ACUTE MILIARY TUBERCULOSIS. 253 



and, indeed, when we consider that coughing is an irritant to the bron- 

 chial mucous membrane, which is the principal source of the secretion, 

 it seems quite probable that a diminution of the inclination to cough 

 may result in a decrease of the expectoration. Nevertheless, it is best 

 not to commence using the narcotics too soon, and, instead of opium, 

 we should begin with small doses of something else, as, extract of 

 lactucaria virosa, gr. ss to gr. j, in powder, or in the form of a syrup. 

 By a too early resort to narcotics, it may happen that they fail of 

 effect at a later period, when the need for them has become most 

 urgent, as when the tormenting cough of a laryngeal phthisis deprives 

 the patient of rest both by night and by day. It seems also, that, as 

 soon as it becomes necessary to give large doses of opium, the progress 

 of the consumption becomes more rapid, an additional reason against 

 a too hasty employment of a remedy which becomes indispensable to 

 the patient. When the narcotics are not tolerated by the stomach, 

 they must be injected subcutaneously. 



For the night-sweats we may order small doses of " Haller's acid," 

 or the patient may drink a cup of cold sage-tea, if the antipyretic 

 treatment fails to do good. The efficacy of the above articles is some- 

 what questionable, no doubt, but it would be cruel to tell the patient 

 that there are no means of relief from this distressing symptom. Some 

 physicians recommend the boletus laricis (a very unsafe article), as a 

 most efficient remedy against the night-sweats of consumption. 



With regard to the treatment required by the complication of 

 laryngeal and intestinal phthisis with consumption of the lungs, as 

 well as that demanded by the secondary diseases of the liver and kid- 

 neys, etc., we must refer to the sections in which affections of those 

 organs are described. 



CHAPTER XIY. 



ACUTE MILIARY TUBERCULOSIS. 



EiiOLOGY. Acute miliary tuberculosis, which is not to be con- 

 founded with acute ("galloping") consumption, depends upon an 

 eruption of tubercles in the lungs as well as in most other organs, 

 and is accompanied by the symptoms of an acute disease. In the 

 great majority of cases the disease is seen in persons whose lungs 

 .or other organs contain old caseous deposits. This fact, and the cir- 

 cumstance that the symptoms and course of acute miliary tuberculosis 

 bear a strong resemblance to those of the acute infectious diseases, 

 would make it appear highly probable that the malady arose from in- 

 fection of the blood by the caseous products (JBuhl), were it not that 

 the occasional although rare occurrence of the disorder, unnrer-pded bv 



