longer period of time. Crazy. So that's the incubation period. Then you have the prodrome, which I'll talk about in a second, acute neurological symptoms and then coma and death. And basically, yeah, those are the five stages.

And we'll talk more about why, like, death is, it's just like a stage of rabies infection at this point for humans. Okay, so the virus has already had this crazy journey. And sometimes you might actually start to enter the, projome stage, which is the second stage, while the virus is still in your peripheral nervous system. So in the nerves in your arms or your legs or your body. And that stage is basically like you might have some tingling, some weird like nerve tingling in your arms or legs. You might have some muscle spasms. You might just have some weakness. But it's really not specific. And it's

actually really mimics some other diseases like Gian Barre. So can you can you tell me what prodrome is usually used to refer to? Like what does it mean? So prodrome usually means like the lead up to or the build up to a disease phase, at least in terms of disease. Yeah. And then once it makes it into your central nervous system, you'll start having these nervous system effects. And the thing that's such a bummer about rabies is that there's pretty, much almost no hope for you once you get to that stage. So once you start showing clinical symptoms, the average time till death is like a week. Wow. And that's pretty much it. So there's two forms of rabies once it hits the clinical stage. And one of them is called furious rabies. And it's

exactly what you think of as rabies. Like when you think rabies, you're thinking of fear. rabies. Okay. And so we'll talk about all the symptoms of furious rabies in a second. Okay. But the other form is called paralytic rabies. And it's just as deadly. It's just instead of having the furious form, you have exactly what it sounds like paralysis. Okay. So that one, you tend to die a little bit more slowly. Oh, God. And then in, in furious form, you die usually within five to seven days. with paralytic you might last like 11. What a blessing. Yeah.

What's the split on this? What do you mean the split? What proportion? Oh, yeah, great question. So it's almost 70 to 80% furious and then 20 to 30% paralytic. So furious is definitely the reason it's the most well known is also because it's the most common. Okay. Yeah.

Okay. So I know you want to know about the symptoms. Yeah. You know it. You read my mind. But you also, you already know. a lot of the symptoms, right? So what do you think of when you think of rabies? I think of fear of light, fear of water.

Okay. Sort of like angry spells but also calm periods of like not comatose but just sort of not moving. Okay. Oh, foamy mouth, sorry. There we go. Yeah, so all of those are exactly what the rabies symptoms are. And so I want to talk about how those actually happen because it's ridiculous. Yeah.

So the first one is actually we can talk about how two symptoms happen with one effect. And that's both hydrophobia, the fear of water, which like, what kind of a symptom is that? I'm afraid of water. I know. It's weird. It's really weird. So hydrophobia and foaming at the mouth, which is caused by excessive salivation, those are caused by the same thing. This is crazy. Okay. Okay. Let me tell you about it. I'm really excited. Okay. So the rabies virus has traveled on your nerves all the way to your central nervous system, right? It's made its way to your brain. Once it's in your brain, it keeps going and it'll travel to your salivary glands. Okay. But it's not only in your salivary glands. It's infected all of the nerves that innervate the muscles of your mouth and your throat. Oh, gosh. So if you try to swallow.

it causes extreme and extremely painful spasming, muscle spasming. Your throat, your mouth, it spasms, and it's extremely painful. And this is because your salivary glands are where this virus replicates again. So it's replicating like crazy in your salivary glands, which is what produces excess saliva. That's why you get foaming at the mouth. Firal replication in your salivary glands. It infects all of the nerves in your mouth and throat because if you were to swallow that saliva, you could not transmit the virus. So it's like, don't dilute me, bro? Exactly.

That's terrifying. Isn't that crazy? So the reason that people have fear of water is because if you were to be able to drink water, you'd wash away all the viral particles in your mouth. How did this evolve? That I do not know. But isn't that crazy? see it's this is like fiction it does it's like a michael crayton novel stephen king

it is yeah yeah well yeah well yeah coo jo by the way but yeah so that's that's why you get that crazy excessive salivation and this foaming at the mouth and then you it's transmitted by biting because that's where all of the viral particles are is in the saliva oh my gosh that's crazy It's crazy and it gets crazier. How? Because the other thing that you mentioned was aggression, right? Or at least like behavior modification. I really wanted to know how the rabies virus could cause this.

Like how does it end up causing this intense amount of aggression? And I actually didn't get quite as great of an answer as I was hoping for. Like I wanted one nice mechanism. Like it infiltrates your frontal lobe and releases inhibitions. But I didn't see anything like that. Okay. What it seems happened. is that your neurons kind of just get very, very full of virus.

