Chapter 7. Historical aspects of differential diagnostics (19th–20th)

The modern term «rheumatoid arthritis» was introduced by an Englishman, Alfred B. Garrod (1819–1907) in 1859 (Fig. 7.1, 7.2).

In continental Europe, as the author, who described rheumatoid arthritis (RA) in the modern term, has long been considered by J. M. Charcot (1825–1893), who was a renowned Clinician and mentor to Sigmund Freud. He described not only the clinical manifestations in RA, but also including its effect on mental status (Dissertation 1853 and 573 pages about gout and rheumatism in volume VII of his collected works, 1890) (Fig. 7.3).

Fig. 7.1. Alfred Baring Garrod (1819–1907) — British Doctor

Fig. 7.2. The Nature and Treatment of Gout and Rheumatic Gout. 1859

Fig. 7.3. Jean-Martin Char­cot (1825–1893) — French Clinician

At the same time, it is known that back in 1800, the French­man A.J. Landre-Beauvais studied in detail for his dissertation the clinical signs of RA, which are absolutely different from gout and OA (osteoarthritis). However, his work was ignored by Englishmen engaged in this pathology — A.B. Garrod, B.K. Brody, R. Adams. The fact that it took almost two centuries to recognize Landre-Beauvais priority in the description of RA is probably primarily due to the misleading term he proposed for this nosology: «de goutte asthénique primitive» or primary asthenic gout.

British doctor Alfred B. Garrod in 1859 published the work: «The Nature and Treatment of Gout and Rheumatic Gout», which still contains illustrations of the hands of patients with rheumatoid arthritis: changes in the hyaline cartilage of the femur, tibia, and talus in gout, as well as changes in the kidneys. This example shows that medical illustrations developed after the appearance of photography. 11 years earlier (1848), the author described an increase in uric acid in the serum, tophus content, and urine of patients with gout and the absence of similar uric acid concentrations in patients with RA.

Researchers of A.J. Landre-Beauvais, creative work regret to state that in his further scientific work. He never studied RA again and did not publish anything else on this topic [4]. The main work of Landre-Beauvais is «Semiotics» (Fig. 7.4). The author paid attention to small things which we in the 21st century do not take into account, especially early symptoms of the disease, because he saw how important this is for the prognosis. Descriptions of the pulse in various nosologies take about 40 pages.

Fig. 7.4. Title page of the third edition of «Semiotics» by A.J. Landre-Beauvais (1772–1840). Paris, 1818. And the original is in the National library (Bibliothèque nationale de France. Catalogue Général)

The most important work of Benjamin Collins Brodie (Fig. 7.5), admittedly, is the 1818 treatise (repeatedly reprinted) «pathological and surgical observations on diseases of the joints», in which he tries to trace the origin of the disease in the various tissues that form the joint, and to give a precise definition of pain as evidence of organic disease. This treatise led to the adoption of more conservative tactics by surgeons.

Fig. 7.5. Benjamin Collins Brodie (1783–1862) was an English physiologist and a surgeon who pioneered research on bone and joint diseases

In 1854, he anonymously published a volume of psychological research—eight years later, an expanded, revised, and updated volume of 1862 appeared under his name. During his career, he received many awards and took care of the health of the Royal family, starting with George IV. He was also a Sergeant-surgeon to William IV and Queen Victoria and was made a Baronet in 1834. He became a corresponding member of The French Institute in 1844, a foreign honorary member of the American Academy of Arts and Sciences and the University of Oxford in 1855, President of the Royal Society in 1858, and subsequently the first President of the General Medical Council. In 1858, Henry Grey dedicated his work Grey’s Anatomy to Sir Benjamin Collins Brodie. [2].

Jean Cruveilhier was a highly influential anatomist (Fig. 7.6) who made important contributions to his study of the nervous system. Jean-Martin Charcot (1825–1893) believed that Trouville was the first who described the nosology, which today we would call multiple sclerosis.

Fig. 7.6. Jean Cruveilhier (1791–1874) — French anatomist and pathologist

His experiments on callus formation in the pigeon experiment showed the influence of periosteum in restoring limb function.

He conducted extensive research involving the vascular system, remembered for his research on phlebitis. His injections of mercury into the blood vessels and bronchial system confirmed the theory of phlebitis, which, in his words, «dominates all pathology». This made possible the concepts of embolism and infarction that were developed by Virchow starting in 1846. But while Virchow considered vascular thrombosis to be a primary lesion, and venous wall damage to be secondary, Cruveilhier believed that a change in the venous wall leads to thrombosis. Later research confirmed his statements. His name is associated with the Cruveilhier sign (persistent hypertension and portal vein occlusion) and Cruveilhier-Baumgarten disease (cirrhosis of the liver without ascites), a condition named by the German pathologist Paul Clemens von Baumgarten (1848–1928). These observations are very important in the 21st century, in the context of prevention of venous thromboembolic complications after endoprosthetics.