47 



of mercury in doses of three to ten grains daily, in 

 powder placed on the tongue. 



Care must be taken that wounds are not being 

 re-infected by flies, dressings, etc., or that the patient 

 does not bite them, or rub his nose or eyes in them ; a 

 dose of physic should be administered at the outset, 

 the patient kept on soft feeding and given a little Epsom 

 salts periodically if thought necessary. 



Mortality and Prognosis 



From statistics the average mortaUty is about ten 

 to fifteen per cent., and under favourable conditions the 

 prognosis is invariably favourable, provided that the 

 case has not been allowed to run too far before proper 

 treatment is taken in hand. I always look upon the 

 prognosis as unfavourable when proper means for 

 isolation, and strictly aseptic arrangements for energetic 

 treatment, and an intelligent dependable attendant are 

 not available. 



The prognosis of cases in which the nasal mucous 

 membrane, conjunctiva, scrotum and sheath (after 

 castration), joints, or sheaths of tendons are affected, is 

 generally most unfavourable, particularly those in which 

 the mucous membranes are the seat of the disease. 

 As it is most difficult to ascertain the extent of the 

 disease, the delicate membranes attacked will not stand 

 the severe treatment required, and finally it is practically 

 impossible to know for certain when such a case is 

 absolutely cured of the disease. Therefore very great risk 

 to the well-being of the community is incurred by keep- 

 ing such cases under treatment ; in fact, unless the most 

 thorough and complete arrangements exist for isolation 

 and treatment, immediate destruction of all verified 

 cases is recommended, particularly where large numbers 



