13 June 2013

Arthroblog No 11 - Rheumatic Fever (the 'most tedious of all the acute inflammations')

These days rheumatic fever tends to be an uncommon disease of children and adolescents, but can affect adults. Its importance was not fully understood until the end of the 18th century when Archibald Pitcairne (1652-1713), a distinguished Scottish physician, pointed out that it could “touch” the heart (particularly the valves) as well as the joints. It is “ushered in by a sudden attack of rigors, followed by the usual symptoms of pyrexia, and ... great pain and swelling which affect one of more joints, coupled with an utter inability to move them, and very commonly with considerable redness. Several joints are commonly affected at the same time but one of the most singular phenomena is its tendency to abate in one or two joints, often very suddenly, and to become as suddenly violent in another and a distant part.”* A preceding infection with a microbe known as the beta-haemolytic streptococus, which can infect throat and skin, is known to have a great deal to do with the disease which, with the advent of antibiotics, is preventable.
*George Gregory, Elements of the Theory and Practice of Medicine, 1839

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