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the various ankylosing spondylarthropathies, and chronic fluorosis, and from the spinal changes in acromegaly, hyperparathyroidism, ochronosis, and simple degenerative and postinfective spondylarthropathies. Being relatively benign and often symptomless, its importance lies essentially in the diagnostic confusion it may cause with these other conditions and in its coexistence in some cases with diabetes mellitus. It is not an uncommon condition, Vernon-Roberts and his colleagues4 finding it in 20 of about 500 necropsies. Recently a study has been reported from the United States of America by Utsinger, Resnick, and Shapiro.5 Of their 30 patients 25 were men and 5 women, their ages ranging from 50 to 85 and averaging 67 years. In 23 the main complaint was of stiffness in the thoracolumbar spine of many years' duration, usually mild, intermittent, and non-radiating. This spinal stiffness was most apparent first thing in the morning and faded within an hour with simple movements. Normal spinal flexion, extension, and lateral rotation were present in all patients. Eleven of their patients complained of peripheral bone and joint pain, and in seven this was the main or only complaint, the areas affected being shoulder, hip, knee, and ankle; five had acute synovitis of a single joint. Eight had pain in the heels and in five it was the chief complaint. Laboratory investigations were essentially negative, and no evidence was found of abnormality of serum growth or parathyroid hormones; 132 samples of drinking water consumed by 11 patients showed no fluoride concentration levels above 2 parts per million. Only five patients had fasting hyperglycaemia; three others had gout. Every one of the 30 patients had hyperostosis of the thoracic spine and in 21 it affected the whole spine. A radiolucency was often seen between the newly deposited bone and the underlying vertebral body, and extraspinal manifestations included irregular new bone "whiskering" of the pelvis, large bony spurs, mostly on olecranon and calcaneus, and obvious calcification of sacrotuberous, iliolumbar, and patellar ligaments. As Forestier and Rotes-Queroll stated in their original paper the mild nature of the symptoms gives little indication for active treatment: the purpose of their publication was to distinguish the condition from ankylosing spondylitis and spinal osteoarthrosis. It is referred to in Hollander and McCarty's textbook on arthritis only in the radiological section6; most general textbooks, with a few exceptions,7 do not mention the condition. Pathological findings are also scantily reported. The association with diabetes mellitus and obesity has been noted,8-1' and Harris and her co-workersl2 found 4 diabetics in a series of 34 patients with ankylosing hyperostosis. Pain in some region ofthe back was found in 29 oftheir cases, and, like Utsinger and his colleagues,5 they found peripheral joint complaints not uncommon, 24 of their 34 patients having such symptoms. The diagnosis centres essentially on the spinal radiological findings, but the American workers found the extraspinal features so common that they suggested the title "diffuse idiopathic skeletal hyperostosis. " The shorter title suggested by Bywaters and Forestier"3 at the 6th European Congress of Rheumatology, ankylosing hyperostosis, seems preferable. UItsinger et al described their recent paper' as "diffuse skeletal abnormalities in Forestier disease"-a title which underlines the debt rheumatology and, indeed, general medicine, owes to this brilliant Frenchman. From his early studies with Sicard on radiographic techniques with iodised oil in the 1920s, his extensive work later on the place of gold salts in the treatment of rheumatoid arthritis, his pioneer research on ankylosing spondylitis, and many other contributions over the years, Jacques Forestier has won the highest place in the esteem and affection of his colleagues. His life history shows that great clinicians can still extend and improve medical knowledge and understanding. Forestier's original description ofsenile ankylosing hyperostosis ofthe spine is worth rereading as an example of clarity in the description of clinical and radiological findings.