The Relation Between Heart and Joint Disease Including "Rheumatoid Heart Disease" and Chronic Post-Rheumatic Arthritis (Type Jaccoud)

This study sets out to re-examine the relationship between rheumatic fever and rheumatoid arthritis in the light of a series of cases, studied mainly at the Postgraduate Medical School, on which biopsy or autopsy material is available.It will be concluded that there is every justification for regarding these two as separate diseases.HISTORICAL SURVEY Knowledge of the relationship between the disease of the heart and of the joints dates from comparatively recent times.In 1788 David Pitcairn, in his lectures to the students of St. Bartholomew's, drew attention to the frequent occurrence of heart disease in patients who had been affected with rheumatism.The only record that exists of Pitcairn's original observations is in the second edition (1797) of the Mlorbid Anatomy written by his friend Matthew Baillie, to whom he passed his practice and the gold-headed cane (Macmichael, 1932).Edward Jenner, independently, in 1789 at a mneeting of a Gloucestershire Medical Society at the Fleece Inn, Rodborough, reported An affection of the heart following acute rheumatism, but again this failed to reach print (Keil, 1936).Matthew Baillie himself fully endorsed Pitcairn's opinions, and William Wells, one of Baillie's closest associates, in his classic article on Rheumatism of the Heart (1812) gives the full story and a number of very pertinent cases illustrating this first association of heart and joint disease.It was left to Jean Bouillaud in 1836 to emphasize this association in his famous law of coincidence: " in the great majority of cases of acute generalized febrile articular rheumatism, there exists a variable degree of rheumatism of the fibrous tissue of the heart.This coincidence is the rule and the non-coincidence the exception."Between Wells in 1812 and Bouillaud in 1836, Laennec had introduced the stethoscope (1816), and thus it was, through the development of such new techniques, that the succeeding generation of French clinicians were able to establish so firmly the major clinical syndromes.It was not until 30 years later, with the accumulation of a good deal more clinical experience with these new methods, that this " law " was called into question.In 1869 F. S. Jaccoud gave a clinical demonstration in the Hopital de la Charite in Paris.The patient was a man of 29 who had had six attacks of articular rheumatism, the first four being severe but short-lived and the last two persistent.The first two attacks subsided completely, leaving neither symptom nor sign.In the third attack the patient developed a severe endocarditis which left him with dyspnoea, aedema of the legs, and well-marked valvular disease.Several months later a fourth attack of rheumatism occurred lasting 4-5 weeks, and once again the joints cleared up completely.