The “galloping” history of intermittent claudication.

This research paper looks at the historical understanding and diagnosis of Intermittent Claudication (IC), a condition primarily caused by arterial occlusive disease, as first diagnosed in horse and subsequently in humans. Primarily, it discusses how the affliction was first recognized by Jean-François Bouley jeune in a horse in 1831 and later diagnosed in humans by Jean-Martin Charcot in 1858.

History of Intermittent Claudication (IC)

• The paper begins with how Jean-François Bouley jeune, a French veterinary surgeon, diagnosed Intermittent Claudication (IC) for the first time in a street horse in Paris in 1831. Upon exercising, the horse frequently started limping with its hind legs at similar exertion levels. An autopsy of the examined horse revealed a partially thrombosed aneurysm of the abdominal aorta and the occlusion of both femoral arteries, which Bouley jeune successfully identified as the causes of IC.
• Subsequent to the recognition in animals, the famous neurologist Jean-Martin Charcot who worked at the Salpêtrière in Paris recognized the presence of IC in humans for the first time in 1858. The condition was observed in a patient wounded by a bullet during the conquest of Algeria, who later developed an iliac artery aneurysm obstructed by a thrombus. Charcot’s diagnosis in humans was presumably influenced by the first known description of the condition in horses.
• The author also reflects on the history of the disease in Germany, where it was first reported in horses by Rademacher in 1838. Furthermore, case reports of the disease in human patients were presented by Heinrich Erb, a neurologist, in 1898 and 1904.

Understanding the Phenomenon of Intermittent Claudication

• The paper outlines some intriguing characteristics of IC, such as the amount of exercise needed to provoke it, its localization, societal relevance, prolongation of the Achilles tendon reflex, reduction of the foot’s maximal plantar flexion intensity, and production of the “Lewis factor p”.
• In humans, arteriosclerosis is identified as the primary cause of arterial blockages leading to IC, whereas in horses, the lesions primarily result from a roundworm infection (Strongylus vulgaris). This elucidates the varying etiology of the disease among different species. The paper elaborates on the parasitic worm’s life cycle, where the larvae migrate into the intima of small and large arteries, leading to the formation of aneurysms and intravascular thrombosis, highlighting the cause and effect in equine cases.