The diseases of infancy and childhood : for the use of students and practitioners of medicine / by L. Emmett Holt and John Howland.
- Luther Emmett Holt
- Date:
- 1911
Licence: Public Domain Mark
Credit: The diseases of infancy and childhood : for the use of students and practitioners of medicine / by L. Emmett Holt and John Howland. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
1149/1178 page 1087
![even the muscles. These symptoms may persist for two or three weeks and lead to a siisj)ieion of incipient tuberculous disease of the joint, liheunuxtism is distinguished by its more acute onset and usually by the presence of slight fever; some elevation of temperature being the rule, tliough it is not often mucli over 100° F, A family history of rheu- matism, or a history of previous similar attacks in the patient affecting the same or other joints, or other manifestations of rheumatism, are also of assistance in the diagnosis. Occasionally all dou])t is removed by the disease extending to otlier joints, or by the development of endocarditis. In some cases the symptoms are less in the articulation than in the muscles, and they are dismissed as simply growing pains, having noth- ing characteristic about them except their occurrence in damp weather. Cardiac Manifestations.—These may occur when the articular symp- toms are very mild, and in some cases when they are entirely absent. The most frequent is endocarditis. This is much more often seen in the acute rheumatism of children than of adults, and probably occurs in the majority of all severe cases; if it does not come in the first attack, it is likely to be seen in the later ones. It frequently occurs with a mild rheumatic arthritis, often being unnoticed until valvular disease of con- siderable severity has developed. Sometimes there is only high fever with severe constitutional symptoms of an indefinite character, but no arthritis, and no suspicion that the attack is rheumatic imtil endocar- ditis is discovered. Such cases are not infrequent. If the patients are kept under observation, articular symptoms are almost certain to develop later, and often there are other manifestations of rheumatism, especially chorea. Pericarditis is much less frequent than endocarditis, and usually oc- curs in children over seven years old. It is often associated with endocar- ditis. The most characteristic form of inflammation in early life is a sub- acute, dry, fibrous form, often resulting in great thickening with extensive adhesions, and frequently in obliteration of the pericardial sac. When once started it shows a strong tendency to recurrence and persistence. The heart is so frequently affected in the rheumatism of childhood that it should be closely watched whenever articular symptoms are pres- ent, no matter how mild they may be; and not only in these cases, but in all the conditions hereafter enumerated with which rheumatism is likely to be associated. Inflammations of other serous membranes—the pleura, peritonaeum, and pia mater—were much more frequently ascribed to rheumatism in the past than now. There is little doubt that on rare occasions any one of these may be due to rheumatism. The pleura is most often Involved, but even this is rare in young children. Torticollis when it occurs acutely is frequently rheumatic. This form is characterised by its sudden development, continuous spasm, the](https://iiif.wellcomecollection.org/image/b21218407_1149.jp2/full/800%2C/0/default.jpg)
