Minutus

Robert&Shannon Nelson wrote:
(((( Muchas gracias, senora Wisconsico.

Here are some stories involving the topic---A present day medical school professor claims that Edgar Allen Poe died of Rabies, not alcohol. This is a debate about this, not without useful information. Also a couple of reports of recent cases of rabies. It appears now that Bats are the main carriers that infect humans.

Best,
Andy

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DID POE DIE OF HYDROPHOBIA?

The life of Edgar Allan Poe, author of “The Cask of Amontillado,” is shrouded in mystery. Most scholars believe that Poe died as a result of drinking
too much alcohol. According to another theory, Poe died of rabies, a disease people can get when they are bitten or scratched by an animal infected with the rabies
virus. The following four selections present a debate about what killed this tragic genius.

Rabies Death Theory
This biography traces the last few days of Poe’s life, in 1849. He had just parted from Elmira Shelton, to whom he was recently engaged. Shelton lived in
Richmond, Virginia, and Poe set out from there for Baltimore, Maryland, eventually planning to go to New York City. He never reached it.

Poe’s Final Days

from Edgar A. Poe: Mournful and Never-Ending Remembrance
Kenneth Silverman

In the early morning of September 27, a Thursday, Poe began the first leg of his return to the North, setting out from Richmond for Baltimore on the 4 A.M. steamer,1
with a trunk containing some clothing, books, and manuscripts.

No reliable evidence exists about what happened to or within Poe between that time and October 3, a week later, when a printer named Joseph Walker saw him at
Gunner’s Hall, a Baltimore tavern, strangely dressed and semiconscious.

It was Election Day for members of Congress, and like other local watering holes2 the tavern served as a polling place. Poe seemed to Walker “rather the worse
for wear” and “in great distress.” Apparently flooded with drink, he may also have been ill from exposure. Winds and soaking rains the day
before had sent Baltimoreans prematurely hunting up overcoats and seeking charcoal fires for warmth. . . . Poe managed to tell Walker that he knew Joseph Evans
Snodgrass, the Baltimore editor and physician with whom he had often corresponded while living in Philadelphia. As it happened, Walker had worked as a typesetter
for Snodgrass’s Saturday Visitor. He sent Snodgrass a dire note, warning that Poe needed “immediate assistance.”

When Snodgrass arrived at Gunner’s Hall, he found Poe sitting in an armchair, surrounded by onlookers. Poe had a look of “vacant stupidity.”
He wore neither vest nor tie, his dingy trousers fit badly, his shirt was crumpled, his cheap hat soiled. Snodgrass thought he must be wearing castoff clothing, having
been robbed or cheated of his own. He ordered a room for Poe at the tavern, where he might stay comfortably until his relatives in Baltimore could be notified. Just
then, however, one of them arrived—Henry Herring, Poe’s uncle by marriage, who somehow had also learned of his condition. A lumber dealer now
nearly sixty years old, he had wed Muddy’s3 sister, and spent time with Poe during his early days in Baltimore and later when both families lived in
Philadelphia. But he refused now to take over his care, saying that on former occasions, when drunk, Poe had been abusive and ungrateful. Instead, he suggested
sending Poe to a hospital. A carriage was called for. Poe had to be carried into it, Snodgrass said—insensible, muttering.
From Edgar A. Poe: Mournful and Never-Ending Remembrance by Kenneth Silverman. Copyright © 1991 by Kenneth Silverman. Reproduced by permission of
HarperCollins Publishers, Inc.

from The New York Times, September 30, 1996

POE'S DEATH IS REWRITTEN AS CASE OF RABIES, NOT TELLTALE ALCOHOL

NEWSPAPER ARTICLE

The following newspaper article announced a new theory about Poe’s death, developed by Dr. R. Michael Benitez. In response to this article, Burton R.
Pollin and Robert E. Benedetto wrote a letter disputing Dr. Benitez’s theory. Dr. Benitez replied by writing a letter defending his ideas. Both letters follow
this article.

