The First Description of Rheumatoid Arthritis. Unabridged Text of the Doctoral Dissertation Presented in 1800

This unabridged version of the dissertation presented in 1800 by Augustin Jacob Landré-Beauvais for his medical doctorate describes a disease different in many ways from the condition known since Hippocrates as gout. The patients were nine long-term residents of the Salpêtrière hospice in Paris. After reviewing the main features of ordinary or regular gout, Landré-Beauvais points out that the disease he calls "asthenic gout" exhibits several distinctive features, including predominance in women, a chronic course, involvement of many joints from the onset, and a decline in general health. Despite the tentative tone of his title ("Should one recognize...), he clearly is convinced that he is describing an as yet unreported entity, as indicated by the last sentence of his dissertation: "...we must recognize the existence of a new form of gout under the designation primary asthenic gout" And although he stops short of emancipation from the term "gout", which had been used for centuries to designate specific joint manifestations, he makes several keenly discerning observations -- particularly regarding the influence of psychological factors, the need for gentle treatments, and the inappropriateness of bloodletting - thus breaking free from contemporary doctrine. This text is acknowledged as the first description of rheumatoid arthritis. A brief biography of Landré-Beauvais is provided.