And this virus is very good at two things. The first is that, okay, so we'll do a little background on how your immune system works. Okay. If you get infected with a virus in one of your cells, you have immune cells, T cells, that come around and they can, your cell can send out a signal that's like, hey, hey, I'm infected. come kill me. And then that T-cell comes over and it kills the infected cell. And it does that by what's called apoptosis, which just means cell killing, essentially. Yeah.

So in theory, neurons especially that are infected signal to the T cells to say, come and kill me. And killing neurons is actually really bad because your neurons don't regenerate. Right. That's not what happens in rabies. rabies actually inhibits your immune system from killing any of the neurons. So you don't see widespread neuronal death in rabies. Okay. Like you would expect to see if cell death were happening the way it should under the principles that?

Yeah, yeah, exactly. And on top of that, so not only does rabies basically take away the signaling molecules that your neurons would normally use to tell your immune system to come and help out. So it basically pulls those in and puts them away so that your immune system can't come in and help out.

But then if your immune system does happen to come in because it heard about it from a friend or whatever and it comes over, it kills off your T cells. So it induces apoptosis in your T cells. So now your immune system is just like, boom, boom, killed. And your neurons are like,

I'm going to live forever full of rabies. Oh my God. How did this happen again? What is it? What is going on? I don't understand. And then on top of all that, so it's like literally just imagine it filling up your neurons, like blocking them in some places, blocking signals from being transmitted because there's just

so many viral particles there and also other things that come to be like, what's going on and everything just blocks your neurons. On top of that, there's at least some evidence. that the virus can modulate the release of certain molecules like serotonin. If you've heard of serotonin, serotonin is a neurotransmitter that basically like your brain uses. It's one of the like happy transmitters. Right. So if a lot of depression medications increase the amount of serotonin in your brain, that's how they work.

So this can inhibit the release of serotonin. Right? And it can inhibit the release of other neurotransmitters as well. So it basically just completely screws up all of your brain's normal signaling. And that's what can result in this aggression and also just weird behaviors. It's wacky. It just completely, like it comes in and it like just destroys the way that your brain normally communicates with itself and with the rest of your body. It fully takes over.

It fully takes over. And that's it. And so then you have viral encephalitis because your brain is just so full of this viral particle. It's like swollen. You've got immune cells trying to come in and just dying. So then you've got these dead cells everywhere. And then you die. Yeah. And death just why? How do you die? So actually most of the time it's either cardiac or respiratory arrest. So your brain just either your brain just tells your heart to stop beating or or your lungs to stop breathing or something. It's, yeah. That's terrifying.

It's not great. And talk to me about mortality rate. I mean, it's not 100%. If it's untreated, it's 100% essentially. Even if treated, if you get to the point where you have any sort of clinical symptoms, it's also almost 100% fatal. We essentially have no treatment. We do have what's called post-exposure prophylaxis,

but that is not treatment. We don't have any antivirals that work on rabies virus. Yeah, it's bad. So what is post-exposure prophylaxis? Yeah, so if you get exposed to rabies, you will get post-exposure. prophylaxis, which consists of a vaccine, which is, in this case, is just killed viral particles.

And so by putting these viral particles that are dead, they don't replicate, they don't cause disease into either your muscle. It's either injected intramuscular, so into your muscle, just like your tetanus shots are, or intradermal, so right under your skin like maybe your TB test is. You can do either. There's two different vaccines. that allows your immune system to actually generate antibodies. Antibodies can make it into your brain and your nervous system and actually attack this virus.

Oh, okay. So it's actually giving your body the opportunity to defend itself before it gets all the way there. Right. And so you'll get those. And then depending on the sort of category of your exposure, in addition to the vaccines, you're also going to get immune. You know, globulins. So these are actual antibodies that they make in a lab that are specific to the rabies virus,

and they're going to give you those near the site of potential infection, like near your bite wound or whatever. And then they're also going to give you vaccines, because you want as much possible protection, as many antibodies as your body can generate, plus some extras, to really try and kill this virus. Yeah. Yeah.

Yeah. And it's intense. Like, it's an intense course. Even if you've had the rabies vaccine beforehand, it's still at least two to four vaccinations afterwards. If you've never had any sort of rabies vaccine, then it can be up to 12. So, yeah, it's not great. No.

