COURSE, PROGNOSIS AND MORTALITY 187 
matter consisting solely of blood and mucus with an un- 
bearably evil smell; sunken eyes, and the vomition of a 
putrid brown-coloured fluid, are all conditions which lead 
one to predict with fair certainty the hopelessness of 
the case. 
' Some writers consider the appearance of ‘pustular 
lesions occurring late in the disease as a grave sign, 
whilst others regard it as particularly favourable, 
Youatt giving as his reason that “the disease is leaving 
the vital parts and expending its last energy on the 
integument.” Personally I attach no significance what- 
ever to the cutaneous symptoms, these being usually 
absent, or, when present, seeming to affect the course of 
the malady very little either one way or the other. 
Perhaps, on the whole, I can remember more cases 
_which have recovered than which have not, among 
those dogs whose skins were implicated, though what 
influence the exanthema exerted, or could exert, I cannot 
say. 
In distemper, as in every other disease, relapses are to 
be feared, for whilst a patient may emerge safely from the 
initial attack, death is very often the sequel to a second 
infection. It must not be forgotten that although an 
animal may reach the stage of resolution, it is neverthe- 
less still liable to become a subject of one or other of the 
secondary complications—or rather, sequela—such as 
chorea, paralysis, epilepsy, etc., even as late as several 
months afterwards; so it becomes apparent that the 
versatility of this treacherous disease must baffle, from 
beginning to end, all attempts at prognostication, leaving 
us as dubious at last as we were at first. 
