File:Diseases of children (1916) (14579589218).jpg

Identifier: diseasesofchildr00grah (find matches)
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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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 elsewhere in the body, the absence of fever and ofa;-ray findings, and by the negative tuberculin reaction.
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Fig. 76.—Stills disease. Same patient as in Fig. 75, but one year later. Prognosis.—^The prognosis is good as to life; but, as a rule, littlecan be done to relieve the condition of the joints. Treatment.—The treatment of chronic rheumatism and of otherforms of chronic arthritis is much the same. In the syphilitic types,antisyphilitic treatment is usually effective. Tuberculous jointsare best treated by putting them in a cast, but rest is not indicatedin rheumatoid arthritis, Stills disease, or chronic rheumatism, andchildren suffering from these diseases should be encouraged to usethe affected joints as much as possible, stopping short of fatigue. 762 MWMAflBM Warm bathing is very beneficial, and the affected joints shouldbe massaged daily. Ichthyol is one of the best local applications,and a 25 to 50 per cent, ointment should be rubbed into the jointtwice daily. In certain cases baking or dry hot air baths may befollowed by marked improvement. Passive motion should be prac-tise

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