On June 16, 1944 (D-Day plus 10), at the AMA's Section on Pediatrics symposium on rheumatic fever (RF) in Chicago, T(homas) Duckett Jones first outlined his criteria for the diagnosis of RF in a “lantern demonstration”. The proceedings were published in JAMA on October 12, 1944. RF then was the leading cause of death in children 5-19 yo, and accurate diagnosis was a major problem. The components of RF had been described in the 17th-19th C. by de Baillou, Sydenham, and Morgagni, and unified into the RF syndrome by W.B. Cheadle in the 1880's. The association of RF and group A streptococci (GAS), however, was recognized much more gradually. In his Criteria publication, Jones barely noted GAS and did not include GAS infection in the Criteria.
Who was T. Duckett Jones? Born in 1899 he was educated at Virginia Military Institute, U. of Virginia Med. School, Massachusetts General Hosp. under Paul Dudley White, and University College, London. He was Research Director of the House of the Good Samaritan, a Boston RF hospital, from 1929-1947 and organized (without computers) longitudinal observations on 1000 RF patients. He also served as President of the American Rheumatism Assn., chair of the American Heart Assn.'s (AHA) Council on RF, Vice-President of the AHA, President-elect of the National Health Council, on the first National Advisory Heart Council of the National Heart Institute of NIH, and Director of the H.H.Whitney Foundation. He died in 1954 of vasculitis with malignant hypertension.
The Jones Criteria cleverly organized the features of RF into major and minor criteria based on their diagnostic value and indicated that any combination of major criteria, or one major plus two minor criteria, “would seem to place the diagnosis on reasonably safe grounds”. Based on advances in knowledge and technology, the Jones Criteria were revised(1955), modified (1965), tinkered with (1984), and updated (1992) by the AHA. The most important changes 1) made evidence of recent GAS infection nearly mandatory, 2) changed arthralgia to polyarthritis, 3) reduced minor criteria to two clinical and two laboratory criteria, and 4) limited application of the Criteria to first attacks of RF. Jones recognized in 1944 that changes in the Criteria would be likely, and they likely will continue to evolve over the next decades unless a highly sensitive and specific test for RF that obviates reliance on clinical criteria is developed.
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Shulman, S. Tom Jones and his Criteria for the Diagnosis of Acute Rheumatic Fever ♦ 912. Pediatr Res 43 (Suppl 4), 157 (1998). https://doi.org/10.1203/00006450-199804001-00933
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DOI: https://doi.org/10.1203/00006450-199804001-00933