SCARLET FEVER. Synonyms.—Scarlatina; Scarlet Rash. Definition ...

lesion, a tubercular bone-marrow, or the involvement of the liver or
spleen.
Acute Miliary Tuberculosis.—Typhoid Form.—This form bears a
striking resemblance to the infectious fevers, especially that of enteric
fever, and unless the physician is familiar with the family history,
where tuberculosis is well established, the diagnosis may not be
confirmed till after death.
There is usually a period of incubation as in typhoid fever, though
.somewhat different. The patient notices that he is growing more feeble,
is losing flesh, and is taking on a cachectic appearance. The appetite
fails or is capricious, and the tongue is dry or furred. After days, or
sometimes weeks, of progressive decline, the patient becomes feverish,
though the temperature chart shows it to be different from that of
enteric fever. It is irregular, and does not show the gradual “step-ladder”
rise the first week, so characteristic of typhoid. In fact, there may be
subnormal morning temperature, and in rare cases it is afebrile.
There is generally some cough, though not more marked than often
attends enteric fever. The respiration is more hurried, and the pulse is
small and rapid, rarely dicrotic. There may be active delirium, though
more often the patient grows dull, and is inclined to be passive, sleeping
much of the time. There is nausea, and sometimes vomiting. In the early
stages there is constipation, but as the disease progresses, there is
diarrhea, and where there are tubercular ulcers of the intestines, there
may be some hemorrhage. There may be tympanites. There is no
eruption.
As the end approaches, there is the Cheyne-Stokes respiration. The
spleen is somewhat enlarged, though not so marked as in typhoid. This
form is fatal, and a favorable prognosis should never be given.
Diagnosis.—While there is a marked resemblance to enteric fever, if
the physician is careful he need make but few mistakes. During the
period of incubation, there is a normal or subnormal temperature, the
patient loses flesh and strength, and there is nearly always some cough.
When the fever makes its appearance, it is irregular in character, not
uniform. There is no eruption. The respiration is generally more rapid
and the pulse never dicrotic; and, lastly, though perhaps I should say
first, there is the family history, which generally points to tuberculosis
as a primal factor.
The Eclectic Practice of Medicine - PART I - Infectious Diseases - Page 184