. American practitioner. -ever, I believe, by the few facts that we are in possession of regardingthe course of the disease, and particularly regarding the visceraleffects of it. When Dr. Still published his first report he based his observationsupon nineteen cases. In practically all these cases the disease hadbegun before the sixth year of age. Its onset was insidious in manyinstances, but occasionally a case was encountered in which the jointsbecame swollen and tender, rather abruptly. The enlargement of thejoints symmetrical, smooth and fusiform was progressive and aftera varying time, fro
. American practitioner. -ever, I believe, by the few facts that we are in possession of regardingthe course of the disease, and particularly regarding the visceraleffects of it. When Dr. Still published his first report he based his observationsupon nineteen cases. In practically all these cases the disease hadbegun before the sixth year of age. Its onset was insidious in manyinstances, but occasionally a case was encountered in which the jointsbecame swollen and tender, rather abruptly. The enlargement of thejoints symmetrical, smooth and fusiform was progressive and aftera varying time, from a few months to a year, more completely inca-pacitated the patient. He remarked that an invariable accompani-ment of the disease was an enlargement of the lymphatic glands andof the spleen. In 1903 Dr. Royal Whitman reported the final results of two casesof this disease (Medical Record, April 18, 1903), and discussed itsrelationship to rheumatoid arthritis. He remarked upon its obvious 553 554 The American Practitioner. Fig. i Original Articles 555 rarity in this country, basing his statement upon his experience at theHospital for Ruptured and Crippled. The first case which he put onrecord was apparently a typical example of the disease. Upon au-topsy the liver was found to be three times its normal size and theseat of profound amyloid degeneration, the spleen was correspond-ingly enlarged and the seat of similar degeneration. The kidneys
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