The demonstration of bacilli by inoculation of the blood into animals requires too long a period to render it of practical importance. Rarely there may be a sufficient number of bacilli in the blood to per mit us to find them in blood spreads. We may, however, find the bacilli in the cerebrospinal fluid, especially in the characteristic web, in the absence of all cerebral symptoms. Failure of the fluid to react to Fehling's test points to an inflammatory process, generally tuberculous in nature.
The tuberculin test is of value only early in the disease, on account of the temperature in the later stages. Examination of the fundus of the eye should never he omitted, as sometimes chorioid tubercles are found.
Of the diseases which may offer difficulty as regards differential diagnosis we must place typhoid fever in the first rank.
At -times diagnosis is impossible, especially as typhoid fever so often runs an atypical course in childhood. For example it. may show no continued fever, on the other hand this is also true of miliary tuber culosis. I would never rely on the temperature to differentiate between these diseases. The large spleen and the diazo reaction arc common to both, although absence of the latter points rather against typhoid fever. Even the roseola may be present in miliary tuberculosis. The lungs do not serve to differentiate the diseases. Involvement of the pericardium and pleura early in the disease, or meningeal symptoms, points rather to tuberculosis. The Widal reaction if positive decides in favor of typhoid fever.
Next to typhoid fever, cryptogenetic sepsis offers most difficulty in the differential diagnosis. Here again the temperature, spleen, and
general symptoms do not aid us. Chills and marked variation of the temperature point to sepsis, but are of rare occurrence. The diazo reaction points to tuberculosis; on the other hand, hminorrhages of the skin or mucous membrane favor the diagnosis of sepsis.
I once saw a case of sinus thrombosis with such indefinite symp toms that it was regarded as miliary tuberculosis to the very end.
Lobular pneumonia and capillary bronchitis may be mistaken for miliary tuberculosis or vice versa. In this regard we should consider that in the latter disease the rapidity of respiration and dyspncea are in marked contrast to the intensity of the pulmonary symptoms. The diazo reaction speaks in favor of tuberculosis.
I have also seen serere influenza with meningeal involvement resembling miliary tuberculosis.
Localized tuberculosis of the bronchial lymph-nodes with caseous formation may cause difficulty in diagnosis.
prognosis of miliary tuberculosis is bad. In pronouncing the diagnosis you doom the child to death. The disease lasts a varying period. Death may ensue after S to 10 days or it may be postponed for 4, 6, or even more weeks.
is none. We may give symptomatic treatment; chloral hydrate as mentioned above, or cold compresses or ice bags to relieve headache. Hydrotherapy, prolonged baths at 30-32° C. (SO 90° F.) often quiet the patient. Free access of fresh air should he allowed in order to relieve the dyspncea. The use of oxygen inhalations may be indicated.