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May 5, 2021
Rheumatic Heart Disease William Charles Wells

William Charles Wells (1757-1817)

On rheumatism of the heart. Trans. Soc. Improve. Med. Chir. Knowl., 1812, 3, 373-424.

Williams Charles Wells was an American physician who studied medicine at the University of Edinburgh. He described a series of fourteen patients with rheumatic arthritis and cardiac manifestations in 1812.

In the introduction of his article, Wells gave credit to the work of David Pitcairn: "Dr. DAVID PITCAIRN, about the year 1788, began to remark, that persons subject to rheumatism were attacked more frequently than others, with symptoms of an organic disease of the heart. Subsequent experience having confirmed the truth of this observation, he concluded, that these two diseases often depend upon a common cause, and in such instances, therefore, called the latter disease rheumatism of the heart." He also briefly commented on the prior works of Baillie and Dundas.

Similar to Dundas' accounts, the dominant cardiorespiratory symptoms in Wells' series were dyspnea, chest discomfort, palpitation with tachycardia and occasionally hemoptysis. After the detailed description of seven cases that were followed by him directly, wells concluded: "Having finished the description of the cases seen by myself, which I think may be properly arranged under the title of rheumatism of the heart, I shall next relate several more, the knowledge of which I have derived from other sources."

In his article, Wells presented a detailed account of autopsy findings of six patients who died from this disease, primarily due to congestive heart failure.  He described lesions of pericarditis in all his autopsy reports. In the postmortem examination of the case nine, Wells identified the lesions of pericarditis and cardiomegaly as follows:

"...The lungs adhered to the pleura costalis almost at every part. The left side of the chest contained about five ounces of water; in the right side there was about one ounce. The pericardium adhered to the whole surface of the heart; the adhesion was easily separable by means of the fingers.  The heart was twice as large as natural; its muscular structure was increased in thickness, and all its cavities were very much loaded with blood..."

The autopsy report of case eleven is of great interest as it attempts to describe endocardial injuries including extensive valvular lesions of rheumatic carditis:

"...There were adhesions every where between the two folds of the pericardium. On the internal surface of the left auricle of the heart, there was a space, of about an inch square, studded with very minute excrescences resembling small warts.  Three excrescences of a larger size were found on the internal surface of the left ventricle, about an inch below the semilunar valves. One of these was so large, as to project about half an inch into the cavity of the ventricle. Two or three similar excrescences were attached to the mitral valve, and semilunar valves of the aorta."

After reading this postmortem examination report, one may wonder if these were not lesions of rheumatic carditis complicated with infective endocarditis. It is important to emphasize that the germ theory of the disease was not described in the first half of the 19th century and infective endocarditis was not yet identified as a separate clinical entity.  Most reports of that era included valvular lesions due to rheumatic fever or from infectious origin under the same umbrella. It is particularly difficult to recognize cases of rheumatic valve disease which were complicated with infective endocarditis.

Although Dundas and Wells reported cases of rheumatic arthritis with cardiac manifestations, they provided little information about valvular lesions resulting from this disease. An accurate description of this causal relationship with the precise identification of valvular lesions was given by Jean-Baptiste Bouillaud in 1835.



 Wells WC. On rheumatism of the heart, in Cardiac Classics (Eds. Willius FA, Keys TE), St. Louis, Mosby, 1941


David Dundas Jean Baptiste Bouillaud