Poe's Death Is Rewritten as Case of Rabies, Not Telltale Alcohol

from The New York Times, September 15, 1996

Edgar Allan Poe did not die drunk in a gutter in Baltimore but rather had rabies, a new study suggests.

The researcher, Dr. R. Michael Benitez, a cardiologist1 who practices a block from Poe’s grave, says it is true that the writer was seen in a bar on Lombard
Street in October 1849, delirious and possibly wearing somebody else’s soiled clothes.

But Poe was not drunk, said Dr. Benitez, an assistant professor of medicine at the University of Maryland Medical Center. “I think Poe is much maligned in
that respect,” he added.

The writer entered Washington College Hospital comatose,2 Dr. Benitez said, but by the next day was perspiring heavily, hallucinating, and shouting at imaginary
companions. The next day, he seemed better but could not remember falling ill.

On his fourth day at the hospital, Poe again grew confused and belligerent, then quieted down and died.

That is a classic case of rabies, the doctor said. His study is in the September issue of The Maryland Medical Journal.

In the brief period when he was calm and awake, Poe refused alcohol and could drink water only with great difficulty. Rabies victims frequently exhibit
hydrophobia, or fear of water, because it is painful to swallow.

There is no evidence that a rabid animal had bitten Poe. About one fourth of rabies victims reportedly cannot remember being bitten. After an infection, the symptoms
can take up to a year to appear. But when the symptoms do appear, the disease is a swift and brutal killer. Most patients die in a few days.

Poe “had all the features of encephalitic3 rabies,” said Dr. Henry Wilde, who frequently treats rabies at Chulalongkorn University Hospital in Bangkok,
Thailand.

Although it has been well established that Poe died in the hospital, legend has it that he succumbed in the gutter, a victim of his debauched4 ways.
“Poe’s Death Is Rewritten as Case of Rabies, Not Telltale Alcohol” from The New York Times, September 15, 1996. Copyright © 1996 by The
Associated Press. Reproduced by permission of the copyright holder.

LETTER TO THE EDITOR

If Only Poe Had Succeeded When He Said Nevermore to Drink

from The New York Times, September 23, 1996
To the Editor:

Dr. R. Michael Benitez, an assistant professor of medicine at Maryland University Medical Center, is wrong to ascribe the death of Edgar Allan Poe to rabies through
animal infection rather than to the traditionally maintained cause of alcoholism (news article, September 15).

Poe was found outside a Baltimore saloon in an alcoholic stupor on October 3, 1849, and died four days later. Dr. John J. Moran’s account of his final days is
given in a letter to Poe’s aunt and mother-in-law, Maria Clemm, a New York Herald article in 1875, and a book by Moran in 1885. Supplementary accounts of
Poe’s alcoholic condition came from Joseph Walker, a Baltimore printer who first found him; Dr. Joseph Snodgrass, an editor well known to Poe; and two of
Poe’s relatives. None of these confirm Dr. Benitez’s statement that “Poe was not drunk.” Evidence of Poe’s chronic binges is
strewn through his letters, in periodic admissions of “recoveries” and promises to his wife, Virginia, and her mother to “reform.”

Dr. Benitez admits the primary weakness of his theory—lack of evidence of a bite or scratch. In those days, rabies was well known as to causes and symptoms,
including itching and other sensations that could affect an entire limb or side of the body. How could Moran and his staff ignore such symptoms in a patient?

And what of Poe’s cat, dearly loved but left behind in the Bronx over three months earlier? Guiltless was the pet Caterina, who, uninfected and showing no sign
of rabies, died of starvation when deserted by Clemm after Poe’s death.

In short, there is no need to whitewash° the self-destructive behavior of this literary genius and major American poet, critic, and teller of tales.

