Occasionally obese children may take on the neuro-arthritic habitus after the second year, or the pastous habitus may be less clear later, etc.
Similar types have been differentiated among the scrofulous children, and this we can explain by the close relation between lymphatic consti tution and scrofulous. This had been recognized for a long time but has been explained satisfactorily only quite recently; of this we will speak again later.
Symptoms.*—In the older literature the picture of lymphatic diathesis is frequently inaccurate owing to the admixture of scrofular symptoms. The French descriptions of the constitutional abnormality in children, called "arthritism," especially those of Comby (1901, 1902), define this picture quite clearly. From the description of this last named experienced and careful observer we can give here only an enu meration of the most frequent symptoms, or better, of the disturbances due to this diathesis.
General in the temperature without any apparent cause of the type of an intermittens quotidiana, lasting a few days at a time, together with chills, heat and perspiration, and which will return again and again after intervals of some months. These may change to true attacks of gout, thus forming their equivalent, or they may assume the character of a subeontinua* lasting for some weeks. The fever may be accompanied by headache, fainting spells and considerable weakness.
Systematic swelling of the lymphatic tissues, especially the pharyngeal and fancial tonsils, of the glands around the throat, the jaw and the neck (polyadenopathy and micropolyadenopathy); chlorotic condition of the blood: periodic anaemia.
Circulatory of the heart with pal pitation (so-called hypertrophy of growth), accidental cardiac and venous murmurs, habitual or intercurrent bradycardia and arrhythmic pulse, paroxysmal tachycardia; also various other vasomotor phenomena.
Respiratory Apparatus.Relapsing catarrhal processes in the upper air-passages, coming on very suddenly (spasmodically) principally from colds; for instance coryza (with epistaxis), hay-fever, laryngitis, diffuse tracheobronchitis and bronchiolitis, pseudocroup, bronchial asthma; acute "pulmonary congestion," pleuritic irritation.
Digestive Tract.—This is a frequent seat of symptoms. Anorexia;
parorexia (pica), bulimia, fcetor ex ore; spasms of deglutition (cesopha gism), coated tongue especially the so-called lingua geographica (Bernier as quoted by Alarfan, Betz). Recurrent pharyngitis, angina pharyngea and palatina, dyspepsia with atonic symptoms and colic; habitual constipation and enteritis muco-membranacea either with or without the discharge of concretions (intestinal sand); appendicitis; cyclic vomit ing with acetonxmia; hmmorrhoids.
Genitourinary urine has frequently a high specific gravity and has a sediment of uric acid, urates, phosphates and oxalates. Intermittent albuminuria in some cases of the orthotic type: less often glycosuria; polyuria and pollakiuria; vesical tenesmus; enuresis nocturna; catarrhal cystitis and urethritis; vesical and renal and or concretions accompanied by renal colic; movable kidney; bala-nitis (non-gonorrlimic), vulvoraginitis; dysmenorrhcea and metrorrhagia.
Nervous System and Organs of Sense.—All kinds of disturbances of sleep especially nocturnal restlessness: pavor nocturnes; spasmits nutans; chorea (but not Sydenham's type) and choreiform restlessness; stuttering; convulsions, especially at the beginning of infectious diseases; laryngo spasmus; migraine, neuralgiform pains, sciatica: blepharitis.
Motor affections; arthralgias, ostealgias, usually without any objective changes in the joints, but sometimes with periarticular oedema; rheumatic or spasmodic torticollis, lumbago; in exceptional cases true gouty affections with attacks quite similar to those in adults.
External skin is tender and over-sensitive to all kinds of external irritations, especially heat, great liability to freezing; evanescent oedemata, hyperhydrosis, quick changes in color; nrticaria; pruritus, prurigo, strophulus, intertrigo and most frequent of all chronic eczemas either of the weeping, crustous and impetiginous type or in tough dry plaques together with seborrhea; the former kind mostly in infants as the so-called crusta lactca of the face and scalp, the latter on the neck, back, chest, shoulders and arms, frequently symmetrical; trite seborrhoea, especially seborrhoea sicca of the vertex; rarely only pityriasis, acne, kerat oses, t richophytoses.