Passing on to more modern times we find that the honor of having first differentiated arthritis deformans is shared by a French and an English physician, to the former of whom we owe the first descrip tion of the peculiarities of its morbid anatomy, while to the latter is due the credit of having first recognized clearly its distinctive clinical features.
From the writings of French physicians at the end of the eigh teenth and beginning of the nineteenth century it may be gathered that cases of the disease under consideration were at that period usually classed as examples of gout, whereas in England the tendency was rather to include them in the rheumatic group.
On the 16th day of Therinidor, in the year VIII. of the French Republic (August 3d, 1800), there was read before the faculty of Paris a thesis by Landr€ Beauvais,' on a form of joint disease to which he assigned the name of " Goutte Asthenique Primitive," and it has been claimed by Charcot for this thesis that it embodies the earliest de scription of arthritis deformans as a distinct morbid entity. This claim is to a great extent justified by the fact that Landre Beauvais certainly described the changes which this form of arthritis pro duces in the structures of the joints which it attacks, such as the de struction of the articular cartilages and the enlargement of the articu lar ends of the bones, apart from any deposit of tophaceous material. Yet when we consider the clinical descriptions of cases contained in this thesis, it is impossible to suppose that more than a comparatively small proportion of the cases included were actually examples of arthritis deformans ; some were certainly examples of true gout, and others were of very doubtful nature.
One rises from the perusal of the work of Landre Beauvais with the impression that while the honor of first recognizing the morbid changes clue to arthritis deformans belongs without question to this observer, his ideas as to the clinical phenomena corresponding to such lesions were extremely vague.
Heberden," writing in 1804, was sufficiently alive to the distinc tive features of the disease to suggest that it ought to be separated from both true gout and true rheumatism; and he first described the small nodular outgrowths upon the terminal joints of the fingers which are universally known as Heberden's nodes.
The following year (1805) saw the publication of Haygarth's " classical monograph on "Nodosity of the Joints," a purely clinical essay, in which the author describes his experience of the disease under consideration, during many years of practice as a physician at Bath.
The series of thirty-four cases upon which he based his conclusions sufficed to enable him to observe and describe many of the more strik ing clinical features of the malady. Speaking of the manner in which his attention was first drawn to this subject, Haygarth says : " A case happened to occur to my observation at a very early period which, compared with others at subsequent times, convinced me that there is oue painful and troublesome disease of the joints, of a pe culiar nature, and clearly distinguishable from all others by symptoms manifestly different from the Gout, and from both acute and cron ick Rheumatism." Haygarth remarked upon the peculiar liability of the female sex to this disease, especially at or about the period of the menopause ; the special tendency of the joints of the fingers to be attacked ; the characteristic enlargement of the articular ends of the bones, and the essentially chronic nature of this malady which tends to involve one joint after another, until the patient may be crippled by it; and which as it spreads has no disposition to relinquish its hold upon the articulations which have suffered previously.
It would appear that Haygarth's views did not meet with general acceptance among his contemporaries, and for some years after the publication of his essay there is an almost complete blank in the literature of the subject. Even Scudamore" in his work on Rheumatism, which was published in 1827 (twenty-two years after Haygarth's paper), although he refers to the observations of Haygarth, says that he has seldom met with the condition described by that author except as a consequence of antece dent attacks of gout or rheumatism. Brodie," on the other hand, maintained that this disease differed essentially from both those maladies.