The study of the morbid anatomy of arthritis deformans, initiated as we have seen by Landre Beauvais, was vigorously pursued by a number of observers both on the Continent and in the British isles, and among these Cruveilhier," Lobstein" and Aston Key," Adams" and Robert Smith of Dublin, Canton" and Deville'° and Broca" must be especially mentioned. It is to the researches of Adams and Robert Smith that we owe the recognition of the fact that the disease of the hip-joint met with in elderly men, which so frequently has its origin in an injury, slight or severe, is in its essential nature iden tical with the disease of many joints, both small and large, to which women are specially liable.
There is probably no institution which provides a richer field for the study of arthritis deformans than the Salp'etrire in Paris; and it was from this institution, upon which the brilliant researches of Charcot have conferred a world-wide celebrity, from the pen of Charcot" himself, then an interne, and from that of his colleague Trastour" that the next important contributions to the study of this disease emanated. The graduation theses of these authors and that of their contemporary Vidal " supply, indeed, a most comprehensive account of its clinical aspects.
Both Charcot and Trastour maintained the view that arthritis de formans is merely a variety of chronic rheumatism—an opinion which was very widely held by French physicians, at any rate up to a very recent period, and which still finds distinguished adherents, among whom may be mentioned Dr. Mitchell Bruce who has contributed the article upon this subject in Quain's Dictionary of Medicine, and the late Professor Kaliler of Vienna. One of the most interesting por tions of Chareot's thesis is that in which lie describes and classifies into definite types the deformities of the hands which result from the changes iu the joints, and from the spasm of the muscles which con trol the movements of the fingers.
The view that arthritis deformans is a distinct disease differing in its pathology from both rheumatism and gout was vigorously up held in England by Fuller" and Garrod," whose works, published in the years 1852 and 1859 respectively, contained accurate descriptions of the disease. Both authors urged in support of their opinions the fact that the visceral manifestations of true rheumatism are not met with in the disease under consideration, and Garrod showed that the presence of an excess of urate in the blood which he had demonstrated to be a feature of true gout was not to be detected in cases of arthritis deformans.
Of more recent years the study of arthritis deformans has been approached from many sides by a number of observers, and the prev alent views as to the nature both of this disease and of true rheuma tism have undergone and are still undergoing profound changes; moreover the gradual displacement of the older chemical theories of true rheumatism, by the growing belief that that disease is due to a micro-organism still unrecognized, has tended to draw more distinctly than ever the line of demarcation between them.
The view is now widely held that the nearest allies of arthritis deformans are to be found in the joint lesions which are associated with gross diseases of the nervous system; and this opinion receives powerful support from the undoubted and close resemblance between the morbid changes in the joints to which it gives rise, and met with in the joints of patients suffering from locomotor ataxia and who have developed the so-called Charcot's disease.
It is but a single step further to suppose that arthritis deformans is itself a disease of nervous origin, and that the joints which it at tacks become subject to dystrophic changes; and the hold which this theory has gained upon medical opinion is in great measure due to the writing of Senator" and R. Wichmann" in Germany, Ord." and Duckworth" in England, Weber" in America, to mention only a few of the authors who have dealt with this aspect of the question. An other view which must be mentioned, and of which Hutchinson is the leading exponent, looks upon arthritis deformans as neither a distinct disease nor a variety of gout or rheumatism, but as the product of a blending of gout and rheumatism, in which now the one and now the other element preponderates.
Arbuthnot Lane" and others ascribe a large share in the causation of the lesions to mechanical wear and tear of the joints; while some believe that in its most chronic forms the disease is largely of the nature of a senile change.
It will be seen then that we are very far, at present, from arriving at any degree of unanimity as to the nature, and consequently as to the proper treatment, of arthritis deformans; and that the theories as to its nature which have been propounded are only less numerous than the names which have been assigned to the disease.
He who endeavors to write a consistent account of arthritis defor mans is met at the outset of his task by the difficulty that under this name are included cases which differ widely from each other in their clinical aspects, so widely indeed that we should almost be jus tified in regarding them as examples of distinct disorders, were it not that the morbid changes in the joint structures are of like nature in all. Hence it is that one is driven to take these changes as the sole criterion of the nature of the case, and to classify all cases in which they occur as examples of arthritis deformans.