Milk Sickness. "' The Trembles." 331 



burrow under the litter and are driven out with difficulty, and 

 dogs when called on to follow, do so reluctantly, slowly and 

 stiffly and fail to keep pace with their master ("the Slows"). 



In all animals alike active or continued exertion rouses or in- 

 tensifies the symptoms. 



In man there is at first extreme langour, weariness and weak- 

 ness, the patient cannot be troubled to move, he loses appetite, 

 loathes food, and soon has nausea and retching — often from the 

 first. There is no chill, rigor nor violent headache as in other 

 fevers; but insatiable thirst; large, flabby, tremulous, moist 

 tongue, coated a dirty white; cold nose, ears and general sur- 

 face; dry skin; sweet, mawkish or offensive breath; fiat, flabby 

 empty belly; without peristalsis or defecation. Respiration be- 

 comes very slow, pulse weak and compressible, heart action 

 tumultuous and labored, temperature often below normal, and 

 though sometimes 99 or ioo° F., never higher. The patient 

 takes to bed in four or five days, or, after exertion or fatigue, in 

 a few hours becomes profoundly apathetic, expresses no concern 

 for his business, his own future or that of his family, is intolerant 

 of bed clothes or other covering and utterly oblivious of the de- 

 mands of decency. Nausea continues, but retching becomes 

 weaker, and comparatively ineffective, or brings up a little liquid 

 which has been compared to blueing water of the laundry. The 

 apathy merges into a state of hebetude and this into coma, with 

 fixed, glazed eyes, absence of all winking, and insensibility to 

 irritants and death takes place quietly without a moan or 

 struggle. 



Recovery is slow, and improvement for a time is almost imper- 

 ceptible. In some cases there remains a nervous atony, and in 

 man, a lack of mental and bodily vigor, and a disposition to re- 

 lapse under exposure to intense heat or fatigue has been noted, 

 but in many cases recover}' is complete and permanent without 

 lasting weakness. 



Lesions. Both in man and animals, congestions of the gastric 

 and intestinal mucosae have been noted, usually with a dark firm 

 condition of the membrane, but in some cases with capillar} 7 

 stasis, and sloughing. Beach never saw indication of tenderness 

 in the abdomen or elsewhere, nor did he ever find blood nor 

 stercoraceous matter in the vomited material. The contents of 



