LYMPHATIC CONSTITUTION, NEURO-ARTHRITISM AND EXUDATIVE DIATHESIS These find their expression in an abnormal "habituR," in a predisposition to certain organic diseases and in a number of functional disturbances. The descriptions of different authors do not make it clear, if the three names we have quoted above (to which we might add many others) are really synonyms for the same disturbance or if we have to assume different anomalies of this kind which have only some common symptoms.* This question has to remain open as long as we do not know more about the nature of these disturbances nor possess a reliable biochemical criterion for their recognition.
Some authorities do not like what appears to be the oldest term, that of "lymphatic constitution" (also "Iymphatism" or "lymphatic diathesis") because, as they say, the swelling of the lymph-nodes is secondary and, at that, not always pronounced; they forget, however, that originally this name had nothing to do with the lymph-glands; it is an appellation handed down to us from the times of humoral pathology, according to which the trouble was founded upon an abnormal condition of the lymph, to which noxious humor many symptoms were referred; this is to-day not even called real "lymph" any longer, but no more should it be regarded as a true exudate according to our present views about the inflammations.
To-day one thing is certain, namely, that the practical importance of these disturbances is very great on account of their frequent. occur rence; and any one who does not make the mistake of sonic specialists, in regarding each and every manifestation of these "diatheses" as a separate and autochthonous disease, will meet them daily and may even be in doubt if there is any other habitual symptom (except the mal formations) that is not related to these conditions. In the author's opinion there is no valid reason why we should not go very far in this and include all stages of childhood. To this we are forced by our own personal investigations no matter what others have to say to the contrary.
Under these circumstances it will be easily understood that we can not attempt to give in this chapter a clear, precise and rounded-off description of these conditions; the so-called symptoms of these abnormal constitutions will mostly be described in other chapters of this work, still the editors of this work considered it necessary that we should give a short sketch of these conditions of which we used to hear a great deal years ago and which have lately been taken up again to a large extent, and this for the further good reason that we have made a good start in the rational treatment of these diatheses, the results of which can no longer be considered illusory.
The abnormalities of these children are in many cases observed in their habitus and their disposition and we differentiate principally between: 1. The pastous, torpid or lymphatic-ancemic habitus. Skin and mucous membranes are bloated, pale, fallow; the muscles are flabby and spongy; the skeleton, especially that of the face, is coarse. Hyper plasia of the lymphatic system is shown in the swelling of the visible and palpable glands, especially adenoids (adenoid face). The children are cross, lazy, frequently sleepy, absent-minded, stupid and of a phleg matic (lymphatic) temperament.
2. The erethic or neuro-arthritic habitus. The skin is tender, the eyes bright, the pupils wide, the cheeks change their color frequently. These children are usually skinny, gracile, restless, lively, impulsive, irritable, also very bright, often precocious and highly intelligent; their disposition is changeable, they incline to affectation; they are impetuous, flighty, exalted, unsociable and insufferable youngsters, frequently with pro nounced but one-sided talents (deg6ner& sup&ieurs).
3. The plethoric-obese habitus. Amongst these we may group the so-called "prize-babies" of supernormal weight, tremendous adipose tissue, red cheeks, well-colored mucous membranes, who are inclined to free perspiration.