Burton R. Pollin
Robert E. Benedetto
Bronxville, New York
September 20, 1996

The writers are, respectively, professor emeritus of English, City University of New York, and an associate film professor at the University of South Carolina.
“If Only Poe Had Succeeded When He Said Nevermore to Drink” by Burton R. Pollin from The New York Times, Editorial Desk, September 23,
1996. Copyright © 1996 by Burton R. Pollin. Reproduced by permission of the author.

To the Editor:

Contrary to a September 23 letter, I do not “admit” that the lack of bite or scratch is a weakness in my theory that Edgar Allan Poe may have died of
rabies encephalitis.

Data published by the Centers for Disease Control and Prevention indicate that over the past 20 years in the United States there have been 33 reported cases of human
rabies, yet only 24 percent of these victims could recall an appropriate history of animal exposure. Bat-related subtypes of rabies have been identified in 15 cases of
human rabies since 1980, although patient contact of any sort with bats could be documented in only 7 of these patients.

A diagnosis is not always easy or straightforward. The incubation period1 in humans may be as long as a year, if the inoculation2 is small and occurs on the hand or
foot. Thus the lack of evidence of a bite or scratch is not inconsistent with the diagnosis. Finally, although physicians knew how rabies was transmitted at the time of
Poe’s death, even at the time of Louis Pasteur’s first use of a rabies “vaccine” in 1885 the causative agent, a rhabdovirus, was unknown.3

I was saddened to hear of the fate of Caterina, Poe’s cat, yet nowhere have I suggested that Poe contracted rabies from her, although it is worth noting that there
was no available vaccine for pets at that time.

R. Michael Benitez, M.D.
Baltimore, Maryland
September 26, 1996

The writer is an assistant professor of medicine at the University of Maryland Medical Center.

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Wilderness Emergency Medical Services Institute
Rabies Death Following Bat Bite
On Friday, October 24th, 1997, a New Jersey man died of rabies following a bat bite. Doctors said this was the first case of human rabies in New Jersey in 25
years.

The victim, aged 32, contracted rabies while trying to remove bats from his living room, said Dr. Donald Allegra, infectious disease specialist at Northwest Covenant
Medical Center in Denville, N.J.

Dr. Allegra said he had contacted specialists in Montana and Washington, the only other ctates where human deaths from bat-transmitted rabies have occurred this
year, for help in saving the man's life. By then, the victim was comatose, and was on a respirator.

Thirty-five cases of human rabies have been diagnosed in the United States since 1980. Twently of these, including the New Jersey man, have been linked to bats.
Dr. Allegra said that less than one percent of bats carry the rabies virus.

The man, who was not identified in news reports, was admitted Oct. 15 complaining of flu-like symptoms, but apparently did not suspect he had rabies. The man
claimed he was not bitten by bats, but according to the doctors, a victim can be bitten without realizing it.

Symptoms of rabies include high fever, difficulty swallowing, fever, aches and chills. There is no cure, and death usually occurs three to twenty days after the onset
of symptoms.

The victim, who lived with his wife and two children in an old house in a rural area, had handled two bats in July, according to New Jersey public health veterinarian
Dr. Faye Sorhage.

Dr. Sorhage believed that there could have been a colony of about 200 bats in the house at one time, based on the bat droppings which were present.
The Wilderness Emergency Medical Services Institute

Human Rabies -- Connecticut, 1995

(The following article will be of interest to W-EMTs, and especially to cavers, and thus we have re-printed it in its entirety. The article is taken from the
Health Info-Com Network Medical Newsletter, Compilation Copyright 1996 by David Dodell, D.M.D. Reprinted with permission.)
-----------------------------------------------

On October 3, 1995, a 13-year-old girl who resided in Greenwich, Connecticut, died from rabies virus infection. This was the first case of human rabies reported in
a Connecticut resident since 1932. This report summarizes the investigation of this case, which indicated a bat as the probable source of her exposure.

