Rheumatic Fever and Streptococcal Infection: Unraveling the Mysteries of a Dread Disease

This is a historical review of the development of our knowledge of the clinical picture, etiology, pathogenesis, and prevention of rheumatic fever and rheumatic heart disease over the past four centuries. Benedict Massell examines the major contributions of both clinicians and investigators to our current understanding of rheumatic fever as a separate disease form. Elucidating many facts about this dread disease, Massell examines the frequent epidemics in training camps during World War II, discusses our growing understanding of the pathogenesis and mechanisms by which streptococcal infections cause the disease, and shows the important progress made in prevention through the use of penicillin and other antibiotics. He includes a discussion of the many problems which can hinder our understanding and control of this disease, as well as recent promising developments in the clarification of the molecular structure of the streptococcal protein and the possible application of this information to the development of a safe and effective vaccine for the prevention of streptococcal infection.

About the Author :
Benedict Massell was, until his retirement, Director of the House of the Good Samaritan, a sub-unit of the Children's Hospital in Boston specializing in the care and treatment of patients with rheumatic fever and rheumatic heart disease.

Review :
With Rheumatic Fever and Streptococcal Infection, this highly respected, venerable physician contributes a remarkable scholarly review of the history and current status of this intriguing and enigmatic disease… Massell’s book belongs in the libraries of all physicians interested in inflammatory heart disease. It is both fascinating to read and a valuable resource in which future scholars and medical historians can find a complete history of rheumatic fever from antiquity through the end of the 20th century. Massell’s account rings with the clarity of a good teacher, albeit tempered by his dogged persistence as a researcher and an uncompromising historian. The evidence is sifted and the validity of a possibly prior claim is meticulously examined. The contributions of clinical workers involved in associating the betahaemolytic streptococcus of Lancefield’s group A (Streptococcus pyogenes) with acute rheumatism (rheumatic fever) are described in detail, and the laurels are conferred with exemplary care. No one has had a longer or closer professional experience with rheumatic fever than Dr. Benedict F. Massell… [His book will] unquestionably serve as the ultimate reference for students of streptococcal disease and rheumatic fever worldwide… [Dr. Massell’s] insightful and detailed comments, made possible by his intimate knowledge of virtually every publication cited, make the book read more like a novel than a compilation of medical reports. This is particularly true of his extensive review of 18th- and 19th-century literature describing the painfully long time before the manifestations of rheumatic fever were recognized as constituting a single entity. The direct quotations of observations made centuries ago make fascinating reading… This monumental work should occupy a prominent place in the private libraries of students of streptococcal disease, rheumatic fever, autoimmunity, and medical history. It most certainly should be made available in every public medical library. [Rheumatic Fever and Streptococcal Infection] provides a fascinating insight into the misconceptions, rigid beliefs and flashes of inspiration which litter the path of clinical practice until tools are available to establish evidence based medicine… For those in the field of rheumatic fever it is a ‘must’ because it provides an excellent picture of the strengths and weaknesses of current beliefs and management practices. [A] remarkable review of the literature on rheumatic fever and its responsible streptococcus… [Massell] traces the history of investigations into the disease and its mechanisms, its streptococcus and its prevention, and brings a mastery of the literature and a love of his subject to this important book. He reminds us that new ideas about old diseases may be difficult for the profession to take on board. This book is the most detailed intellectual history we have of rheumatic fever over the past 400 years. Benedict Massell, a leading figure in rheumatic fever research, begins his account with a chronicle of writings on its clinical picture and aetiology, in particular the 1931 discovery that a haemolytic streptococcal infection of the throat always caused the disease… The main audience for this book will be historically-minded clinicians and scientists, though historians will find this a useful survey of various aspects of rheumatic fever and a valuable guide to the primary literature.