Chronic post-rheumatic fever (Jaccoud's) arthropathy.

Case 1,* a married woman, a former nurse, aged 66 years, was admitted to the West London Hospital on November 12, 1967, after a syncopal attack provoked by climbing a long flight of stairs. On regaining consciousness she had had a small haematemesis. There was no history of dyspepsia and she had not taken any drugs. She had suffered from a severe and prolonged attack of rheumatic fever 40 years before, for which she had received treatment in hospital for 7 months, and she had developed a second attack of rheumatic fever the following year. In both attacks the polyarthritis involved the small joints of the hands. She subsequently remained in good health, though aware of a painless ulnar deformity of the fingers of both hands. In recent years she had twice fallen on outstretched hands, injuring both wrists. In 1957 she developedexertionaldyspnoea andorthopnoea and in April, 1967, she first experienced angina of effort.