Notes on rheumatism and its allies in childhood : introduction to a discussion in the Section of Diseases of Children / by Thomas Barlow.

  • Barlow, Thomas, Sir, 1845-1945
Date:
[1883]
Catalogue details

Licence: Public Domain Mark

Credit: Notes on rheumatism and its allies in childhood : introduction to a discussion in the Section of Diseases of Children / by Thomas Barlow. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    9/18 (page 7)
    in strong men, it is by no means rare to note, with the onset of peri- carditis, the occurrence of distinct, though slight, choreic movements of the hands and face. In the unstable period, and in early convalescence during the amemia which is so striking a feature even after a slight attack of rheumatic fever, a slight degree of chorea affecting the fingers is not a very rare condition in young women, and can often be found, if it be looked for. Other nervous phenomena may become dominant during the course of rheumatic fever. They often precede or accompany the hyper- pyrexial attacks; but they may occur without hyperpyrexia. In some of the hyperpyrexial attacks, we have the most conspi- cuous examples of the alternation, or, as the old writers called it, the metastasis of symptoms ; for the joint-affections may entirely vanish, the patient throwing his limbs about in the most violent fashion; and the skin, instead of being bathed in perspiration, may become dry and pungent. The tendency to recurrence of rheumatism is almost as marked a feature as that to relapse, and the after-attacks of rheumatism are as worthy of our consideration as the relapses. How often these consist of a day or two’s inconvenience only, with slight effusion into a joint or the structures round a joint, or some vague muscular pains I In the cases in which the heart has suffered, we are too apt to think of the patient’s subsequent progress as depending on the mere mechanical considerations of cardiac compensation. But, in many •of the febrile attacks of old rheumatic heart-cases, the solitary insidious intercalation of just one small joint-effusion may remind us that we have once again to deal with a rheumatic fever, the principal incidence of which is on valves or pericardium. There are other recurrent attacks, and even primary ones, in which there may be acrid perspiration and pericarditis without any arthritis; and others in which slight pains referred to joints with- out any effusion are followed by pleurisy on one side, pneumonia on the other, and fresh heart-mischief. Now I believe that a survey of the rheumatism of children will show, in addition to the general statements previously formulated with respect to the initial typical attack, that those manifestations which occur in adults as relapsing and recurrent forms, may appear in children as still more isolated and even as initial phenomena; but, when we study the entire life-history, subsequent as well as ante- cedent, we find very often that these are not really isolated phe- nomena, but only members of a series. Thus, without being un- duly fanciful, we may, I think, regard the initial complete febrile attack occurring in an adult, as analysed into separate factors in a child, these factors being appreciable at different periods—some of them intensified, and others minimised. It is only the life-history, and especially the succession or coinci- dence of symptoms, which will enable us to surmise that a given symptom, which by itself would be indeterminable, is in a child truly rheumatic. For example, again and again, cases of organic heart-disease in children are brought under our observation, and no rheumatic history is forthcoming. Excluding the cases due to con- genital malformation, which it is generally possible to do, it is cer- tainly wrong to rush to the conclusion at once that such cases of organic heart-disease are not rheumatic. When we recall how slight and brief the pain and swelling of a rheumatic joint may be in a child, we can readily understand how, especially amongst the poor, it may have escaped attention along with the concomitant initial