Foot and Month Disease. 323 



cheese, and Friedberger and Frohner, cases caused by virulent 

 buttermilk. 



Symptoms in Man. In man there is observed the tendency to 

 localization on the same points as in animals. As the hands are 

 naturally exposed to infection by milking or treating the diseased 

 animals, they are especially obnoxious to the eruption, and the 

 same is true of the mouth when the infected milk or other dairy 

 products are consumed. The bullse on the buccal mucosa are 

 generally confluent, and often extend to the fauces and pharynx, 

 rendering speech difficult and swallowing painful, and leaving ex- 

 tensive and painful sores which, however, soon heal up. In 

 women the bullae have been seen around the congested nipples, 

 and in exceptional cases they have been generally diffused over 

 the body. 



In cases due to drinking the milk, the early febrile symptoms 

 are liable to be accompanied or followed by nausea, anorexia, ab- 

 dominal pain and diarrhoea, and still later by the cutaneous and 

 buccal eruption. 



The duration of the disease is from 10 to 15 days and as a rule 

 no permanent scars are left on the skin or mucous membranes. 



The diagnosis is assisted by the knowledge of the prevalence 

 of the disease in herds in the district, and that the patient has 

 handled the diseased animals, or drunk their milk, or eaten their 

 butter or cheese products. The predilection of the eruption for 

 the fingers, the roots of the nails and the mouth is very significant. 

 The disease follows an acute course and convalescence is complete 

 in ten or fifteen days, which serves to differentiate it from most 

 skin eruptions. From variola which pursues an equally rapid 

 course it is distinguished by the absence of the primary nodular 

 swelling, and of the septa or pillars that divide the mature pock 

 into independent chambers. 



Prophylactics. The best prevention for man is to exclude the 

 disease from the country and its herds as is now the case in the 

 United States. When the disease does exist in herds the attend- 

 ants should cauterize any sores on the hands, and wash the hands 

 with an antiseptic, such as a 10 per cent, carbolic acid solution, 

 after handling the diseased. The milk and its manufactured 

 products— butter and cheese — should be withheld from consump- 

 tion until after the herd has recovered. Infection can be obviated 

 by boiling the milk. 



