M. PASTEUR'S ANTLRABIETIC TREATMENT. MHE statement that on the first
of next month a meeting will be held at the Mansion House to help on a scheme for establishing a Pasteur Institute in this country, turns out not to be literally accurate. The resolutions to be proposed include, however, votes of confidence in M. Pasteur and promises of support. They raise the whole question of the value of his alleged discovery, and render it, in our opinion, necessary to recapitulate as succinctly as possible the questions which laymen are entitled to ask, and which ought to be answered to the satisfaction of laymen, before further encouragement is given to a treatment by inoculation as to the merits of which so much doubt is entertained, and at the methods of which so much horror is felt. We shall endeavour, in stating these questions, to forget for the moment our hatred of vivisection and our mistrust of all conclusions based on the experiments of the laboratory. We shall also endeavour to forget that the M. Pasteur who is said to have discovered the only protection against hydrophobia is the M. Pasteur who proposed to import chicken-cholera into Australia, and is the M. Pasteur whose exploits in the war against anthrax have been discussed before now in these columns. The case for this new treatment of hydrophobia must be tested in a purely scientific manner, just as if no humanitarian considerations entered into the question, and just as if its discoverer had never been guilty of that rashest of rash proposals already referred to,—a proposal which, to our knowledge, startled and horrified distinguished men of science who had been by no means unfavourably disposed towards its author.
The questions we wish to ask the promoters of this meeting may be summed up as follows. Are they prepared with evidence sufficing to prove,—first, that M. Pasteur's method is efficacious ; secondly, that it is safe ; and thirdly, that there are not in existence other equally efficacious treatments, abso- lutely free from danger, and capable of prompter application ? When the Select Committee of the House of Lords was collecting evidence on the subject of rabies, the following question was put to Professor Victor Horsley by Lord Cron- brook: "The only remedy which you can speak of with certainty as having efficacy in some cases is inoculation?" He replied : "It appears so from the statistics, if we can rely upon statistics." Waiving the question whether inoculation should be spoken of as a remedy, and not solely as a preventa- tive, we would ask whether, after eliminating from the cases treated in the Pasteur Institutes now in existence, those in which the patients can scarcely be said really to have been bitten, or were bitten by dogs conclusively proved not to have been rabid, or bitten through clothes, and those in which the wound was subjected to some prompt local treatment, the balance of cases remaining is sufficiently large to argue from. If it is said that it is, and that the death- rate observed is conspicuously lower than that in pre- cisely parallel cases subjected to one and another of the rival treatments, we ask from what data the alleged death- rate amongst the latter cases is derived. It has been pointed out almost ad nauseam that these per-centages are largely conjectural, but that, whichever of them is adopted, there is great danger of proving that M. Pasteur saves far more lives than used to be sacrificed to hydrophobia before he undertook to prevent the disease. It was, for instance, stated the other day, when the Prince of Wales visited the Institute, that during the twelve months ending on May 1st, there had been treated 1,483 Frenchmen bitten by dogs. If these dogs were rabid, there ought, at 10 per cent., a death-rate approved by some authorities, though 15 per cent. is mentioned in the Lord Mayor's circular letter, to have been 140 deaths amongst them ; and we believe the recorded average of deaths from hydrophobia in France used to be less than a quarter of that number. If the dogs were not rabid, the suggestion that, thanks to M. Pasteur, "the mortality is only 1 in 556, less probably than in any other malady," is un-
speakably ridiculous. And we must make another comment on this last batch of statistics. Thirteen cases have recently been treated unsuccessfully. For ten of these failures M. Pasteur is held not to be responsible, because the patients came to him too late. His critics have expressed a hope before now that there will not be classed amongst his successes cases which, had they terminated fatally, would not have been classed amongst his failures. Quitting the question of efficacy, and coming to that of safety, we would, as laymen, ask whether it is still admitted that M. Pasteur's theory of a specific germ of rabies is more than a working hypothesis probably true, but not absolutely established. But a treatment by inoculation should not be experimental both as to the theory on which it is based, and as to the result it will have on the patients. Cases have been from time to time recorded of deaths attributed by M. Pasteur's opponents to the injec- tions used. Has M. Pasteur shown, or can he show, that though injections he has recommended possibly produced the disease they were designed to remedy, the injections he now recommends cannot and will not? His injections probably contain both the micro-organism, if there is one, and its chemical products. Does he know ix what proportion either is present ? Does he know whether the extent to which one or other may be present or absent, determines whether the operation shall be dangerous or beneficial ? Can he guarantee any uniformity of action from his treatment ? And after it has been shown that M. Pasteur's treatment is efficacious and safe, it must, as we have said, be shown to be more trustworthy than other treatments. Professor Horsley apparently admits that cauterisation may sometimes destroy the virus, and with his other dictum we should like to com- pare the evidence of Mr. Rotherham. He and Mr. Kent were bitten by a dog. It was supposed to be rabid, and Mr. Kent died. Mr. Rotherham's symptoms took