218 
demies are reported in some part of Tennessee every two or three 
years. The cases now occur only in the thinly settled regions, usually 
remote from lines of communication. Most frequently they are at- 
tended by a layman, known locally as a milk-sick ” doctor, who has j 
a local reputation for curing the disease. The only modern scientific : 
contribution to the literature of milk sickness is the work of Jordan 
and Harris. 
Milk sickness in man (and trembles in animals) was such an impor- 
tant question in the early years of the last century that several State i 
legislatures ofi'ered liberal rewards for the discovery of the cause of 
the disease. In 1821 the legislature of Tennessee passed an act re- i 
quiring fences to be made around certain coves in Franklin County ' 
‘‘ to prevent animals from eating an unknown vegetable, thereby j 
imparting to their milk and flesh qualities highly deleterious.” 
At the present time when the disease is rare many persons living 
in and near the endemic foci abstain from the use of milk and butter ' 
on account of the danger of contracting milk sickness. 
At the outset one is confronted with the difficult}" that the affection ; 
under consideration is largely a matter of tradition. Satisfactory ; 
accounts of the disease are rare. Drake (1811), who is much quoted 
in all accounts of the disease, appears not to have been personally * 
familiar with the malady; indeed, in his memoir he states that he ! 
has seen no case in man nor in the lower animals. Yandell (1852), 
who is also frequently quoted and has written much on the subject, ; 
makes no mention of having himself seen cases, and in his later publi- 
cations expresses grave doubt as to the existence of a specific disease ' 
corresponding to that described as milk sickness. In his own words : 
“ Upon a review of the whole matter, the conclusion to Avhich all the j 
testimony on the subject has brought me is, that we, who have written ;i 
iqoon milk sickness have been egregiously imposed upon by careless I 
and incompetent observers.” Many of the accounts, indeed I think I 
may safely say, the majority, are based upon hearsay evidence. 
A large number of the articles published on milk sickness were i 
written wholly with the object of proving that a plant poison is the | 
cause of the disease; many others, that a mineral poison is the 
causative agent. The disease has been described as a mild, almost 
trivial affair; and again as most malignant and fatal. A few writers 
have regarded the disease as a manifestation of malarial poisoning. 
However, the mass of the testimony clearly indicates that there is a 
specific disease, known as milk sickness, always derived from a case ' 
of trembles in an animal. 
Distribution . — So far as known the disease has never occurred out- 
side of the United States. In this country it has been endemic in 
many of the newly settled regions, in practically all of the States 
south of New York, and as far west as Missouri and Arkansas. Ten- 
