Four Thousand Years of Concepts Relating to Rabies in Animals and Humans, Its Prevention and Its Cure

Abstract

The epitome of the One Health paradigm-and of its shortcomings-rabies has been known to humankind for at least 4000 years. We review the evolution through history of concepts leading to our current understanding of rabies in dogs and humans and its prevention, as transmitted by accessible and surviving written texts. The tools and concepts currently available to control rabies were developed at the end of the 19th Century, including the first live, attenuated vaccine ever developed for humans and the first post-exposure prophylaxis (PEP) regimen. No progress, however, has been made in etiological treatment, leaving clinicians who provide care to animals or patients with symptomatic rabies as powerless today as their colleagues in Mesopotamia, 40 centuries ago. Rabies remains to date the most lethal infectious disease known to humans. Widespread access to timely, effective, and affordable PEP in rural areas of developing countries is urgently needed.

Keywords: Galtier; One Health; Pasteur; Roux; Semple; dog; history; post-exposure prophylaxis; rabies; vaccine.

Figure 1

Excerpts from the Sumerian Laws of Eshnunna, Northern Babylonia ca. 1930 BCE. (a) Tablets of the Laws of Eshnunna; (b) One possible translation of Paragraphs 56–57 of the Laws of Eshnunna (A iv 20–24) [10]. Another possible translation speaks of a dog becoming “furious” or “vicious” [8,9]. Even 15 shekels was a considerable sum: The Hammurabi code mentions the cost of a boat of sixty “gur” at two shekels. (Source: http://legacy.fordham.edu/halsall/ancient/hamcode.asp). Acknowledgement: Dr. Mark Weeden, Lecturer in Ancient Near Eastern Studies, School of Oriental and African Studies, London, UK.

Figure 2

“Dog incantation”, ca. 1900–1600 BCE (a) Tablet; (b) Translation, adapted from [11].

Figure 3

Ur incantations. (a) Tablets of the Ur III incantations (http://cdli.ucla.edu/P142047); (b) Translation. Acknowledgement: Prof. N. Veldhuis, Professor of Assyriology, University of California, Berkeley, CA, USA.

Figure 4

Goddess Gula represented on her throne, a dog at her feet on a kudurru of Nebuchadnezzar I (12th Century, BCE) [16]. Acknowledgement: Prof. Tallay Ornan, Hebrew University of Jerusalem, Department of Archaeology & the Ancient Near East Department.

Figure 5

Outdoor scene with a mad dog biting a man. Folio from the ‘Kitab al-Hashaish’, an Arabic translation of the Materia medica by Dioscorides (ca. 40–90 C.E.) copied by Abdallah ibn al-Fadl, Baghdad, A.H.621/1224 A.D. Freer Gallery of Art and Arthur M. Sackler Gallery, Smithsonian Institution, Washington, D.C.: Purchase—Charles Lang Freer Endowment, F 1953.91.

Figure 6

Joseph Meister in 1885, the first human to have received Pasteur’s live, attenuated rabies vaccine on July 6, 1885 (© Institut Pasteur-Musée Pasteur).

Figure 7

Albert Calmette and the first two patients to receive rabies PEP in Asia (excluding the Russian Empire), Africa or Latin America, 18 April 1891. The handwritten legend indicates that these were Malay children referred from Singapore (© Institut Pasteur-Musée Pasteur).