"a synochus attended with restlessness, frequent sighing, a fetid sweat, and prickling of the skin; red, small, distinct spots, on an uncertain day of the disease, break out copiously over the whole skin, except the face, whose tops discover, after a day or two, very small white pustules, continuing but a short time." This fever is now generally supposed to be symptomatic only, because it never appears contagious or epidemic. It sometimes attends febrile affections, as well those of an inflammatory as of a putrid nature, but it seldom occurs in any. unless a hot regimen and sweat precede.
The Trench and German authors, however, still con-skier it as an idiopathic disease, and we have twice seen it when the regimen could not be accused as the cause, though it must be allowed to have been often the creature of art, since, after the disuse of the hot regimen, its appearance has been rare. When the 'pustules arc white it is called puipura alba, when red, purpura rubra. It is almost exclusively confined to child-bed women, though it sometimes appears during the sweating regimen in rheumatism.
This disorder is denominated simple when none but miliary pustules accompany the red ones, which, when appearing alone, are called a rash. If we speak of it as an idiopathic disease, we must employ the language of those who have described it as such. They say that it is peculiar to some constitutions, who experience the disease repeatedly in their lives, and peculiarly affects the tender, the weak, and the irritable; preceded by sighing, great lowness, oppression on the praecordia, and ushered in by shivering, followed by heat and a pricking sensation of the skin; nor does the anxiety and lowness cease till the eruption is completed. Unlike other exanthemata, the eruption does not conclude the disease, for successive crops often appear, preceded and attended with the same symptoms. According to circumstances, the fever sometimes rises to phrenitis, and sometimes sinks into a typhus. The pustules, first apparently filled with serum, afterwards with a whitish fluid, at last dry, and scale off in branny crusts.
It is not, we have observed, contagious or epidemic; the eruptions have no regular periods of appearance or duration; and though the origin and source of the disease are said to be at no distant period and country, yet traces of it are discoverable even in Hippocrates. All these circumstances strongly militate against its being an idiopathic disease, and the only connection which has been discovered, if it be really a discovery, between the different states of constitution subject to miliary fever is, that it more often attends those subject to considerable haemorrhages. Such discharges certainly occasion great irritability; and the disease is not connected with mere debility, since it is not peculiarly attendant on typhus. On the other hand, the appearance of the urine is peculiarly pale, and the smell of the perspiration is acid; but the former is an almost constant attendant on fevers in their commencement, and the latter is peculiar to the perspiration of child-bed women.
The accidental symptoms of miliaria are remission and exacerbation of the fever, but at no regular periods. The sleep is disturbed, often interrupted; tremor, sub-sultus, and even convulsions, come on. Occasionally, the pulse sinks, the eruptions assume a purple hue, clammy sweats and death follow. The directions for the cure of this fever have been strangely and without reason embarrassed. If it is symptomatic of a too hot regimen, we shall find little other regulation than with caution to lessen it. If idiopathic, similar plans should be followed, and according to the principles laid down in the articles Diaphoretica and Morbi Cutanei, we should conduct the perspiration steadily and slowly. Cool instead of cold drinks should be employed, the cooling neutrals freely given, and the bowels kept free by the mildest laxatives. The nervous symptoms are best relieved by camphor, which the stomach usually bears with ease, and should the strength sink, a little wine may be cautiously allowed, or ether added to the camphorated draughts. In general, however, cool free air is the greatest cordial. Even Fischer, after the experience of sixty years, advises us not to be too anxious to force on the discharge from the skin; and we have seen that cool air is the most effectual diapnoic. See Diaphoretica.
When the pustules assume a purple hue, which in this country is an occurrence peculiarly rare, the bark and port wine, in quantities proportioned to the violence of the symptoms, arc necessary, and when the debility is considerable, bark, independent of putrcscency, has been given. This may be requisite, but we have never found it so, and there is always danger that bark may occasion a stricture on the skin and check the salutary diapnoc. When inflammatory, phrenitic, or pneumonic symptoms come on, they must be treated according to the rules laid down under the proper heads, urging, however, the general evacuations with caution, and trusting rather to the topical ones. Blisters are never useful, except in such cases of topical congestions.
See Hoffman and Sir David Hamilton's Treatise on the Miliary Fever. Sydenham Miliaris nova Febris, Schedula Monitoria; 'fischer et Febre Miliari; Allioni de Miliaria. De Haen Ratio Medendi; Colin de Miliaria. Cullcn's First Lines, edit. 4. vol. ii.
Miliaris Nautica, and Purpurata, species of Typhus: the former is called by Huxham febris nau-tica pestilentialis.