On September 18, the patient reported general fatigue, stiffness, tremors, and tingling in her left arm and hand. On September 22, she visited a local emergency
department because of pain and tingling in her left arm and shoulder and a low-grade fever. Cervical radiculopathy was presumptively diagnosed and was attributed
to her habit of carrying a heavy backpack; ibuprofen was prescribed. She was given a cervical collar and referred to a pediatric neurologist.

On September 25, because of continuing symptoms, she was evaluated by her pediatrician, who noted sensory changes on the left arm and face. She was again
referred to a pediatric neurologist and, later that day, was admitted to a hospital because of complaints of fever, neck pain, and painful sensations along her left arm
and left side of her face. On physical examination, her temperature was 100.0 F (37.8 C), and she was alert but anxious; there was moderate nuchal rigidity. The
only abnormal neurologic finding was deviation of the uvula to the left. Laboratory findings included a peripheral white blood cell (WBC) count of 13,600/mm3
(normal: 5000-10,000/mm3) with 86% neutrophils, 10% lymphocytes, and 4% monocytes. Her cerebrospinal fluid (CSF) contained 2 red blood cells/mm3 (normal:
0/mm3) and 100 WBCs/mm3 (normal: 0-5/mm3) with 48% neutrophils, 40% lymphocytes, and 12% monocytes, total protein of 104 mg/dL (normal: less than 40
mg/dL), and glucose level of 53 mg/dL; serum glucose was 102 mg/dL (normal: 70-110 mg/dL).

The diagnosis on admission was possible Lyme meningoencephalitis with peripheral nerve involvement; treatment was initiated with intravenous ceftriaxone and
dexamethasone. During the 24 hours following admission, she became intermittently drowsy then agitated, and occasionally was disoriented.

Subsequent manifestations included deviation of her tongue to the right, anisocoria, and progressive weakness of the left arm. She also was observed to be
apprehensive and had difficulty swallowing, accompanied by a prominent aversion to oral intake. Severe pharyngeal spasms were elicited by offering a drink of
water. The diagnosis of rabies was considered, and the patient was placed in isolation. She became increasingly agitated; although she experienced tactile
hallucinations (i.e., complaining of a sensation of insects in her mouth), she intermittently was lucid and self-reflective and apologized for her mood and
hallucinations.

On September 26, the girl was transferred to the intensive-care unit, where she was intubated because of progressive bulbar dysfunction. Beginning September 27,
she became progressively less responsive, and subsequently lapsed into a coma. On October 3, mechanical ventilation was withdrawn, and the patient died. No
autopsy was performed.

Rabies was diagnosed on October 2 at the New York State Rabies Laboratory based on corneal impressions collected on October 1, which were positive for rabies
virus by immunofluorescence, and based on rising rabies virus neutralizing antibody titers of 1:32, 1:64, and 1:512 in serum samples collected on September 25, 29,
and October 2, respectively. The diagnosis was confirmed at CDC through extraction of RNA from saliva and corneal epithelia, which was reverse transcribed with
rabies-specific primers and amplified using the polymerase chain reaction (PCR) assay. Nucleotide sequencing of the PCR products at CDC characterized the
rabies virus as a variant associated with the silver-haired bat, Lasionycterus noctivagans.

The girl lived in a single-family dwelling in a wooded residential area in Greenwich. Although she denied a history of animal bites, multiple potential sources of
animal contact were present in the home and surrounding environment; domestic animals with which she was known to have had contact were accounted for and
were well. Following the diagnosis of rabies, the girl's mother and three siblings recalled that on approximately August 19, a bat flying inside the house struck at
least one person; during this time, the girl was asleep in an upstairs bedroom. Inspection of the house and surrounding property by the Greenwich Department of
Health on September 29 did not identify dead animals or evidence of bats.

Because of possible percutaneous or mucous membrane contact with the girl's secretions during September 10-October 3, rabies postexposure prophylaxis was
administered to 83 persons who reported probable contact with the patient's saliva: 46 health-care workers, 29 children, four family members, three family friends
intimately involved in the girl's care, and one other adult.

