The medical diseases of children . his fact, taken in conjunction with the clinical course of the disease in young subjects,makes it almost certain that theorigin of the arthritis is bac- ?terial. Now that rheumatoid arthritishas been accurately defined anddescribed by Dr. A. E. Garrod(Trans. Med. Soc. 1907),we know that it does not varymuch with the age of thepatient. The enlargement, how-ever, of the spleen and glands,which is exceptional in adults,is the rule in children, in whomalso the acute forms of theinfection are particularly con-spicuous. Etiology- — Girls are rathermore frequ
The medical diseases of children . his fact, taken in conjunction with the clinical course of the disease in young subjects,makes it almost certain that theorigin of the arthritis is bac- ?terial. Now that rheumatoid arthritishas been accurately defined anddescribed by Dr. A. E. Garrod(Trans. Med. Soc. 1907),we know that it does not varymuch with the age of thepatient. The enlargement, how-ever, of the spleen and glands,which is exceptional in adults,is the rule in children, in whomalso the acute forms of theinfection are particularly con-spicuous. Etiology- — Girls are rathermore frequently affected thanboys, in the proportion of threeto two. When it occurs inchildren, the disease usuallymakes its appearance beforethe age of six years. Occasion-ally it starts during it can scarcely bedoubted that the disease is the result of an infection, we cannot asyet say to what organism it is due, nor indeed are we even in aposition to assert on clinical grounds that it is the result of oneorganism Fig. 34.—Hand showing changes of Rheu-matoid Arthritis, from a young Adult withMitral Stenosis. RHEUMATOID ARTHRITIS 171 There is some evidence which points towards the arthritis beingthe result of a streptococcal infection which may have its source insome local focus of suppuration in the mouth or elsewhere, in certainof the cases. The relationship between rheumatoid arthritis and acute rheumatismis of considerable interest. In both conditions we find an infectivedisease of joints, mainly affecting the synovial membranes and peri-articular tissues ; in both we find anasmia, moist skin, a mild leucocytosis,nodules, and affections of the heart. The two latter, the most interest-ing points of similarity, differ very markedly in their characters in thetwo conditions. But the connection between the two diseases is seenin other ways as well. Certain examples of rheumatoid arthritisstart so acutely, that at their onset they cannot be distinguished fromacut
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