THE POET John Donne wrote that no man is an island. Never was this more apt than when applied to the person who is suffering with a crippling disease. For him isolation is disastrous. If intelligent and left too much alone, he becomes embittered, sullen and perhaps an enemy of society. If unintelligent, he deteriorates slowly and steadily into a parasitic, vegetable-like existence, which may eventually sap the lives of all about him. The modern approach to the problem emphasizes adjustment of the handicapped person to the family, the community, and even the nation. All these forces are brought to bear from the social, economic and psychologic points of view, so that such a person is able to live an existence as nearly normal as possible. He contributes to rather than lives upon the society that encompasses him. This consideration of the social aspects of rheumatic heart disease is concerned with these problems and with the extent to which the individual, the family, the community and the nation are able to solve them.
On July 29, 1789, Edward Jenner, who first introduced vaccination against smallpox, reported to the medical society in Gloucestershire, England, on "Disease of the Heart Following Acute Rheumatism." The case was illustrated by dissection. This was probably the first reference to rheumatic fever in scientific medical reports. Unfortunately neither the paper nor any record other than its title has ever been found. Perhaps the first physician who pointedly called attention to the association of acute rheumatism and heart disease was David Pitcairn, born in 1749.
AN INQUIRY INTO THE FAMILY INCIDENCE OF ACUTE RHEUMATISM