The diseases of children : a short introduction to their study / by James Frederic Goodhart.

  • Goodhart, James Frederic, 1845-1916.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: The diseases of children : a short introduction to their study / by James Frederic Goodhart. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

    592/752 (page 568)
    It is liighly probable that an acute endocarditis may, in like manner, be the sole index of the rheu- matic state. One might say that it cei'tainly is so, but that from the nature of the evidence demonstra- tion is less easy. Unless one has watched the onset of the murmur, it is often impossible to say what is its age. From this description it will l)e appai'ent that rheumatism in children is apt to bo exjjressed by very indetinite symptoms. If a child is sufiering from acute pleurisy, for example, what is there in it which will warrant one calling it rheumatic 1 Probably nothing. The significance of indeterminate symptoms as indi- cating rheumatism has been shown by a careful study of life histories, and it is by this study in individual cases that a particular symptom will have to be judged. Acute rheumatism, therefore, is not common. It is represented in childhood by what ai’e called growing pains, by a little transient swelling of one joint, by pleui'isy, by peilcai'ditis, l)y a progressive or pei'sistent ana3inia, which leads to a medical examination, when valvular drsease is detected, and so on ; nothing patho- gnomonic. The disease is only to be correctly appraised by the mo.st careful imjuiries into the family history and tlie small ailments from which the child has pre- viously suffered. It has been said that it is .more common in girls than in boys, and in sixty-nine cases pas.sing under my own notice, forty-two wei'e in girls, twenty-seven in boys. The attack appears most commonly as a general one—that is, localised in no one joint, perhaps in no joint at all, but being associated instead with genei’al pain or soreness all over. I find twenty-six thus generali.sed, fourteen others in which the knees were chiefly at fault, fourteen where the ankles were swollen, three only in which the wrists were alone affected. But tliere are other complaints which ought to be mentioned. Thus, four cases complained only of extreme pain in the .side, which, in the absence of