MILIARY, OR SWEATING, FEVER.
Definition.—Miliary fever is an infec tious disease attended by profuse sweat ing and vesicular eruption of the skin.
Symptoms.—The attacks begin with gastric distress and general discomfort, which may precede the main symptoms by several days; but, in the majority of cases, a person apparently perfectly well will, during the day, complain of great fatigue and feebleness, and in the middle of the night be awakened by a profuse perspiration. The principal symptoms of the first period are, according to Thoinot, perspiration, fever, general de bility, and nervous phenomena of diverse nature. Among the latter may be men tioned dyspncea, usually paroxysmal, and without any pulmonary lesion appre ciable upon auscultation; a feeling of constriction in the epigastric region; great restlessness and delirium. Among the more infrequent are muscular cramps, especially in the muscles of the calf and the hand. The tongue is salmi. ral, and constipation is usual.
Two phenomena are especially marked during the second period, namely: cough and epistaxis. The latter may be quite profuse, and occur daily or several times a day. The eruption is generally mani fested about the fourth day; very rarely it may appear on the second or third, or it may delay until the fifth or sixth. It is preceded by itching and persistent tingling, and, as a rule, all nervous phe nomena are redoubled for the moment, to be mitigated when the exanthem ap pears. The eruption consists of two forms: 1. The miliary eruption, properly so called, — that is to say, a miliary papule which appears as a little acumi nated point upon the cutaneous surface, and is slowly transformed to a vesicle, which discharges and finally exfoliates. 2. The exanthem, which is the sub stratum, the base of the nailiary eruption. This may be classified into three forms: the rubeolar, which is composed of cres centic patches, more or less confluent; the scarlatiniform, where the cutaneous
.surface is of uniform coloration; and the amorphic or purpuric form, the cutane ous surface being tinged a dark red, which does not disappear upon pressure, and in which purplish patches are to be observed.
1111mAtus A LBA.—Under this name may be described a special variety of the eruption, consisting of diaphanous vesi cles upon a normally-eolored skin. The sweating becomes less marked as the eruption progresses, the skin remaining moderately moist; fever is less active; general debility and cephalalgia dimin ished. Nervous phenomena become quieted. The pulse-rate greatly dimin ishes, falling often to 55 in a minute; cough becoines more frequent, ausculta tion revealing bronchial rides; constipa tion persists. The stools are of the con sistence and appearance of tar, and quite ft-kid. The urine, which at first was di minished, and in some cases totally sup pressed for several hours, restunes its nor mal characteristics. Albuminuria is not to be found. Epistaxis continues in some cases, other hmorrhages being, added. lla.moptysis occurred infrequently.
The third period is that of desquama tion, which process may take place dis cretely at separated points, or in large patches. The disease has virtually come to an end when the eruption appears. and usnally about the eighth or the tenth day convalescence begins. This is uncertain and tardy.
The convalescents present pronounced anmmia; very often there is (edema of the lower limbs; the muscles of the face exhibit fibrillary tremors; the tongne trembles after the fashion of the tongue of paralytics; insomnia, persistent ano rexia, and a tendency to profuse perspi ration upon the slightest exertion, are noticed. Among the rarer phenomena are rectal crises analogous to those of locomotor ataxia, crises of costal neural gia, and irregularity of the heart. These phenomena disappear gradually, but it may be two months or more before the last trace of the disease bas been effaced.