Fourteen Bites

I

On 6 July 1885, in a Paris laboratory that was not a clinic, a chemist who was not a doctor gave the first injection to a nine-year-old Alsatian boy who had been bitten by a rabid dog two days earlier.

The boy was called Joseph Meister. He had fourteen bites on his legs, his hands and his thighs, some of them deep, washed with carbolic acid by a village doctor twelve hours after the attack.

Rabies, once the symptoms appear, always kills. Then and now [there are three or four documented survivors in history, and all of them are disputed].

Louis Pasteur had no licence to treat anybody and he knew it perfectly well; he had two doctors come to examine the boy and sign, and one of them gave the injections. The material was rabbit spinal cord infected and dried in air for days [fourteen numbered bottles, one per day of drying], which is how a virus was weakened at the time.

Thirteen injections in ten days, beginning with the oldest and least dangerous cord and ending with the freshest and most virulent.

Meister did not fall ill. He went back to Alsace and lived.

Of those ten days no account of his own remains. What there is is the laboratory notebook, with the dates and the bottle numbers, and a letter in which Pasteur says he did not sleep at night thinking about what he had done [“an anguish that cannot be described”, he wrote]. Of the boy, nothing. He was nine, he spoke Alsatian and he was in a city he did not know, with his mother, waiting to be jabbed again the next day.

In the following months hundreds of bitten people arrived at the laboratory, from Russia and from America, and Pasteur treated them on a staircase that was not a consulting room. Within a year more than two thousand five hundred people had passed through there; the staircase turned into an institute.

II

It has to be said what the risk consisted of, because it was not the one it seems.

Pasteur was not testing whether his preparation worked against rabies; he was doing something more uncomfortable, which was inoculating a healthy child with infectious material, a little more virulent each day, in the hope of getting ahead of the disease that was already climbing his nerves.

If he got the order or the timing wrong, the treatment killed him; the remedy itself was the risk.

There is another thing the heroic account usually skips, and it is the one that weighs most. It is not known whether that dog had rabies. No check was made. A proportion of those bitten by rabid dogs do not develop the disease, so Meister could have been saved by nothing at all.

That was not a clinical trial. It was a wager with a child on the table, made by somebody who could not sign it.

III

A dog bit me in 2019, on a path, on the thigh, and nothing happened because in western Europe urban rabies has been eliminated.

But the prophylaxis exists and I have seen it close up: a friend found a bat in the bedroom of a country house and was told there was no way of ruling out contact while he slept. They gave him immunoglobulin around the site and four doses of vaccine spread over two weeks.

What fell to me was the small part, the boring and free one. Washing with soap for a long fifteen minutes in a petrol station toilet, with the water coming out lukewarm and pink soap from a dispenser [the part of the treatment that most reduces the risk and the one nobody remembers].

One dose of rabies vaccine, at a travel clinic, costs around sixty euros in Spain [the full course is four, plus the immunoglobulin if there is a wound]. The immunoglobulin, which is calculated by weight, can go over a thousand.

There are countries where that is more than a monthly wage, and there rabies kills tens of thousands of people every year —almost all children, almost all bitten by dogs—. It is a completely avoidable disease since 1885.

IV

Inside, this race is among the strangest in biology.

The rabies virus enters through the muscle at the site of the bite and does not get into the blood [that would be a mistake on its part], because there it would be waited for. What it does is look for the ending of a nerve and get inside.

Then it travels inside the nerve towards the cord and towards the brain, riding the transport system the cell itself uses to move things, and at a ridiculous speed: a few centimetres a day.

That slowness is the only reason a treatment exists.

Because while the virus climbs inside the cable, hidden from view, the immune system knows nothing about it; there is no fever, no inflammation, no symptoms. That is where the vaccine comes in: it arrives by another route, meets the defences in the nodes and sets them making antibodies with two or three weeks' margin.

The race is won by getting ahead [not by curing, which is another thing and here does not exist]. When the virus reaches the brain there is nothing to be done, and that is why rabies remains practically a hundred per cent fatal once the first symptoms appear.

That is also why a bite on the face is worse than one on the foot. Not for the severity of the wound; for the distance.

A bite on the ankle gives weeks of margin. One on the cheek can give days. The same disease, the same virus and the same vaccine, with two different prognoses according to the geometry of the body.

V

What Pasteur invented was not a vaccine, in the sense that the smallpox one was.

That one was given beforehand, to healthy people, against a disease that might arrive one day. This one is given afterwards, to somebody already infected, to win a race against something that is already inside.

It is a different category and it is called post-exposure prophylaxis, a vaccine that arrives late on purpose. It works only with slow diseases, and rabies, which takes weeks or months to climb, is the perfect case.

It is also the first time a treatment was administered without knowing whether it was needed, because there was no way of knowing whether that child was infected, and there is none today either in most cases. The possibility is treated; it is always treated, because the alternative is waiting for certainty, and certainty arrives when it is already too late.

From there comes a scene repeated in any consulting room in the world. Somebody comes in with a cat scratch or with the doubt about whether a bat came in through the window, and leaves with a course of four jabs and a bill. Most of those people were not infected. All of them did right to go.

That has a practical consequence that changes the whole scene of a consultation. Nobody who receives this treatment will ever know whether they needed it. There is no way of checking afterwards: if they do not fall ill, it may be because the vaccine worked or because the animal was healthy. Everybody who is saved is left with the doubt, and that doubt is the price of being alive.

In Pasteur's archive there is a letter from a father asking whether it really was necessary. Nobody could answer him then and nobody could answer him today.

VI

The objection is against Pasteur himself and against the way we tell it.

His laboratory notebooks, opened a hundred years later, show that he had made earlier attempts in humans that he did not speak of, and that the method he used with Meister was not the one he had described publicly. That does not take the result away from him; it takes away the clean account [which is what school teaches].

Against me: I can afford to write about rabies as history, at museum distance, because I live in a place where dogs are vaccinated. The disease has not been eliminated. It has been eliminated from here.

VII

Meister lived. As an adult he worked as a porter at the Pasteur Institute, in the same building where the crypt of the man who treated him was.

He died in 1940, at sixty-four, a few days after the entry of the German troops into Paris —the same city, the same building, fifty-five years later—. About the circumstances there are more versions than documents, so I do not set them down.

6 July 1885, first injection, two days after the bite.

Thirteen injections in ten days, from least virulent to most.

A few centimetres a day: the speed of the virus inside the nerve.

Close to a hundred per cent mortality once there are symptoms, today the same as then.

Vaccine at a travel clinic: around sixty euros a dose.

Immunoglobulin: more than a thousand.