The diseases if infancy and childhood; for the use of students and practitioners of medicine / by L. Emmett Holt.

  • Holt, L. Emmett (Luther Emmett), 1855-1924.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: The diseases if infancy and childhood; for the use of students and practitioners of medicine / by L. Emmett Holt. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    ine rheumatic patients for them, I have seen them but seldom, and they have been marked in only two or three cases. This, I think, has also been the experience of most observers in New York. From published reports, however, they apjoear to be much more frequent in England. There can be no doubt regarding the connection of these nodules with rheumatism. Erythema.—Th.Q connection between rheumatism and the various forms of erythema—marginatum, papulatum, and nodosum—has been very clearly shown by Cheadle. None of these are frequent conditions in childhood, but when seen they should always suggest rheumatism. Purpura.—The association of purpura with rheumatism is so often seen that there can be little doubt of the close connection between the two conditions. Rheumatic purpura, however, is quite distinct from the other forms of purpura, and is a much less frequent disease. Diagnosis.—In 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 special symptoms, but by the association or combination of a num- ber of conditions which may appear unrelated. In determining whether or not any given set of symptoms is due to rheumatism, one should con- sider : (1) The family history, since in early life heredity is so important an etiological factor; (2) the previous history of the patient, not only as regards articular pains and swelling, the slight joint-stiffness without swelling, the indefinite wandering pains of 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 pericar- ditis, and, in cases which are at all acute, the temperature. In doubtful cases with mon-articular symptoms much importance' is to be attached to the presence of slight fever, the. abrupt onset, and tenderness of the neighbouring muscles and tendons,—all occurring without a history of traumatism. Rheumatism is more often overlooked than confounded with other diseases ; although in childhood multiple neuritis and tubercu- lous 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 skeptical regard- ing 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 (page 213). Prognosis.—Rheumatism in a child is in itself seldom if ever danger- ous to life. In the great majority of cases the articular symptoms soon