PROGNOSIS. — TREATMENT. 177 



cases as are protracted or fatal are pulmonary. With the 

 appearance of these congestions and inflammatory advances 

 the chances of recovery are materially lessened. 



Prognosis. — Any attempt to forecast the course and termi- 

 nation of this disease in the early stages of the fever is most 

 uncertain ; it ought always to be remembered that it is both an 

 erratic and a fatal malady. In every outbreak with which I 

 am acquainted the percentage of fatal cases has been large, 

 but rather irregular, ranging from ten to eighty ; while in 

 many it has been shown that the death-rate has usually been 

 highest at the commencement of the epizooty. 



In some of the American States, where it has on several 

 occasions been extensively distributed, the fatality has not 

 been so large. 



Although, when terminating fatally, the larger number suc- 

 cumb during the first week of the attack, we yet find that 

 relapses and comjDlications are liable to augment the death-roll 

 after this time, and that the common results and complications 

 so largely operative in determining, if not in inducing, death 

 do not develop until some time has elapsed. 



Treatment. — It is to be feared that until a more definite 

 knowledge is obtained of the active inducing agent, no real 

 advance will be made in attempts to give certainty to our 

 efforts in controlling the spread or movements of the fever, 

 A consideration of the morbid anatomy of the malady would 

 lead us to believe that endeavours directed to the controlling 

 of the supply of blood to the great nerve-centres, and lessening 

 its tendency to retardation and effusion, as also, failing the 

 securing of these results, the employment of such agents as are 

 likely to expedite the reabsorption of exuded material, were 

 those from which most benefit might be expected. Practically, 

 the former of these ends is sometimes attained by the applica- 

 tion to the region of the spine of ice-bags, or heat with or 

 without moisture, and by inducing a free movement of the 

 bowels by the administration of aloes combined with, or 

 followed by, saline purgatives. 



Following this, and subsidence of the more active symptoms 

 should the animal survive such, recovery of tone and removal 

 of exudation is favoured by the employment of tonics, as iron 

 with sulphuric acid, and stimulants with mild diuretics. In 



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