The correct selection of potentially treatable cases using these criteria requires experience but is essential. Not all chronic cases are treatable. The management of selected cases has been the subject of study by the Grass Sickness Research 'ream since 1989 and the results have challenged the view that chronic cases either die or at best only partly recover. Treatment of chronic cases involves provision of palatable, easily swallowed food e.g. chopped vegetables, grass and high energy concentrates soaked in molasses. It is essential that high energy foods are consumed as chronic cases fed roughages and succulents alone will invariably die.
Nursing is also vital and provides the mainstay of management.
The patients require constant stimulation by human contact, frequent grooming to prevent them becoming scurfy and sticky with sweat and, in some cases, rugging which has been found to reduce sweating and prevent hypothermia. A trial using cisapride, a drug which is used to increase gut activity in man, has been completed recently. The results indicate that when given by mouth to horses with chronic grass sickness, cisapride increases the activity of the partially paralysed gut. Although cisapride does not cure grass sickness it is a valuable part of the management of chronic cases. Unfortunately, it is of no help in acute and subacute disease.