The medical diseases of children . ominencesof the back. They arise very rapidly and are soft in consistence. Theskin covering them is discoloured and bruised in appearance. Theylook like rapidly-growing sarcomata, but are distinguished by theirposition and symmetrical distribution, and by the associated orpreceding rheumatism, which is usually of a severe type. The clinical significance of rheumatic nodules in children is , they are in their typical form quite distinctive of acuterheumatism. Secondly, their presence indicates the severer formsof cardiac rheumatism, almost inva
The medical diseases of children . ominencesof the back. They arise very rapidly and are soft in consistence. Theskin covering them is discoloured and bruised in appearance. Theylook like rapidly-growing sarcomata, but are distinguished by theirposition and symmetrical distribution, and by the associated orpreceding rheumatism, which is usually of a severe type. The clinical significance of rheumatic nodules in children is , they are in their typical form quite distinctive of acuterheumatism. Secondly, their presence indicates the severer formsof cardiac rheumatism, almost invariably endo- or pericarditis. Thirdly,generally speaking, in number they correspond to the severity of theinfection, and where most copious, pericarditis is usually , they give a clue to what is happening in the valves of theheart : where they are rapidly absorbed, we may conclude that thevalvular vegetations are also disappearing ; where they remain andbecome fibrosed, we may suspect similar sclerotic changes in the. Fig. 29.—Rheumatic Nodules (acute) over second METACARPOPHALANGEAL JOINT AND I,OWER END OF ULNA. THE RHEUMATIC INFECTION 149 valves. This mental association of the changes in the nodules andin the valves will be seen to be quite legitimate if we consider whatposition the nodules occupy in the disease. Pathologically, rheumatic nodules take the same position in rheu-matism that pyaemic abscesses occupy in pyogenic infections. Thesemi-gelatinous fibrinous exudate which is found in the nodules is alsofound in the valvular vegetations in the pericardium, on the pleuraand in the joints and peri-articular tissues. As Dr. Poynton has said,it is to be regarded as rheumatic pus. It is, that is to say, theresult of the reaction of the tissues to the rheumatic organism, andone which we cannot help regarding as a specific reaction to aspecific organism. The type of nodule described above as thehemorrhagic, would seem to fall into line with the hemorrhagic form
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectpediatrics, bookyear1
