remains clear, but in fatal cases, coma for several hours may precede 
dissolution. The average duration of cases is about one week. The 
cases referred to in the recent outbreak in Tennessee died in from 
two to ten days after the onset of symptoms. 
A common sequel of milk sickness is a lasting debility. I have 
seen a considerable number of persons who claimed that since an 
attack of the disease, they were incapacitated for hard work, especially 
in warm weather. 
The mortality is quite high. Physicians who have had a large 
experience with this disease tell me that at least half the cases will 
perish, even when carefully treated. Numerous family outbreaks 
are recorded where the mortality has been 100 per cent, as was the 
case in the last outbreak in Tennessee. 
Treatment . — The early settlers had worked out the very successful 
preventive treatment of keeping their animals from lands known to 
be dangerous, or what is better, to use for purposes of pasture in 
endemic foci, only “ tame ” lands ; that is, land from which the timber 
had been cut. It is even better to bring the land under cultivation, 
but this does not appear to be essential. 
With our present knowledge the treatment of the disease should 
be purely symptomatic. We have no specific remedy. Rest in bed, 
abstinence from food, stimulating enemeta, and a judicious use of 
stimulants would appear to be indicated. 
The treatment of cases in the early days was somewhat vigorous 
in accordance with the therapeutic customs of the day. Graff recom- 
mended free drawing of blood and the use of calomel not to exceed 5 
grains every two or three hours. Some advised a much more liberal 
use of calomel. Counter irritation over the abdomen was a favorite 
measure used to allay abdominal pain and vomiting. It was gener- 
ally regarded as essential to secure a free movement of the bowels, 
and when this had been accomplished the case was regarded as offer- 
ing a favorable prognosis. 
Drake (1841) considered blood letting of doubtful value, but ad- 
vised the free use of cathartics. Enemeta were frequently used. 
Philips (1877) used a purely expectant plan of treatment and urged 
against the use of strong purgatives. He used strychnine in liberal 
doses, apparently with benefit. 
BIBLIOGRAPHY. 
Allen. Illinois Med. Recorder, 1878-79, p. 88. 
Barbee. West. Jour. Med and Surg., 1840, p. 178. 
Beac-b. Transactions Ohio Med. Soc., 1884, p. 125. 
Beck. Chicago Clinic, Sept., 1905. 
Borland. An essay on the “ Milk sickness,” 1845. 
