Cheyenne, a Great Dane who stands waist-high to the average human, was chowing down at his bowl when he noticed something slinking under his belly. It was Brittany Douglas, all of 18 months old, angling for a better view.
The dog snapped -- taking a quick bite that left Brittany with cuts and scratches on her eyelid, earlobe and cheek. "It wasn't a vicious bite," said the girl's mother, Trina Helms of Towson, "but it did a lot of damage."
Emergency room doctors have seen much worse in the aftermath of dog attacks: fractures, infections, limb detachments, even scalpings. Recent studies have shown that dogs injure hundreds of thousands of Americans each year, findings that have surprised many in the medical profession and brought new attention to a problem that has long been dismissed.
In a recent report, researchers at the University of Pittsburgh said dog attacks accounted for about 330,000 visits to hospital emergency rooms each year in the early 1990s -- about 904 per day. The U.S. Centers for Disease Control and Prevention estimates that doctors inside and outside emergency rooms treated 800,000 dog bites in 1994, up from 587,000 a decade earlier.
"These are not rare things we're talking about," said Dr. Jeffrey Sacks, a CDC epidemiologist who tracks dog-bite injuries. "We ought to do something about it, and you don't need an anti-ballistic defense system to protect ourselves against it. Just a commitment."
Based on the two surveys taken a decade apart, Sacks is convinced that dog attacks are on the rise. Veterinarians such as Dr. Kim Hammond of the Falls Road Animal Hospital cannot cite hard numbers but say they are hearing more and more owners complaining of dogs they can't control.
More than half of all dog attacks involve pets turning on their owners or other family members. Veterinarians and trainers place much of the blame on humans, citing the effects of inbreeding, the frustration of pets left alone for long periods, the popularity of pit bulls and other ag- gressive dogs, and a widespread ignorance of canine behavior.
Emergency physicians are all too familiar with the damage that a dog can inflict in a single outburst. At the Greater Baltimore Medical Center, which treated 123 bites last year, doctors recently operated on a 12-year-old boy who was attacked when he reached out to pet his family's English setter.
The dog tore off half his lip.
"I came downstairs and went over to him," said the boy, Will Pierce of Hereford. "It was over like that." After a surgical reattachment at GBMC, Will's lip healed nicely. Eventually, he will have additional surgery to lighten the scars.
Dr. Raymond Wittstadt, a Baltimore hand surgeon, recently treated an 8-year-old girl from the Eastern Shore who was attacked by her brother's pit bull. "The dog had urinated on the rug, and she went to scold it and pointed her finger. The dog went for her arm, almost ripped it off."
The dog clamped onto her arm with its viselike jaws and didn't let go until the girl's grandmother issued a fatal blow with a baseball bat. "Her arm was hanging by the nerves and arteries," said Wittstadt, who reattached the girl's arm after she was flown to Union Memorial Hospital. "There were a lot of crushed bones below the elbow."
Dr. Adam Basner, a Baltimore plastic surgeon, recalled two people -- a woman and her son -- who were attacked serially by the family dog. First, the dog removed the boy's earlobe. When the mother swatted him in anger, it ripped off part of her nose. Basner reshaped the boy's ear and has begun reconstructing the woman's nose.
Some of the most serious injuries are caused by bacteria that live harmlessly in the canine mouth but don't belong in human tissue. "The myth is that dog bites are bad but human bites are real bad," said Dr. Robyn Gershon of the Johns Hopkins School of Public Health. "The truth is that both are real bad."
Orthopedic surgeons tell of patients who lost the use of fingers and joints because they didn't seek help until their wounds became infected. Early treatment with antibiotics can prevent permanent injury.
Each year, about 20 people across the United States die from dog-inflicted injuries. Most of the deaths are caused by pit bulls, Rottweilers, German shepherds, wolf hybrids, Doberman pinschers and chows -- animals that were bred to be strong and aggressive.
The last dog-related fatality in Baltimore occurred in 1994, when a pit bull broke its leash and mauled an 11-month-old boy who was playing with a toy truck. The attack occurred in the apartment of a family friend, where the boy and his mother were visiting.
Nationally, pit bulls account for about a third of all dog-related fatalities, but experts say it's important to recognize that all domesticated dogs -- regardless of breed -- are capable of behavior that harks back to their ancestral roots.
Roger Caras, president emeritus of the American Society for the Prevention of Cruelty to Animals, says the story started 15,000 to 20,000 years ago, when cave men started to breed wolves for companionship and protection.
Bit by bit, people started to mate dogs that possessed the natural variations they found useful or appealing. Some dogs were valued for their herding instincts, others for their strength. Some, of course, were prized because they were docile and affectionate. Over the centuries, the differences were magnified to the point where the family of dogs came to include Chihuahuas and chows, dachshunds and Dobermans.
People tend to divide the dog world into vicious and gentle breeds, a mistake that amounts to nothing more than "dog racism," said Caras. But he concedes that breeders in search of the perfect attack dog have made some varieties -- say, pit bulls and Rottweilers -- worthy of special handling.
"I've spent my life around dogs and other animals, and 'rotties' worry me," said Caras. "When I'm with a Rottweiler, I pay as much attention to that dog as I do when I'm around a leopard or a lion, and I've done that too. I'm more concerned about a Rottweiler than a 450-pound Bengal tiger."
Another problem, says Hammond, is the huge market for pure-bred dogs. Puppy mills maintain the purity of breeds by mating dogs that are related -- cousins, in fact. Over the span of generations, the practice can heighten the frequency of undesirable traits.
"I'm seeing mean golden retrievers," he said. "Whoever saw a mean golden retriever?"
Types of spaniels, he said, have begun to exhibit a fury that seems to come from nowhere. "Here's a spaniel, happy-go-lucky and feeling great," he said. "All of a sudden, it attacks viciously and then goes back to its normal self. My personal opinion is that it's the way they are bred."
Many attacks, however, can be traced to poor handling by humans.
"There's an appalling ignorance on the part of the public about how to behave around a dog," said Sacks of the CDC. Many owners court danger by playing tug of war with a rag, or by playfully sticking a hand in the dog's mouth. People ask for trouble by disturbing a dog that's busy at its food dish. Children who don't know better can anger a dog by jumping on its back.
Sacks suspects that dogs who spend long days alone are more likely to strike out when their owners come home. The trend toward two-income families could mean a larger number of lonely, undisciplined dogs -- and more attacks from pent-up rage. Working couples often make the mistake of buying high-strung dogs that will never get the attention or exercise they need.
Once dogs attack, veterinarians often ask owners to consider putting their pets to sleep. "It's a tough choice," said Hammond, "but we live in a social environment where we really have to protect our children and the elderly."
Trina Helms, whose daughter was bitten by the family Great Dane, said she couldn't bring herself to have the dog euthanized. Instead, she tries to make sure that Brittany doesn't inadvertently provoke the dog. And when Cheyenne eats, he eats alone.
Kim Pierce, whose son lost part of his lip in an attack, considered having her dog destroyed. Instead, she gave the dog to someone who used English setters for hunting.
"If we didn't have a place to take him that had no children, the dog would have been dead that night," said Pierce. Recently, she heard that the setter attacked two fellow hunting dogs.
In hindsight, Pierce realizes that she never felt comfortable around the dog even though it had never really lashed out at anyone. The dog had a tendency to "knock around" the family's other English setter and to take seemingly harmless nips at people.
"The biggest lesson we learned is that regardless of whether you own a pet or not, the pet is an animal and needs to be respected," she said. "A nip or a bite or any sort of aggressive act needs to be taken seriously."