We talked about the fatality in humans, or the mortality rate in humans. Yes. What about dogs? What about bats? What about other mammals? Great question. it's not 100% fatal in bats. Okay.

I don't know what the exact fatality rate is, but I do know that it's not, like, not every bat who gets infected with rabies is going to die. And for dogs, at least one source that I found said that about 14% of dogs infected with rabies can actually survive the infection. Wow. Yeah. Yeah. So.

Okay. That's interesting. Yeah. So what the heck, dude? How did this? How did we get to have this. sane virus that kills so many people and that, like, it's... I can answer some of those questions with a little my own flavor in there.

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very happy to oblige. And, yeah, it's actually been at the top of our long list of diseases that we've wanted to cover for many good reasons. some of them you just heard about. I mean, it's just a super exciting disease. Yeah. Right. And I feel like it's been part of social consciousness for millennia.

And as it turns out, it kind of actually has been there for millennia. Oh, my God. Whereas many of the diseases that we covered in our first season left these big imprints on society through huge outbreaks with the victim counts and the tens of thousands, the hundreds of thousands, the millions of thousands, the millions of, the millions of things. the millions, rabies seems more insidious and its effect on culture and humanity. The threat of madness and an agonizing death lurking in every shadow. Maybe Darth Sidious was rabid. That's why he was so evil. Even for a science podcast, that was really nerdy.

I'm proud of it. I'm proud of you. Yeah. But even with this relatively low death toll, It's no wonder that rabies has led to the creation of laws, inspired supernatural tales. Oh, my God. And continues to terrify even today. Oh, my God.

Before modern medicine and germ theory, the link between exposure and disease was, let's say, tenuous. And often incorrectly assigned. Bad air, an imbalance of the body's humors, cats, demons, the same thing. Just kidding. whatever. No, I take it back. So hurtful. But also they weren't wrong about cats. I mean, there's a lot of disease there. Sure. Sure. But they're often blamed more than they should be. We talked about that. We did. Yeah. But people needed an explanation for why they were sick and so they received one. Incorrect, though it may be. Doesn't matter. Sometimes the link was more easily drawn, such as in the case of rabies, which I think is pretty interesting also.

That is interesting. Yeah. You're getting. Get bitten by a mad dog, and you'll soon become mad yourself. Huh. Yeah. But how far back does this knowledge of the slink extend? Just tell me I even know. So I couldn't find anything about evidence of rabies virus and ancient DNA, but we do know a couple of things about its early history or prehistory. Okay.

Okay. So one of the things that we know is that it originated in bats. Even though we probably most commonly associate rabies with dogs, Studies of the different strains of rabies virus show that it first spilled over from bats into dogs thousands of years ago with additional spillover events occurring every so often and probably still happening today. And they needed to happen. These spillover events needed to happen because the rabies virus would kind of burn itself out by killing all the dogs. Yep. And it turns out that several types of rabies viruses are exclusive to insectivorous bats.

So that means bats that eat insects. And some researchers think that around 7,000 to 12,000 years ago, one of these bats picked up a virus similar to the rabies virus from an insect at eight and it either recombined or mutated into the rabies virus that we know and love today. Stop it. Yeah. They think it came from an insect virus? Yes. This is why I'm an entomologist. Are you kidding me?

Yeah. I didn't dig too deep, but it seems fascinating that, yeah. Oh, that is freaking awesome. I know. It's really cool. Despite the fact that rabies came from bats, most of the early references to rabies center around man's best friend, the dog. The poochin.

Which brings me to the other thing that we know about early rabies. We know that it has been observed and feared by humans for millennia, largely in association with dogs. This comes from the first written references to rabies, a law in the Mesopotamium Codex of Eschnuna, or something like that, from around 4,000 years ago. So like 1930 BCE. They had a law about rabies, 4,000 years ago. And they wrote it down. Yeah.

That's how important of a law it was. Especially considering that rabies only spilled over a few thousand years before that. Yeah. Crazy. Oh my gosh. So under this law, if you had a rabid dog and didn't watch over it and then it ended up biting someone and killing them, you would be fined. From that point on, we see a lot of references to rabid or mad dogs. We see descriptions of disease progression, incantations or treatment options.

Ancient Greece lags a bit behind in their medical knowledge of rabies, which is unusual for ancient Greece. Yeah. But they make up for it by giving the name to. the family of viruses that rabies belongs to. So the rabies virus, as you mentioned, is known as a Lissa virus, and that is L-Y-S-S-A. Yep. The word Lissa has origins either in Lycos, Likos for Wolf or L-U-D for Violent. Ooh.

