Emergency Medicine and The Hair Of The Dog…Who Knew?
“The hair of the dog”: We all have heard it, said it or done it. Where did it come from? How does it apply to us? The hair of the dog is classically a shot of alcohol sucked down to mitigate a hangover. In reality, the phrase “hair of the dog” was originally related to how people that were bitten by rabid dogs attempted to treat themselves. They did so by killing the animal and applying the hair of the dog to the wound. In the seventeenth century, it was believed that to fry such a hair and place it with rosemary on the bite wound was protection against rabies! Other attempts to treat rabies included eating the hair, or the rabid animal’s liver or heart.
New trends and lore must be validated by the scientific method. Where would we be if medicine stuck with that 17th century unproven medical care plan of sewing rabid dog hair into the wound? Theoretically though, if the rabies virus was licked onto the fur and became inactivated by drying before the patient applied the hair into the wound, one could actually inoculate one’s self with the dead virus and generate an immune response without producing disease. But the variables would be hard to scientifically define and the scientific method would be heavily compromised. Pasteur solved these concerns by killing the virus before inoculation.
Nickerson, Barilla et. Al., biologists from the Arizona State University Biodesign Institute, recently revealed a discovery that Salmonella becomes several times more virulent while living in space! Interestingly this increased infectivity disappears within hours after being brought to normal gravity; (a process thought to be dependent upon gravity’s effect on stress gene expression). This infectious disease discovery madness is brought to us on a daily basis. When faced with these amazing scenarios both 17th century and space shuttle based, it’s no wonder how difficult it is for the clinician to not jump on any bandwagon a drug company sends at us.
One of the most recent trends that have backfired for our patients was the heavily touted use of third generation fluoroquinolones for acute sinusitis. Clinical experience has later revealed the significant increased risk of tendonopathies and retinal detachments incurred by this cavalier, trendy indication. The seventh commandment of emergency medicine: ‘trust no one believe in nothing’ contains a subset of wisdom: Always maintain an element of skepticism about old adages or new trends. The travesty generated by this indiscriminant antibiotic sales pitch really gives Emergency Physicians and Hospitalists a reason, as part of our patient management job, to heed this commandment for our patients’ best interest.
While there is a theory that a hangover is a form of withdrawal, and that another stiff drink will relieve the hangover, the only part of this that is validated scientifically is that additional alcohol can have sedating and anesthetic effects. In support of this, I’ve never met any journeyman alcohol drinker that denied the benefits of “the hair of the dog that bit you” after tying one on the night before. Without question, this practice has been validated for hundreds if not thousands of years. Alas, I still cannot find one scientific publication or rabies research study that references this acclaimed, ‘off label’, best practice point of care use for “the hair of the dog that bit you.”