There are numerous difficulties in making a diagnosis of a low grade active rheumatic state. The laboratory has been of little service in this regard. One of us1 observed adventitious friction-like murmurs, somewhat musical in character, in the majority of children who at various times experienced one or several symptoms of childhood rheumatism, such as muscular and joint pains, paroxysmal abdominal pain,2 sore throats, stiff neck, involuntary twitchings resembling tics,3 pallor, weight fixation and persistent low grade elevation in temperature (to be found only when carefully looked for). From our studies, these friction-like, at times somewhat musical, murmurs appear to be the earliest objective signs in low grade childhood rheumatism and are apparently due to pericarditis at the base of the heart, in the region of origin of the great vessels, involving the fold of the pericardium at the point of reflexion of the latter structure. The
WOLFFE JB, DIGILIO VA. BASAL PERICARDITISA SIGN OF EARLY RHEUMATIC INFECTION. JAMA. 1937;108(25):2101–2102. doi:10.1001/jama.1937.02780250015004
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