It's kind of debated what... Which one it is? Yeah. That's cool. Yeah. And ancient Greeks used this word poetically to describe a primal antics. animalistic rage. So like Homer wrote about Hector, viciously attacking the invading Greeks in the Trojan War. He was in Alyssa or he was... Oh, interesting. Yeah. And let's not forget

Cerberus's spit, which I talked about in our crossover episode with In-Defensive Plants many months ago. Oh, go listen to that if you haven't. It's great. So when brought from the underworld to the surface of the earth, the three-headed watchdog, foamed at the mouth and thrashed about because he probably saw sun for the first time ever. Oh, wow. He was afraid of light. So it sounds like rabies, yeah. For sure, or also just he was slobary.

I mean, we all know those dogs. Lissa also meant straight up rabies to the Greeks in a medical sense. Okay. The best early medical description of rabies comes from the Shushuruta. Samhita, which is a Sanskrit text of ancient Indian medicine. And it actually does a really good job of describing the posture of rabid dogs, the fear of water, the inevitable death of a sufferer. So it was comprehensive, like, yeah, you could look at that and go, ah, that's rabies. Like clinical diagnosis, check. Yes, exactly. To some, rabies was a disorder of the mind.

Madness sprung up spontaneously in a dog who then transferred it to you. you, while to others rabies was a venom, similar to that of a snake or a scorpion. How interesting. Yeah. And whichever cause your doctor believed in dictated the treatment, which, let's be honest, wasn't going to work. Yeah, no. No.

At first bite, cupping, or cauterizing the wound was a pretty routine option. Oe. Maybe filling it with clarified butter, which the victim was then supposed to drink. wait what you're telling me that they took your calf wound they filled it with ghee

and then they told you to lick it out of your own calf wound they might add some wine or something to it but yeah no dude oh that's like the most vanilla of all of these cures and this is also where we get our hair of the dog saying

rubbing a few hairs from the dog that bit you. So hair of the dog is short for the hair of the dog that bit you. Yes. Right. So rubbing a few of those hairs or maybe the burnt ashes from the dog's tail. Yikes. Oh, does that mean they burnt the whole tail?

Yeah. Oh, poor pooch. Yeah. Into the bite wound was supposed to protect you against rabies. Oh my gosh. Wow. That's a terrible idea. Another common preventative for rabies was to cut the ligament attaching the dog's tongue

to its lower jaw called the Lissa or worm and then carry that around with you. Well, you're supposed to walk around a fire three times and then put it in your shoe or a pouch and carry it. So you don't carry the whole tongue. No, no, no. Just that little nooper thing? Yep, yep, yep. So if you did it right, neither you nor the dog would get rabies.

Oh, it's like, I want to see my dog. Yeah, so they would do it to puppies and stuff like that. Oh, babe. And unfortunately, this. this very inhumane practice was carried out through the early 20th century. Wow. Seriously? I think it just goes to show what superstition and fear. Yeah, like we knew that's not going to do anything by then.

Like, what the heck? I know. Okay. So if those cures seem a little crazy to you. Yeah? Hold on to your butts. O' clenching. Because I'm about to tell you what Pliny the Elder had to say on the

matter. Wait, we've talked about Pliny before, right? Oh yeah. He was pretty indiscriminate about where he got his information and just sort of kitchen synced it. It was actually Pliny who came up with the hair of the dog treatment. Oh. Maybe, probably, who knows. Okay, all right. But he didn't stop there. Oh, no. Oh, no. How about rubbing? I apologize in advance. Oh, just skip forward 22 seconds. Yeah. Okay, What about eating the dog's head? No? Okay. All right.

Well, you can also administer the ashes of the tail of a shrew mouse, but only if the shrew mouse survived the tail removal and then was set free. It's the only way it's going to work. How do you administer? How do you administer the tail of a shrew mouse? So here's my favorite, though. The old skin of a snake that has been cast in spring. I don't know what that means. Beaten up, wait, with a male crab in wine.

I don't understand. With a crab. A male crab. A male crab in wine. Don't forget. You don't want those ovaries in the rain. What kind of wine? Yeah.

Oh, that's a good question. Could be anything. Oh my God. Yeah. So I don't know what you do with that. It doesn't say what you do with it. It just beat up a snake's skin. But besides curing rabies, it also will keep moths out of your chests and drawers.