the form of lockjaw. He recovered, and he attributes his recovery to the use of the vapour-bath. Dr. J. H. Clarke quoted alleged cases of the cure of developed hydrophobia by that and other means. Men of science who are not content with the evidence in support of these alleged cures, should give some grounds for their discontent beyond the general belief that hydro- phobia is incurable. So far as prevention, not cure, is concerned, we may point out that the older remedies pro- ceed on the natural and simple plan of at once attempting to destroy the virus at the spot where it has gained or is gaining entrance, a wiser plan where possible, we should imagine, than choosing as the battle-ground the tissues amongst which it is ultimately diffused. The phrase, "modern Naamans," which has been applied to the more bigoted believers in M. Pasteur, exactly expresses the danger of relying exclusively on his treatment. The fact may have no significance, but we learn from a return obtained by Sir H. Roscoe, that sixty-four English persons were treated at the Pasteur Insti- tute in 1887, and twenty-one in 1888, and out of the larger number there were only eighteen cases in which there was any doubt whether or how the person had been cauterised. That doubt existed in no less than twelve out of the twenty-one cases in the following year. These persons may have gone to M. Pasteur because prompt measures had been neglected or were impossible. The return does not, we hope, indicate that a tendency to trust in M. Pasteur, and M. Pasteur alone, is taking root in England. We need hardly remind our readers that there are old statistics strongly in favour of cauterisation. The whole question is one of evidence, and we admit that very careful attention should be paid to statements which have recently appeared as to the different death-rate amongst the French cases treated and those not treated by M. Pasteur. The difference is said to be very much in favour of M. Pasteur, and we are anxious to do justice to his case.
It will, no doubt, be said that we bring forward no new arguments, that M. Pasteur proved his case long ago, and that the Report of the Local Government Board's Committee to which the Lord Mayor refers is there to show it. It is not wise to underrate the weight that Report will carry ; but it is equally unwise to treat it as the production of infallible persons. We have not space to go over all the ground covered by the comments which Surgeon- General Gordon published, nor perhaps should we, without very careful consideration, adopt as our own all his conclusions. It is, however, obvious that reliance on that Report means reliance either on the statistics it contains, or the experiments described, or both. If the case is to rest on statistics, let us have the further statistics since the date of its preparation. Two years are a large fraction of the time during which M. Pasteur has been at work. Above all, let us have statistics excluding the possibly good as well as the possibly bad results of the "intensive method" now modified. So far as the ex- periments go, they were held to entirely confirm M. Pasteur's discovery, the " protected " animals living and the "unpro- tected" animals dying, "with rare exceptions." Professor Horsley experimented on six protected dogs. One died, but not of rabies. Now, it is generally understood that dogs inoculated by rival investigators were not equally fortunate. Much may depend upon the care taken by the operator to per- form the operation thoroughly. Much also may depend upon the rabid dog. No one knows how often the bites communi- cate rabies. Far be it from us, however, to suggest that such experiments should be repeated or multiplied. We will admit, for the sake of argument, that they were absolutely successful; and if so, what would they prove ? They would show that a virus can be obtained and so attenuated as not to endanger the lives of certain animals, and yet protect them against rabies for a period of doubtful duration. Nothing but the records of a large number of cases actually treated can, we presume, show that in the case of human beings the same virus can be attenuated enough to be used safely and yet not forfeit its protective power. If rabies and hydrophobia are one and the same specific disease, caused by one and the same specific micro-organism, it is less fallacious than usual to argue from the results of experiments on animals as to what will happen to human beings ; but the existence of the micro- organism must be proved, and we are bound to point out that the paralytic rabies observed in rabbits differs from the convulsive form which is usually the one recognised in human beings. One further observation we have to make with great diffidence. It is known that the virulence of some diseases varies from time to time, and that remedies which are found apparently most valuable when an epidemic is running out its course prove to be most disappointing failures when a new epidemic begins. Hydrophobia is said not to be subject to these variations. Can this be proved, or may it turn out that inoculation, though valuable at one period, is futile at another? These are all points on which laymen may turn to experts for guidance. Until the questions we have asked are answered, the least incautious attitude to adopt towards M. Pasteur's method is that of the Select Committee of the House of Lords already referred to. Though not prepared to throw doubt on the conclusions of Professor Horsley and his colleagues, they phrased their last recommendation thus :—" In the event of its- being conclusively proved that M. Pasteur's system provides a preventive remedy, facilities should be afforded for its applica- tion in England." In other words, fresh evidence is being accumulated every day. A conclusive proof must rest on the whole of the evidence now available, and nothing short of that is worth considering. Conclusive proof is equally required whether the point under discussion be the establishment of an Institute in England, or sending English patients to the Institute in Paris.
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