256 DISEASES OF THE PARENCHYMA OF THE LUNG. 



tion soon vanishes, as the violence of the fever, the rapid collapse, and 

 the malignant course of the malady, but especially the shortness of 

 breath which often renders it impossible for the patient to breathe in a 

 recumbent position, and which is in striking contrast with the absence 

 of physical signs of disease, afford data for diagnosis. 



A differential diagnosis between miliary tuberculosis and typhus 

 is based upon the following points : 



1. In tuberculosis, the cough and dyspnoea appear, as a rule, at an 

 earlier period and with far greater intensity than in typhus. In exan 

 thematic typhus, it is true, we likewise find early and violent bron 

 chitic symptoms ; but here the distinction is easy, as the eruption of 

 exanthematic typhus is highly characteristic and scarcely to be over- 

 looked, while there is no eruption in acute miliary 'tuberculosis. 



2. In abdominal typhus (typhoid), likewise, we rarely fail, after 

 careful and repeated search, to discover a few spots of roseola upon the 

 upper region of the abdomen, which do not exist hi acute miliary tu- 

 berculosis. 



3. Enlargement of the spleen can rarely be found in acute miliary 

 tuberculosis, and when found scarcely ever is an enlargement of much 

 magnitude, while we hardly ever fail to find it in abdominal typhus : 

 and even though it were not found, in exanthematous typhus the ex- 

 istence of the eruption would render this clew almost unnecessary. 



4. Meteorism, liquid stools, tenderness in the ileo-ccecal region, 

 are seldom absent in abdominal typhus. These symptoms are not ob- 

 served in acute miliary tuberculosis. 



5. Typhus rarely supervenes upon chronic disease of the lungs, 

 while acute miliary tuberculosis seldom attacks any save those who 

 are suffering from such disease. Dulness at the apex of either lung 

 is therefore of great diagnostic significance. 



6. Wunderlich has observed that the temperature in acute mil- 

 iary tuberculosis is much lower than in typhus, seldom reaching 104 C 

 F., and is out of all proportion to the enormous rapidity of the pulse. 



PROGNOSIS. Prognosis as to the issue of acute miliary tuberculo- 

 sis must be almost absolutely unfavorable. Only a very few observa- 

 tions ( Wunderlich) allow us to suppose that tubercles thus deposited 

 may become atrophied, and the malady terminate in recovery. The 

 cases, too, in which the acute disease has become arrested, and chronic 

 tuberculosis and phthisis have followed, certainly must be considered 

 as among the greatest of rarities. The more violent the fever, the 

 more pronounced the brain-symptoms, so much the sooner is the entf 

 to be expected. 



TREATMENT. The treatment of acute miliary tuberculosis is of 

 course a mere treatment of symptoms. The most important sympton? 