I'm not joking. This is plenty of the elders. I love everything about the things that you find. I know. I'm sorry, Dr. Aaron. Oh, Dr. Aaron, thank you. It's so good. Wow.

Okay. In any case, the extremely wide variety of rabies preventatives or cures, in quotes. Wait, so was the crab and snake thing a prevention or a cure? Who knows? Both. A little bit of everything. Yeah. Most of these are preventions, I guess preventatives if you were bitten. Okay, all right, okay. Post-exposure prophylaxis, if you will.

Yeah. I will. Yes. So the wide variety of these is a pretty good indication that desperation drove people to try all kinds of things to prevent themselves or their loved ones from dying. A pretty horrific death. Makes you feel sad for laughing anyway. And sometimes these cures probably appeared to work, either because the bite from the dog didn't break the skin or the dog was just angry and not rabid. but really no actual advancements in effective treatment or knowledge about rabies were made at all throughout ancient times and up into the Middle Ages past the Middle Ages really until pasture set his mind to rabies in the 1800s but we'll get to that later oh okay this is this one more is just for you okay if this is a middle ages cure okay if you are bitten by a rabbit you are bitten by a rabbit

dog, I want you to grab a live rooster, pluck all of the feathers from around its anus, and then hold said anus to the bite wound. Now, now wait, wait. I can't wait. If the rooster swells up, it has sucked the poison out, and you'll be fine. But if not, it's a nice note, yeah. I don't have any... worse.

The poor freaking rooster man. Also, I think it's called a cloaca. I know. That's what I loved the best about this. Is that they called it an anus. And I was like, well, wait a second. There's just one hole as far as I'm aware. Oh, yeah. Ooh.

Okay. Check that Ologies egg episode if you don't know what a cloaca is, by the way. At this point in our rabies history, we've just just kind of breeze past the Middle Ages, the Renaissance. Of course. You know, we're well into the Victorian era. They don't have it figured out. Yeah.

So we're well into the 1800s with little to nothing to show for it. Besides a laundry list of cures that don't work are more often than not inhumane and probably smell really bad. But we've also got fear. After all these thousands of years, the bite of a rabid dog carries as much horse. as it did from the very beginning. It's true. The reputation of rabies as a viciously contagious and violent disease grew throughout this time,

and it grew somewhat out of proportion to the actual risk of disease, as per usual. Fear drove the widespread belief that a bite wasn't necessary for disease. A lick alone from a rabid dog would also lead to inevitable death. So while you mentioned that a lick can actually... it's very rare. It's likely that an actual increase in rabies cases was responsible for some of this fear, but with it came some tragic consequences. Mass extermination of dogs following rabies outbreaks.

A dog tax in Britain and France that restricted the ownership of dogs to the wealthy, as if only dogs from poor people could transmit rabies. And fear of rabies was probably responsible for adding all. whole lot of color and depth to two classic figures in literary horror, the vampire and the werewolf. Both of them? Both of them. Oh.

Okay, let's talk about this. Werewolves have been around for ages. They probably have their roots in a Greek myth about Lycaan, a king who, according to one version of the myth, tried to serve the roasted flesh of his own son to zheaval. Zeus to test Zeus's all-knowing abilities. Zeus, being all-knowing, found out immediately, raged out, killed a bunch of Lycaean sons, and turned Lycaan himself into a wolf. Ooh.

Kind of loses it. And these elements, transformation into a wolf or dog-like creature, loss of control, and violence make up the hallmark of a werewolf when the legend boomed in popularity in the 1600s-ish time, with one crucial thing added to the mix. The bite or scratch of a werewolf could turn you into one. Yeah. And this is still more or less how the werewolf is portrayed today with a few exceptions. Do you mean wrong ones?

Because that's the right. That's how you become a werewolf. It is law. It is correct. At some point, the full moon became also. also crucial in werewolf transformation. That's true. Which I will also point out was thought to correspond to times of increased rabies risk.

I don't know why. Okay. Yeah. But there do seem to be too many parallels between rabies and werewolves to ignore. Yeah. On the other side of this coin is the vampire. Yeah. Vampires have been around for millennia, and many different cultures have their own version of a vampire or a creature with a vampire-like qualities.

So pinning the creation of vampires on rabies is a little bit more difficult. But let's talk about the form of vampire that most of us are probably familiar with. Spike from Buffy. Just kidding. No. Okay. The Dracula type. Thank you.

