In all animals alike active or continued exertion rouses or intensifies the symptoms.
In man there is at first extreme langour, weariness and weakness, the patient cannot be troubled to move, he loses appetite, loathes food, and soon has nausea and retching—often from the first. There is no chill, rigor nor violent headache as in other fevers; but insatiable thirst; large, flabby, tremulous, moist tongue, coated a dirty white; cold nose, ears and general surface; dry skin; sweet, mawkish or offensive breath; flat, flabby empty belly; without peristalsis or defecation. Respiration becomes very slow, pulse weak and compressible, heart action tumultuous and labored, temperature often below normal, and though sometimes 99° or 100° F., never higher. The patient takes to bed in four or five days, or, after exertion or fatigue, in a few hours becomes profoundly apathetic, expresses no concern for his business, his own future or that of his family, is intolerant of bed clothes or other covering and utterly oblivious of the demands of decency. Nausea continues, but retching becomes weaker, and comparatively ineffective, or brings up a little liquid which has been compared to blueing water of the laundry. The apathy merges into a state of hebetude and this into coma, with fixed, glazed eyes, absence of all winking, and insensibility to irritants and death takes place quietly without a moan or struggle.
Recovery is slow, and improvement for a time is almost imperceptible. In some cases there remains a nervous atony, and in man, a lack of mental and bodily vigor, and a disposition to relapse under exposure to intense heat or fatigue has been noted, but in many cases recovery is complete and permanent without lasting weakness.
Lesions. Both in man and animals, congestions of the gastric and intestinal mucosæ have been noted, usually with a dark firm condition of the membrane, but in some cases with capillary stasis, and sloughing. Beach never saw indication of tenderness in the abdomen or elsewhere, nor did he ever find blood nor stercoraceous matter in the vomited material. The contents of stomach (paunch in cattle) and bowels formed hard balls like cemented sawdust, firmly adherent to the dry mucosa.
Treatment and Prevention. Treatment by the Indians consisted in giving large doses of powdered charcoal suspended in milk. The early physicians attempted to open the bowels by calomel and jalap, olive oil, magnesia citrate, and even croton oil, but the last generally with fatal results. Milder and hardly less effective treatment consisted in large doses of elm bark. Beach believed he got better results with quinine and egg nog. It might be suggested to try such antiseptics as potassium permanganate, peristaltic stimulants like eserine or pilocarpin, as an eliminating agent pure water or weak diuretics, and nerve stimulants nitroglycerine or ammoniacal preparations.
Prophylaxis. The time-honored resort of clearing the timber and brush land so as to let the sun act freely on the soil, and the putting in of cultivated crops, is proved reliable and permanent. The other precautions in use are valuable in protecting the herd, but lack the merit of thoroughness and permanence and thus fail to strike at the root of the trouble. They are: 1st. the exclusion of domestic animals from the infected woods in late summer and autumn and in very dry seasons; and 2d. the exclusion of stock from such pastures from before nightfall until after the dews have evaporated on the following morning.
The danger which attends on passing the night in the forest, strongly suggests the intervention for the transfer of the poison of some nocturnal animal, perhaps a night-flying insect, like the anopheles, which transmits the plasmodium of malaria. If the germ and its intermediate bearer (if any) were demonstrated, probably other and simpler means of prevention could be adopted.
The fact that the propagation of the disease is not constant and wide spreading, like a genuine plague, lessens the urgency for a rigid sanitary police, yet animals kept on such infected farms, should be tested by long or vigorous driving before they are killed for food, and all milk devoted to the production of butter and cheese should be Pasteurized or sterilized before use. It might well be questioned whether the clearing and exposure of infecting places should not be undertaken by the state as a sanitary measure.
In view of the fact that a milch cow may not show symptoms of the disease, and yet yield deadly milk, and considering that the owner cannot always tell whether she has been in the infecting woods, or having been in, whether she is infected, it becomes an important public health question whether such a source of deadly disease should be perpetuated, where human food is open to contamination.