Medicine: Dogbite: What Not to Do

If a man gets a deep flesh cut from a jagged instrument, the doctor usually washes out the wound with soap & water, cuts away dead tissue, and stitches up the wound. He may put a mild antiseptic on the surrounding skin. He would never think of cauterizing such a wound with fuming nitric acid and then leaving it open. But if the patient in such a case is the victim of a dogbite, he is all too likely to be subjected to painful cautery, and perhaps scarred for life.

Dr. Roald T. Vinnard, now a general surgeon in Fresno, Calif., saw a lot of this sort of thing as a resident physician in big New Orleans and Los Angeles hospitals, and it infuriated him. In Postgraduate Medicine, he tells why: there is no need to treat a dogbite differently from any other flesh wound; this has long been known to medical science, but too many doctors are still using oldfashioned, discredited methods.

The only thing that makes a dogbite (or the bites of other animals*) different from an ordinary wound, says Dr. Vinnard, is the possible presence of rabies virus. It was proved eight years ago that rabies virus can be removed from a wound more thoroughly by soap & water than by nitric acid or any other of the cauterizing agents. As for leaving the wound open, this increases the chance of disfigurement.

After circulating a questionnaire, Dr. Vinnard found that in many cases, hospitals and doctors used the old cautery method because they thought the law required them to, or because public-health officials prescribed it. (One benighted hospital in Wisconsin used it against the recommendation of public-health authorities who advised soap & water.)

“It is easy for doctors in public-health departments to recommend the cauterization of dogbite,” says Dr. Vinnard. “Many of these doctors seldom or never are confronted with an actual dogbite to treat. It is difficult to imagine a responsible doctor caring for a pretty child and feeling complacent about having the frightened child held down while he converts the wounds into acid burns which will leave permanent, disfiguring scars.”

*As distinct from that of man, whose dirty mouth, even if non-rabid, makes his bite the most likely to cause serious local infection.