This is the kind of vampire created in the early 1800s and popularized by Brom Stoker in Dracula. As with werewolves, hypotheses as to the origin of, of vampires abound. But let's go through the evidence for rabies and see what we think. Yeah. Okay. We've got fear of sunlight. Check.

Check. No reflection. Check. Wait. Why? A historic method for testing if someone had rabies was if they could recognize their own reflection. If they couldn't, it meant that the rabies' madness had seized them and they were doomed.

That is super fascinating. Yeah. Okay. A sexual nature check. So I'll keep this as PG-13 as I can. Male suffers in particular of rabies are reported to frequently get erections or ejaculate many times up to 30 in one day. I read somewhere. Human males?

This is, I don't know, citation needed for this. Citation needed, I'd say. Okay. Well, but anyway, the whole sexual nature, maybe that's part of, I don't know. bats so most deaf kind of check i mean is what i'm going to say because okay because it wasn't really until the 20th century so the 1900s when people started linking the poison of some vampire bats to an illness in cattle that turned out to be rabies i see so it's like we know now that it's bats but when people were inventing this bromstoker's dracula they didn't know that it was bats necessarily necessarily

Okay. All right. Okay. All right. And last but not least, biting. Yeah. Kind of check again. Yeah.

So this is because dogs and other mammals definitely become aggressive and bitey when infected with rabies. But the disease doesn't really seem to necessarily make humans bite or to be able to transmit rabies through a bite. Maybe because our teeth just aren't as good at breaking skin. Yeah, I mean, there is not really a lot of cases of human-to-human transmission. Yeah. And that's in part because the disease doesn't necessarily progress to that exact. Like, the symptoms aren't exactly the same between humans and dogs, for example, right? Or foxes.

So we might become aggressive but not in a bitey way because humans don't bite as a general. rule, right? Whereas carnivores, like a dog or a fox, that's what they do when they get aggressive is they bite. But yeah, so there we have it. Okay. Some decent evidence for rabies as at least a partial inspiration for the modern vampire. Cool. There is a third supernatural creature linked to rabies that you may have noticed I've conspicuously left out. The zombie. The zombie. And that is because we are going to take a special episode to cover this topic in much more detail at another time. Yeah.

So stay tuned. Just get like really excited about it. Because we are. Whether or not rabies inspired the legends of werewolves and vampires, it was clear that the disease had insinuated itself into public consciousness. And by the 19th century, fear of it had risen to historic levels. In the western U.S. were tall tales of, quote, phobie cats. phobia being short for hydrophobia,

rabies telltale sign. Yeah. These animals, normally quite shy, would come wandering into a cattle herders camp and bite indiscriminately when rabies infected with nearly 100% fatal outcomes for the poor souls bitten. Do you want to know what these phobie cats are? Do you have any idea?

No. You look so excited, though. I just need to know. There's just skunks. Wait, skunks? Yeah. That's a phobia cat. That's a phobia cat?

That's how they were known for a long time. I'm going to call them that from now on. That's a really cute name. Yeah. A phobie cat? A skunk? I love it. They were apparently one of the most feared animals on the Western Plains.

Oh my gosh. Alongside the rabid wolf, which lived up to its fear because in one account, one, one, rabid wolf, bit 12 men, 11 of whom died from rabies. Oh, man. Yeah. And it wasn't just in the great outdoors that fear of rabies had grown. In cities and small towns, all over the world, the fear was apparent.

And it makes sense. One day, your beloved canaan companion is snuggling next to you while you read. Stop, I'm going to cry. And the next, its bite could spell certain death for both of you. It would have felt like a terrible, tragic betrayal in some ways. Yeah. Dr. Jekyll, Mr. Hyde, these kinds of stories really led to that. It was amidst this rabies-inspired fear and hysteria that Louis Pester grew up and trained to be a scientist.

He was a pretty important dude, as you know. Pester claimed to be driven by a desire to alleviate the world of unnecessary suffering, and he set his eyes on vaccination as a way to do so. He developed his first successful vaccine against anthrax. Then it was time for rabies. Yeah. It's kind of curious why he chose to tackle rabies since it wasn't one of the big killers of the day.

And if he really wanted to alleviate human suffering, the research time and money may have been better spent on another disease whose death toll was much higher, like malaria, cholera, tuberculosis. something like that. But even Pasture's own student suggests that pasture was drawn by the flashiness of rabies as a way to gain maximum interest in his research. Oh. Yeah.

