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Arthritis Deformans in Children

middle, joint, clinical, childhood, disease, examples and chronic

ARTHRITIS DEFORMANS IN CHILDREN.

The time is not yet ripe for any adequate description of arthritis cleformans as it occurs in children, for the whole subject of the chronic joint diseases of children constitutes a chapter in clinical medicine which still remains to be written.

Unlike most of the other maladies which are especially common at the later periods of life, arthritis deformans, although rare, cannot be spoken of as extremely rare in the period of childhood, and is cer tainly more commonly met with in children than true gout. On the other hand I am convinced that some cases which, on account of their clinical features, are classed as examples of arthritis deformans in children are not truly of that nature, if it is permissible to adopt the presence of the changes in the cartilages and bones described above as the criterion; and this conviction is based upon post-mor tem evidence.

How great is the difficulty of assigning to any definite category some at least of the chronic arthritides of children is well illustrated by some cases recorded by T. Barlow" and W. Pasteur." In both in stances chronic affection of many joints was accompanied by a pecu liar hidebound condition, and in Barlow's case there were many subcutaneous nodules which both in their distribution and clinical characters resembled very closely the subcutaneous fibrous nodules of rheumatic children which are so closely associated with the name of that physician.

Cases somewhat similar have been described by Wagner," of Munich.

In some cases the clinical features leave no doubt upon the mind that we are really dealing with the same disease from which adults suffer, but such examples are least uncommon in the later years of childhood.

The following will serve as an example: Eliza C., aged 10 years, whose maternal grandmother had suffered from acute rheumatism, but in whose family there was no history of arthritis deformaus or gout, had always been a delicate child, and her health had lately been further impaired by the privations which the family had undergone owing to her father being out of work. Two months before she was first seen she began to complain of pain in the middle joint of the index finger of the right hand, and shortly after ward the corresponding joint of the right middle finger became involved.

She exhibited enlargement of the middle joint of the right middle, ring, and little fingers, and also the same joint of the left middle finger.

There was already some distortion of both hands conforming to the type of flexion of Charcot. The wrists were also involved, being somewhat painful and swollen. The muscles of the right arm were markedly atrophied. The supinator jerks were not obtained, the triceps jerks were normal, and the knee jerks were feeble. No numb ness or tingling had been noticed.

The cervical spine and temporo-maxillary joints were not involved. The pulse-rate was 104 per minute, and the beats were irregular. Nothing abnormal was detected in the heart or lungs.

In this instance we have a delicate child, developing, after a pe riod of scanty food and general privation, a condition indistinguish able from the arthritis deformans in adults; attacking first, as that disease does, the smaller peripheral joints and unattended by any recognizable cardiac lesion.

The subject of arthritis deformans in children has been specially studied by itIoncorvo Brazil and by Diamantberger " in Paris, the latter of whom has devoted a lengthy monograph to its discussion. As the outcome of the personal study of some cases of the kind, and of the examination of recorded examples, Diamantberger concludes that the special liability of the female sex which is so conspicuous in adult life is also noticeable in childhood; that in some instances direct inheritance of the disease can be traced, but that bad hygiene, cold, privation, and some kinds of infection contribute to its develop ment. He states that in most oases the disease tends to be somewhat acute, and that the prognosis is more favorable in childhood than in adult life.

Among clinically associated conditions Diamantberger mentions exophthalmie goitre, a point which has also been dwelt upon by Kent Spender, who adduces as points of affinity between these two maladies the occurrence in both of pigmentation of the skin, rapidity of the pulse, and tremor.