Jarcho (1958) has, however, pointed out that Benjamin Rush, in 1794, quoted a letter from a correspondent in Dublin in which a case of acute rheumatism was described.Abnormalities of the pulse were present and, 'The opinion of some of the physicians was that the heart was affected as a muscle, by the rheumatism, and alternated with the limbs'.Whether these Irish physicians had, directly or indirectly, become acquainted with Pitcairn's teaching or whether this was an independent diagnostic tour de force is not known.
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Peter Fleming (1977) studied this question.