All the way back then. Sort of showmanship kind of a thing. No changes. But whatever. He went to work. He learned that you could collect the virus in the brain of an affected animal, and which is still the way they test for rabies today. And this greatly reduced the danger of lab work. Now that they had the agent, they needed to find a way to attenuate it, to make it less harmful

so when introduced by vaccine, it would not kill the person but induce them to start making protective antibodies against it. Pesture found that air drying, the spinal cord of intentionally infected rabbits, would lead to a weakened virus. Air drying it? Yep. Just like hang it out on your laundry line? I don't know. He tested a vaccination schedule and dogs. He tested a vaccination schedule and dogs or inoculation schedule, both as a preventative and as a post-exposure treatment. The routine consisted of 13 or so shots and started with the oldest, driest bit of spinal cord and progressed until the last shot was a much more recent, much less weakened version of rabies. Interesting. So he just used like straight up spinal cord from a rabbit.

I don't know exactly. I don't think he was able to culture rabies. Right. Yeah. I think he just used. some sort of inoculation of the spinal cord. That is so cool. Yeah. And it worked in dogs. Okay. Pester was still very hesitant to try this out in humans, but he was soon confronted with a decision that didn't leave him long to waffle.

Uh-oh. In July of 1885, a young boy had been bitten 14 times by a grocer's dog. Oh, my God. Likely rabbit, just all over his body. Oh. Pestor's rabies research by this point was well known, and the family went to Paris to seek help from the man himself. Secretly terrified, but outwardly confident. Very important.

That's my life. Yeah, right? I wish. I wish. Pestcher agreed to treat the boy with the 13 inoculations. He waited through many sleepless nights, sure that he had condemned the boy to death. But the inoculations proved successful, and the boy. boy made a full recovery. The news of this achievement spread like wildfire across the globe,

and soon people began flocking to Paris to seek treatment. Wow. Yeah. Soon it was apparent that these inoculations, when given to a bite victim, before any symptoms or signs of disease began, represented the first actual successful prevention for rabies. That is so cool. And what year was this again? 1885. Wow. So, yeah, it was, it was, it was, pretty big. Yeah. And so this, the development of this vaccine marked a huge turning point in the history of rabies. Prevention was finally possible and many countries who could afford to either manufacture or purchase rabies vaccine, the emphasis being on who could afford. Right. Began to attempt eradication. And some were pretty successful, actually. So the UK has been

declared rabies free for almost 100 years. It's an island. So they've got that going. for them. Yep. So even though the vaccine was in use and cases were dropping, people still get rabies and still die from rabies. Almost all of them. Almost. Almost. Not Gina Giesie, who in 2004 was bitten by a bat. The 15-year-old Wisconsin native tested positive for rabies and was put into a medically induced coma to help her body fight off infection. Wow. Yeah. And after seven days in the coma, the infection seemed to be going away and doctors slowly brought her out of the coma, which is unheard of. It's crazy.

Yeah. Recovery was slow but steady and Gina made a full recovery. She was the first known person to survive rabies without having received any portion of any rabies vaccine. Yeah. She did receive some immunoglobulin, but no portion of any vaccine, which is, insane. Yeah. Yeah. Since then, other people have used the so-called Milwaukee protocol, which is putting

into the coma, putting a person into a coma. That was like developed by the guy who treated Rodney Willoughby. Right. Yeah. But it's with varying success. And so its effectiveness is still really heavily debated amongst physicians. So even though we may not have a treatment, we do have a vaccine. Aaron, tell me. Where do we stand with rabies today? Okay. It's a good question. I actually...

This is not a good way to start our first episode of season two. I don't know. Let me tell you why. Because it's interesting. The World Health Organization, according to their most recent reports, there are 59,000 deaths per year from rabies.

59. 59. So almost 60,000 deaths from rabies. A lot. And they say about 60% of these deaths occur in Asia, and 35% are in Africa. And actually, those 59,000 only account for canine-associated rabies. Okay. And that accounts for about 99% of all the rabies in the world. Okay.

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in 2015, which estimates 17,400 deaths from rabies. Different number. Yeah. So that paper came from the global, regional, and national life expectancy, all-caused mortality, and cause-specific mortality. So it wasn't specific to rabies. It was this paper that looked at the overall causes of death across the world from 2005 to 2015. so trying to see what kind of progress we had made on various different infectious and non-infectious diseases and other causes of mortality. And their estimates of rabies were so drastically lower than this one single paper that now the whole World Health Organization and everyone else is citing that came out in 2015.

