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: email@example.com.