(sometimes called “hydrophobia”). This disease is caused by a virus that is present in the saliva of infected animals. The disease occurs most commonly in wild animals, but it has been found in domestic animals and household pets; in fact, it is probable that all mammals are susceptible to it. The virus that causes rabies is ordinarily transmitted by a bite, but it can be transmitted by the saliva of an infected animal coming in contact with a fresh wound or with the thin mucous membrane of the lips or nose. The virus does not penetrate normal unbroken skin. If the skin is broken, DO NOT attempt wound closure.
If rabies develops in man, it is usually fatal. A preventive treatment is available that is very effective if it is started shortly after the bite; this treatment is outlined in BUMEDINST 6220.6 series. Since the vaccine can be obtained only at a medical treatment facility or a major ship, any person bitten by an animal MUST be transferred quickly to the nearest treatment facility for evaluation, along with a complete report of the circumstances surrounding the incident. Remember, prevention is of utmost importance.
Immediate local treatment of the wound should be given. Wash the wound and the surrounding area carefully, using sterile gauze, soap, and sterile water. Use sterile gauze to dry the wound, and then cover the wound with a sterile dressing. DO NOT use any chemical disinfectant. Do not attempt to cauterize the wound in any way.
All of the animal’s saliva must be removed from the victim’s skin to prevent further contamination of the wound. (CAUTION: DO NOT allow the animal’s saliva to come in contact with open sores or cuts on your hands.)
When a person has been bitten by an animal, every effort must be made to catch the animal to keep it confined for a minimum of 8 to 10 days. DO NOT kill it if there is any possible chance of catching it alive. The symptoms of rabies are not always present in the animal at the time the bite occurs, but the saliva may nevertheless contain the rabies virus. It is essential, therefore, that the animal is kept under observation until a diagnosis can be made. The rabies treatment is given if the animal develops any definite symptoms, if it dies during the observation period, or if for any reason the animal cannot be kept under observation.
Remember that any animal bite is dangerous and MUST be evaluated at a treatment facility.
SPECIAL CONSIDERATIONS IN WOUND TREATMENT
Shock
Shock is likely to be severe in a person who has lost a large amount of blood or suffered any serious wound. The causes and treatment of shock are explained elsewhere in this chapter.
Infection
Although infection may occur in any wound, it is a particular danger in wounds that do not bleed freely; in wounds in which torn tissue or skin falls back into place and prevents the entrance of air; and in wounds that involve the crushing of tissues. Incisions, in which there is a free flow of blood and relatively little crushing of tissues, are the least likely to become infected.
Battle wounds are especially likely to become infected. They present the problem of devitalized tissue, extravasated blood, foreign bodies such as missile fragments, bits of cloth, dirt, dust, and a variety of bacteria. The devitalized tissue proteins and extravasated blood provide a nutritional medium for the support of bacterial growth and thus are conducive to the development of serious wound infection. Puncture wounds are also likely to become infected by the germs causing tetanus.
There are two types of bacteria commonly causing infection in wounds—aerobic and anaerobic. The former bacterial live and multiply in the presence of air or free oxygen, while the latter are bacterial that live and multiply only in the absence of air. The principal aerobic bacteria that cause infection, inflammation, and septicemia (blood poisoning) are streptococci and staphylococci, some varieties of which are hemolytic (destroy red blood cells). The staphylococci and streptococci may be introduced at the time of infliction, or they may be introduced to the wound later, at the time of first aid treatment or in the hospital if nonsterile instruments or dressings are employed.
Wash minor wounds immediately with soap and clean water; then dry and paint them with a mild, nonirritating antiseptic. Apply a dressing if necessary. In the first aid environment, do not attempt to wash or clean a large wound, and do not apply an antiseptic to it since it must be cleaned thoroughly at a medical treatment facility. Simply protect it with a large compress or dressing and transport the victim to a medical treatment facility. After an initial soap and water