So I feel very like I honestly don't know. And so maybe people will yell at us one way or the other about this, but I don't know who to believe, quite honestly, in this case. Because the problem is that the vast majority of rabies deaths are not reported. And that's what it really comes down to, is that all of these estimates are based on mathematical modeling and are based on our best guesses in all these various countries, based on risk factors, based on demographics.

And so we don't know how bad rabies is. What we do know is that in Africa and Asia, especially, canine rabies is still a big problem. There are definitely tens of thousands of deaths that are occurring there due to dogs that are infected with rabies. The Pan American Health Organization, which is the World Health Organization for the Americas, essentially, And they had a really huge campaign, and their goal was to eliminate canine rabies by 2015 throughout the Americas.

2015. Yeah. They didn't quite hit that, but they have reduced. But canine rabies is almost non-existent throughout the Americas, not just in the United States, which is incredible. So now throughout the Americas, the real root of transmission is through bats and through other wild animals. And so what is sort of the new goal? There is a, quote, United Against Rabies Collaboration. Okay.

And it is a combination or a cross-sectional effort between the World Health Organization, the World Organization for Animal Health, the Food and Agricultural Organization, the FAO, and the Global Alliance for Rabies Control. So these four, is that right? One, two, three, four. Yeah, four organizations all working together have this new United Against Rabies collaboration. And their goal is to have zero human rabies deaths by 2030.

Okay. So they've got some time, which I think is respectable. Granted, this thing literally just was published in June of this year. That's sort of where it stands now. There's a really big push to kind of get a better handle on what the disease, burden really is and to really the real push is to vaccinate dogs. And so it's massive dog vaccination campaigns and trying to rid the world of canine rabies, which in theory rids the world of almost all human rabies because there are very few cases of rabies outside of dogs.

The World Health Organization stance and the CDC stance is that with proper vaccination and post-exposure prophylaxis, this is a preventable disease. Right. So it's preventable by many different mechanisms. Number one, if you have a domestic animal, you need to vaccinate it. Like, it's not an option. It's a law. It's a law, but that doesn't mean people follow it, right?

And if you have interaction with an animal that you have any suspicion might be or any bat whatsoever, then go to your doctor. and say, I got bit by a bat, and then you can be treated. And yeah, I mean, the World Health Organization, I will say the numbers that they do know for sure is that 15 million people around the world receive post-exposure prophylaxis. That means that we know that potentially hundreds of thousands of lives are being saved by the fact that this exists. It's pretty much 100% effective.

And wait and see, we'll be. kill you. Yes. If you are infected. Yeah. Not to scare you. No. No, no, not to scare you because it has a very low incidence relative to some of the other diseases that are out there and it's entirely preventable. Yeah. And so waiting and seeing, it's not worth it. Right. Yeah. Oh, is that fun? That was so much fun. This is one of the craziest diseases with covers. It's a fascinating virus from a biology perspective, and it's so interesting the way that it's sort of crawled up the neurons of our collective consciousness. I like that. Yeah, exactly. Yeah. Exactly. Just the way it manifests in your body. Yeah. It's very, it's very crazy. That's wonderful. Yeah. Okay. Wow. All right.

We, as always, we'll post all of our links to our sources on our website. This podcast Will Kill You.com. And I'll give a specific shout out to Dr. Trivat Hemachuda. I think that's their name. Who wrote a lot of the articles that I read. Oh, cool. And who is one of the World Health Organization, like experts on the rabies committee. Cool.

Okay. I'll post all of the articles. Yeah. I read a couple of books. There's a book called Rabid by Bill Wausick and Monica Murphy, and that's a popular science book, which is about the history and culture of rabies. And I also took from a book called Historical Perspectives of Rabies in Europe and the Mediterranean Basin. Finally, the information on the evolutionary history of rabies virus I took from an

article called host switching in Lissa virus history from the Chioptera to the Carnivra orders. Oh my God, I want to read that. Yeah, it's really interesting. That sounds so fascinating. Chiropractor are bats, by the way. Yes. Thank you. But yeah, as always, thank you so much for listening. Yeah, this was really fun. Thanks to Bloodmobile for providing all the music. And you know what? Wash your hands. You have filthy animals. Success starts with your drive, and American Public University is here to fuel it. With affordable tuition and over 200 flexible online programs, APU helps you gain the skills and confidence to move forward.

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