. The diseases of children : medical and surgical. nearthe disc, but usually they are eccentrically seated : five or six may often becounted. Often a branch of a retinal artery or a vein may be seen to crossin front of one. They appear very rapidly, being apparently formed inthe course of a few days ; if there is tubercular meningitis, the disc may beswollen and indistinct. In a case recorded by Proebsting the detection of tubercular bacilli in theurine decided the diagnosis of a doubtful case in favour of miliary tuber-culosis. In this;-:|nstance the miliary tuberculosis was secondary to chro
. The diseases of children : medical and surgical. nearthe disc, but usually they are eccentrically seated : five or six may often becounted. Often a branch of a retinal artery or a vein may be seen to crossin front of one. They appear very rapidly, being apparently formed inthe course of a few days ; if there is tubercular meningitis, the disc may beswollen and indistinct. In a case recorded by Proebsting the detection of tubercular bacilli in theurine decided the diagnosis of a doubtful case in favour of miliary tuber-culosis. In this;-:|nstance the miliary tuberculosis was secondary to chronictuberculosis of the kidney. The duration ^f the disease varies, in some cases being short, often onlythrs,e weeks ; in others, perhaps the majority, it is longer, the patient linger-ing for six or seven weeks. The supervention of tubercular meningitis orbroniiho-pneumonia quickly brings the end. Tl|ef. broncho-pneumonic form occurs most often in children from twoto fiveyea:rs of age, and in the vast majority of cases is mistaken for an attack. Fig. 64.—Miliary Tubercles of the Choroid ; slightoptic neuritis. (From a drawing by P. H. Mules.) 234 Tuberculosis of acute broncho-pneumonia. There is often a history of measles or whoopingcough shortly before the attack, and probably there has been a period ofill health with wasting. The symptoms are precisely those of acute broncho-pneumonia ; there is fever, dyspnoea ; rales or crepitation are heard over anextended area of lung, with more or less impaired resonance over a corre-sponding area. The disease usually runs its course in about ten days to twoweeks, death resulting from exhaustion and more or less asphyxia. Thefamily history or previous health may suggest tuberculosis in any given case,but no definite diagnosis of tuberculous broncho-pneumonia can be madeunless tubercles are seen in the choroid. The supervention of meningitissuggests tubercle, but a simple meningitis may accompany or follow broncho-pneumonia, especially
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