File:Diseases of children (1916) (14579765477).jpg

Title: Diseases of children Year: 1916 (1910s) Authors: Graham, Edwin Eldon, b. 1864 Subjects: Children Disease Publisher: Philadelphia and New York, Lea & Febiger Contributing Library: Columbia University Libraries Digitizing Sponsor: Open Knowledge Commons

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Text Appearing Before Image: ology.—^This disease is now believed to be infectious in origin,and the earlier theory that it originated in the nervous system has-^been largely discredited. It is usually the result of exposure to damp-ness and cold, and the infection is supposed to have its origin indecayed teeth, diseased tonsils, or other suppurating foci. 760 RHEUMATISM Symptoms.—In exceptional cases the onset of rheumatoid arthritismay be sudden, but, as a rule, it is slow. There is usually no fever,but the joints are painful and swollen, and gradually become worse.When the pain increases, motion becomes limited, and in protractedcases marked ankylosis and muscular atrophy occur. As the diseaseprogresses, and additional jomts are involved, pain on motion becomesmore severe, and all movements of the body are restricted. Theskin over the affected joints has a shining, waxy appearance, butthere is no local heat, although the body temperature may rise adegree or so at intervals during the course of the disease. Text Appearing After Image: Diagnosis.—The differential diagnosis between the several forms ofclu-onic arthritic disease is difficult at the onset, but can usually bemade after careful study. Chronic rheumatism is characterized bystiffness in the joints, little or no deformity, and a history of repeatedacute attacks; while in Stills disease there are both deformity ofthe joints and stiffness due to thickening of the soft structures, andalso glandular hypertrophy. The chief diagnostic feature of rheumatoid arthritis is enlargement RHEUMATOID ARTHRITIS—ARTHRITIS DEFORMANS 761 of the articulating ends of the long bones, which results in ankylosisand marked muscular atrophy. Syphilitic arthritis may simulatechronic muscular rheumatism; but children with luetic changes inthe joints usually show other symptoms of syphilis, such as Hutchin-sons .teeth and keratitis, and in doubtful cases a Wassermann shouldbe made to clear the diagnosis. Tuberculous arthritis may be differentiated by the absence oftuberculous foci

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