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.
1151/1178 page 1089
![RTFErMATIRM. 1080 nile lo examine rlioumaiic patients for Hkmii, I have seen tlieni hut sehluiii, and they hasc hccii prominent in only two or three canes. This, I think, has also been the experience oi' most observers in Xew York. From published reports, however, they appear to be much more frequent in England. There can he no doubt regarding tlie connection of these nodules witli rheumatism. Erythema.—'I'he connection between rheumatism and the various forms of erythema—marginatum, papulatum, and nodosum—has been very clearly sliown by Ciieadle. None of these are frequent conditions in childhood, but when seen they should always suggest rheumatism. Purpura. ■— 'i'lie association of purpura with rheumatism is so frequent tliat there can be little clou])t of the close connection be- tween tlie two conditions. Riieumatic purpura, however, is quite distinct from the other forms of purpura, and is a much less frequent disease. Diagnosis.—Tn order to recognise rheumatism in a child, one must free his mind from preconceived notions of the disease drawn from its manifestations in adults, as very few cases correspond to the adult type of acute rheumatism. In early life the disease is recognised not by any one or two ppecial symptoms, but by the association or combination of a number of conditions which may appear unrelated. In determining whether or not any given set of symptoms is due to rheumatism, one should consider: (1) The family history, since in early life heredity is so important an etiological factor; (2) the previous history of the pa- tient, not only as regards articular pains and swelling, the slight joint- stiffness Avithout swelling, the indefinite wandering pains in damp weather, and the so-called growing pains, but also the previous existence of chorea, frequent attacks of tonsillitis, torticollis, or erythema; (3) the examination of the patient, which should include a careful search for tendinous nodules, as well as a thorough examination of the heart for signs of endocarditis or pericarditis, and, in cases which are at all acute, the temperature. In doubtful cases with monarticular symptoms much importance is to be attached to the presence of slight fever, the abrupt onset, and tenderness of the neighbo^^ring muscles and tendons— all occurring without a history of traumatism. Eheumatism is more often overlooked than confounded with other diseases; although in child- hood multiple neuritis and tuberculous and syphilitic bone disease are often mistaken for it, and in infancy the same is true of scurvy. The extreme infrequency of rheumatism during the first two years of life should always make one sceptical regarding it. In an infant, when the symptoms are confined to the legs and are not accompanied by fever, they are almost certain to be due to scurvy, even though the gums are normal and ecchymoses have not yet appeared. Multiple gonococcus arthritis has often been diagnosticated rheumatipm. 70](https://iiif.wellcomecollection.org/image/b21218407_1151.jp2/full/800%2C/0/default.jpg)
