A Fight Against Doom; The Remarkable Story of The Milwaukee Protocol

By Tiago Palmisano
Edited By Bryce Harlan

Before the evolution of modern medicine, a fight with disease was all too often a sentence of doom. The lack of knowledge concerning antibodies and vaccines left doctors with a weak defense against the majority of illnesses, which understandably led to a longstanding association between sickness and the supernatural. Fortunately the work of generations of scientists have shifted the fight in our favor, exemplified by the successful battles against smallpox, polio, and countless others viruses. Yet despite our advances, one virus still carries the ominous horror that it has for centuries. Until 2004, no one had ever contracted the symptoms of rabies without receiving the post bite inoculation and lived, when a pediatrician shocked the medical world with his last-ditch attempt – the Milwaukee Protocol.

Rabies is a virus transmitted through contact with the saliva of an infected animal – most often through a bite wound. The virus travels through the nervous system to the brain and spinal cord, where it causes acute inflammation. The symptoms caused by this inflammation come straight out of a scary movie – delirium, hallucinations, hydrophobia, and hyperactivity to name a few. Zora Neale Hurston famously depicts a case of human rabies in her seminal novel Their Eyes Were Watching God. Since the virus must work its way from the wound site to the central nervous system, symptoms typically don’t appear until one to three months after infection. Louis Pasteur and Émile Roux developed a rabies vaccine in the late nineteenth century, but it is only effective if administered before symptoms appear; once they do, the disease is 100% fatal. Or at least it was, until a bat bit Jeanna Giese, a 15-year old girl from Wisconsin.

Giese, like many other bite victims, did not seek medical treatment. Due to the rarity of rabies, many are unaware that a wild animal could be carrying the disease. Unfortunately, this leads many patients to discover their condition only after symptoms appear, at which point the vaccination is useless. (I highly suggest that you visit a doctor if a wild animal ever bites you!) By the time Giese was in the hospital, her brain had already started swelling and her neurological symptoms were apparent. Her sentence was the same as rabies victims from the Middle Ages – death was inevitable. But one of the doctors assigned to Giese, a pediatrician by the name of Rodney Willoughby, refused to accept the doom that had forever been tied to the disease. After a bout of research, Willoughby reasoned that if Giese’s brain activity could be slowed down, then perhaps the virus would be less damaging to the neurons. So Willoughby and his fellow doctors, with help from the CDC, decided on a combination of drugs that would put Giese in a medically induced coma and slow her brain function.

The treatment, now called the Milwaukee Protocol, did what everyone thought was impossible. By calming the inflammatory effects of the virus, it gave Giese’s body time to produce antibodies and fight. Jeanna Giese survived, underwent rehabilitation, went to college, and got married. She was the first person in recorded history to develop symptoms of rabies and live. The Milwaukee protocol has since been revised, and it has managed to save an additional five patients in 42 attempts. The fourth version of the protocol, last updated in 2012, is available for download on the Medical College of Wisconsin’s website.

Unfortunately, much of the science behind the rabies virus and the Milwaukee Protocol remains hidden behind the biological curtain. Research is currently underway to better understand the disease and to find more effective treatments. Critics of the Milwaukee Protocol have claimed that it is ineffective, expensive, and severely dangerous. Additionally, studies since 2004 have discovered evidence that contradicts Willoughby’s initial reasoning. A 2013 article from the scientific journal Antiviral Researchsuggests that a more detailed pathological understanding of rabies is required for a significant advancement in treatment.

Nevertheless, the story of humanity’s first successful battle against this sinister virus has become medical legend. In fact, this article was inspired by a great piece in Wired magazine titled Undead: The Rabies Virus Remains A Medical Mystery. As an aspiring scientist, I find the tale of Jeanna Giese and the Milwaukee Protocol both romantic and motivating. It is a testimony to the fact that the march of science (with a touch of human persistence, of course) continues to defy longstanding assumptions. The lesson I hope to provide is that with determination and a pursuit of knowledge, anybody can contribute to our fight against the unknown.
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Note:The previous version of the article said that Jeanna Giese was bitten by a rabbit and that she was the first survivor who has not received post bite inoculation. In fact, as Dina pointed out in the comment section, Jeanna Giese was bitten by a bat and she was the first survivor to not receive the post bite inoculation. In 1970, Matt Winkler was the first rabies survivor to be recorded. CSR regrets these errors.