225 
I 
r 
I 
f r remains clear, but in fatal cases, coma for several hours may precede 
' i dissolution. The average duration of cases is about one week. The 
> j. cases referred to in the recent outbreak in Tennessee died in from 
i jj two to ten days after the onset of symptoms. 
' A common sequel of milk sickness is a lasting debility. I have 
i [ 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 
I perish, even when carefully treated. Numerous family outbreaks 
j| 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 
Hi preventive treatment of keeping their animals from lands known to 
k 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 
f had been cut. It is even better to bring the land under cultivation, 
i but this does not appear to be essential. 
L With our present knowledge the treatment of the disease should 
jj be purely symptomatic. We have no specific remedy. Rest in bed, 
I abstinence from food, stimulating enemeta, and a judicious use of 
stimulants would appear to be indicated. 
I The treatment of cases in the early days was somewhat vigorous 
H 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- 
I ally regarded as essential to secure a free movement of the bowels, 
I and when this had been accomplished the case was regarded as offer- 
I ing a favorable prognosis. 
i Drake (ISIl) 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. 
i Allen. Illinois Med. Recorder, 1878-79, p. 88. 
Barbee. West. Jour. Med and Siirg., 1840, p. 178.- 
‘ Beach. Transactions Ohio Med. Soc., 1884, p. 125. 
) Beck. Chicago Clinic, Sept., 1905. 
j. Borland. An essay on the “ Milk sickness,” 1845. 
' 45276°— Bull. 56—12 15 