Reported by: JL Muqoz, MD, R Wolff, MD, A Jain, MD, J Sabino, MD, Westchester County Medical Center; G Jacquette, MD, M Rapoport, MD, Westchester
County Dept of Health, Hawthorne, New York. J Lieberman, DVM, CC Baisley, BH Ward, MA, Greenwich Dept of Health, Greenwich; CR Brown, MD, Town of
New Canaan, New Canaan, Connecticut; PM Stolte, AB Crowley, H Hastings, Nantucket Health Dept, Massachusetts. ML Cartter, MD, JL Hadler, MD, State
Epidemiologist, Connecticut Dept of Public Health. TW French, PhD, Massachusetts Dept of Fisheries, Wildlife, and Environmental Law Enforcement, Westboro;
S Kreindel, DVM, R Knowlton, Massachusetts Dept of Public Health. GS Birkhead, MD, JG Debbie, DVM, CA Hanlon, VMD, CV Trimarchi, DL Morse, MD,
State Epidemiologist, New York State Dept of Health. Viral and Rickettsial Zoonoses Br, Div of Viral and Rickettsial Diseases, National Center for Infectious
Diseases; Div of Field Epidemiology, Epidemiology Program Office, CDC.

Editorial Note:

Since the 1950s, bats have accounted for an increasing proportion of variants of rabies virus transmitted from wildlife reservoirs to humans. The rabies virus variant
identified in this case, and in a case in New York in 1993 (1), is associated with the silver-haired bat, a solitary, migratory species with a preferred habitat of
old-growth forest. However, in neither of these cases was a clear history of bite exposure to a bat or any other animal established.

Of the 28 cases of human rabies diagnosed in the United States since 1980, this case was the 15th to be associated with bats; 10 of the virus variants obtained from
these 15 persons have been characterized as a silver-haired bat variant. Bat rabies is enzootic in the United States, and cases have been reported from all 48
contiguous states (1). In Connecticut, of the 671 bats submitted to the state laboratory for testing during 1991-1995, a total of 47 (7%) were positive for rabies. Nine
of the bats diagnosed with rabies in Connecticut during 1995 were sent to CDC for viral typing. Eight of the bats were infected with a variant associated with the
common big brown bat (Eptesicus fuscus) and one bat was infected with a rabies virus variant associated with red bats (Lasiurus borealis). None of the bats were
identified by species. In New York state, of the 6810 bats submitted to the state laboratory for rabies testing during 1988-1992, a total of 312 (4.6%) were positive
for rabies; of these, approximately 90% were from E. fuscus. Only 25 of the submitted bats were silver-haired bats, of which only two were positive for rabies virus
(2).

The findings of the investigation of a recent case in Washington suggest that even apparently limited contact with rabid bats may be associated with rabies
transmission (3). Because bites from bats may be very small, an exposure may not be recognized--particularly when an unattended child may not be able to
accurately relate events to an adult.

The case described in this report and reports of similar cases (1,3,4) underscore the national recommendation that, in situations in which a bat is physically present
and the person(s) cannot reasonably exclude the possibility of a bite exposure, postexposure prophylaxis should be given unless prompt capture and testing of the
bat has excluded rabies virus infection.

References

1.CDC. Human rabies--New York, 1993. MMWR 1993;42:799,805-6.
2.Childs JE, Trimarchi CV, Krebs JW. The epidemiology of bat rabies in New York state, 1988-92. Epidemiol Infect 1994;113:501-11. 3. CDC.
3.Human rabies--Washington, 1995. MMWR 1995;44:625-7.
4.CDC. Human rabies--California, 1994. MMWR 1994;43:455-7.

Compilation Copyright 1996 by David Dodell, D.M.D. All rights Reserved. License is hereby granted to republish on electronic media for which no fees are
charged, so long as the text of this copyright notice and license are attached intact to any and all republished portion or portions.