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JCR: Journal of Clinical Rheumatology:
Rheumatology Retrospective

Rheumatology Retrospective

Dorwart, Bonnie B. MD, FACP

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From the Lankenau Hospital, Wynnewood, Pennsylvania.

Editor’s Note: Considering the interval between the initial triggering event–a group A streptococcal infection in the throat–and appearance of chorea 6 to 8 weeks, or even 12 months later, it is not surprising that Sydenham described this manifestation of acute rheumatic fever in vacuo. The laborious task of connecting the various manifestations of rheumatic fever was not accomplished until 1889, by WB Cheadle, and codified into Major and Minor Criteria in 1944, by T. Duckett Jones. The Special Writing Group of the Committee on Rheumatic Fever of the American Heart Association of 1992 continues to list carditis, migratory polyarthritis, subcutaneous nodules, erythema marginatum, and Sydenham’s chorea as Major Criteria for the disease. We still struggle with claims of cure in diseases where exacerbations and remissions are intrinsic to their natural history. We can perhaps forgive Sydenham his 5 claims.

Reprints: Bonnie Brice Dorwart, MD, FACP, 124 Maple Avenue, Bala Cynwyd, PA 19004–3031. E-mail: dorwart@verizon.net.

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Thomas Sydenham (1624–1689), on St. Vitus Dance

“Chorea Sancti Viti is a sort of convulsion, which chiefly invades boys and girls, from 10 years of age to puberty: First, it shews [sic] it self [sic] by a certain lameness, or rather instability of one of the legs, which the patient drags after him like a fool; afterward it appears in the hand of the same side; which he that is affected with this disease, can by no means keep in the same posture for one moment…[;] if it be brought to the breast, or any other part,…it will be distorted to another position or place by a certain convulsion, let the patient do what he can. If a cup of drink be put into his hand, he represents a thousand gestures, like jugglers, before he brings it to his mouth; for whereas he cannot carry it to his mouth in a right line, his hand being drawn hither and thither by the convulsion, he turns it often about for some time, till at length happily reaching his lips, he flings it suddenly into his mouth, and drinks it greedily, as if the poor wretch designed only to make sport. Forasmuch as this disease seems to me to proceed from some humor rushing in upon the nerves, which provoke such preter-natural motions, I think the curative indications are first to be directed to the lessening of those humors by bleeding and purging, and then to strengthening the genus nervosum…; I take 7 ounces of blood from the arm, more or less, according to the age of the patient; the next day I prescribe…the common purging potion…of tamarinds [and] sena.”

Sydenham claims a cure in “no less than 5 cases by bleeding and purging by intervals.”

Sydenham, Thomas. In: Pechey, John, The Whole Works of that excellent Physician, Dr. Thomas Sydenham, 7th ed., London: Printed for M. Wellington; 1717: 417–418.

From the Historical Medical Library, College of Physicians of Philadelphia, Philadelphia, PA 19103–3097. Web Site: www.collphyphil.org. Click on Library & Wood Institute, and then on Historical Library.

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Section Description

With this issue of the Journal of Clinical Rheumatology we launch a new feature, Rheumatology Retrospective, which will explore and record the rich and ancient heritage of commentary on the rheumatic diseases. The editor is Bonnie Brice Dorwart, MD, contributor to JCR of 29 “Practice Tips,” dating from the initial issue in February 1995, through February 2002. Now retired, she is writing a history of medicine during the US Civil War, during which pursuit she encountered and rediscovered the rich literature of our specialty. We invite readers to submit for publication historical quotations or photographs relating to the rheumatic diseases.

Sydenham’s unequalled descriptions in 1717 of the chorea of rheumatic fever, acute gout, and “scorbutical rheumatism,” will propel the series, followed by photographs of x-rays showing chondrocalcinosis in a 40-year-old female who died circa 1824. We especially would like citations from journals and textbooks published before the 20th century.

This effort represents a shared resource among colleagues. Attribution of geographic location of archives and of Web sites included with manuscripts is therefore encouraged. Join the challenge; submit some golden prose. Send submissions to Dr. Dorwart at the address provided.

Keywords:

chorea; rheumatic fever; St. Vitus dance

© 2004 Lippincott Williams & Wilkins, Inc.

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