XXXIV.—Gout.
Great difference of opinion exists as to the cause of gout. Ancient physicians called it the daughter of Bacchus and Venus; and truly persons, or their progeny, devoted to these two divinities, offer the greatest number of examples.
To cure this complaint, the ingenuity of thousands of scientific men has been taxed, and the whole pharmacopœia applied to in vain. Perspiration is mostly resorted to; but as this is effected by warm baths, vapour baths, or drugs, the consequences are so debilitating that few constitutions can bear them. The result of all medical treatment in this disease is, the degradation of robust constitutions, and the promotion of diseases worse than the gout itself.
Volumes might be written on the various remedial measures which have been resorted to in this complaint, and of which time has shewn the fallacy. We now ask the invalid, if he ever knew the gout radically cured by any pharmaceutical means? Were Hydropathists asked whether they ever knew cases of gout cured by water, they would unhesitatingly answer in the affirmative. Incipient gout is always curable. The same may be said of chronic gout, except in isolated cases: then Hydropathy invariably gives relief; and by regulating the functions of the body, improves the general health.
The following treatment and cases will shew how the manipulation is varied, to combat this disease in its manifold forms:—
Gout cannot be cured by local applications; the whole system must be purified by a general treatment, or no permanent cure can be effected.
For occasional attacks of gout in the extremities, the constitution being otherwise robust:—
In the morning, put a bandage on the part affected, pack the patient in blankets (sweating process) until perspiration appears in the face.
Then put him into the half-bath—water 62° to 65° Fahr.; let him be well rubbed in this from 5 to 25 minutes, or until friction can be applied to all parts alike. Cold water should be occasionally poured over head and shoulders during the operation. This ended, put bandages round the waist and on the afflicted part.
For the second treatment:—About mid-day, rubbed in a packing-sheet; take a sitz-bath for fifteen minutes—first time tepid 64°, afterwards cold; then put the offending member into cold water for ten or fifteen minutes, and renew bandages.
In the afternoon, at 5 o’clock, repeat mid-day treatment. During the day, drink ten to fourteen tumblers of water.
The above treatment will generally put an end to a slight attack of gout; but to eradicate it from the system, the cure must be followed up. To effect this, for the sweating process on the second day, substitute the packing-sheet until warm, which generally requires the patient to lie in it from thirty minutes to an hour.
Where a bath cannot be obtained, the rubbing sheet is used instead; this should be very little wrung out, and if one does not cool the body, a second or a third should be applied.
The douche is often applied in gout; but as that cannot be the case in ordinary practice, the practitioner must use his discretion in prescribing it.
It is good treatment to use the sweating process in the morning, and the packing-sheet in the afternoon.
The bandages must be worn day and night, and changed often.
Cases.—A patient, fifty years of age, with rheumatic gout, bad digestion, nervousness, fingers blue and swollen, slight pain in the knee, much debilitated, was ordered:—In the morning, five rubbing sheets, two or three minutes each, allowing a short interim between each. At noon, the same. At five o’clock, the same. Ten tumblers of water daily. Bandages to parts affected, and round the loins always. On the patient experiencing great pain under the knees, the morning treatment was changed to lying in packing-sheets until well warmed, followed by the tepid bath. Patient soon improved in health.
A——, forty-six years of age, suffered fifteen years from periodical attacks of gout, and had his last severe attack in his feet, hands, and elbows, accompanied by paralysis, which affected his voice.
Treatment.—Laid in packing-sheet until perspiration ensued (two or three hours); then tepid bath renewed by cold water being thrown over head and shoulders; noon, rubbing-sheet, followed by sitz-bath 62° for fifteen minutes; cold foot-bath fifteen minutes, and head-bath ten minutes; afternoon, morning treatment repeated.
Alternate days, sweating in blankets instead of the sheets; all other treatment the same as before.
This continued treatment was persevered in for ten weeks, when patient was prescribed sweating in the morning, and packing-sheet in the afternoon, followed by cold bath. Sitz and foot-baths as before; head-bath discontinued. Shortly after, sweating twice a day, with foot-baths, fifteen minutes in the middle of the day. Sitz-baths dispensed with. This treatment at the end of six weeks was again changed for perspiring only once a day, for three hours. Patient was at length ordered to discontinue the treatment altogether, and proceed to the sea-side for a month. Soon after his return again to Gräfenberg, he was able to walk fifteen miles at a time, as is seen by his own letter.
B——, fifty-six years of age, suffering from Gout upwards of seventeen years, generally incapacitated from following his occupation seven or eight months in a year. Feet and hands distorted.
Treatment.—Packing sheet and tepid-bath in morning and afternoon, and sitz and foot-bath, each fifteen minutes; at noon, bandages round the waist. After a week’s treatment, a fit of gout came on in foot and ankle, which was combated by packing-sheet and tepid bath before breakfast; tepid sitz-bath at noon, and the morning treatment repeated in the afternoon. After three days, a boil began to form under the left jaw; treatment continued, with the exception of patient’s going (after the packing-sheet), into tepid bath for two minutes, then into the cold bath for two minutes, and back to the tepid, from ten to fifteen minutes.
In eight days, gout returned with greater violence, when recourse was had to the packing-sheet, as before; with tepid baths from twenty minutes to an hour, besides following up other parts of the treatment. In seven or eight days the fit quite subsided. Some time after this he had a relapse, which patient stated to me, under the allopathic treatment, would have confined him to his room at least six months; this was treated as follows:—
Packing-sheet until warm, followed by tepid bath, ten minutes; then walked about the room for a quarter of an hour; then the bath again for a quarter of an hour, a respite of a few minutes, and the bath a third time.
Two hours after the above operation, a tepid sitting-bath 62°, for twenty minutes.
In the afternoon the packing-sheet and bath as before. This treatment was repeated, every day for six days, when patient was out of doors again.
From this time patient felt himself so changed a man, that the author saw him cry with joy. He could use his limbs as he had not done for many years, and to prove it, ran up a hill with astonishing alacrity. Three days treatment were sufficient to reduce the swelling of his knuckles, toes, and hands.
This patient, on his first arrival, Mr. Priessnitz ordered, without any previous preparation, into a tepid bath, where he was rubbed upwards of an hour.
C——, aged forty. Gout generally returned in summer.
Treatment.—Morning, and afternoon, packing-sheet, tepid bath; noon, douche, three minutes.
After six weeks treatment, strong redness and much pain to the conjunctiva; douche omitted.
Sitz-baths of from an hour to an hour and a half; foot-baths; cold wet bandages to the eye, which became effected.
Then sweating processes, with wet bandages to the head, which afforded relief.
Alternate tepid, cold and tepid baths for a quarter of an hour; immediately after the packing-sheet, foot-bath and water poured over the ancle. Eyes still red; foot-bath resorted to three times a day, followed by rubbing sheet, instead of the bath and bandage to the eye. Eyes could bear the light. Patient’s appetite good and sleep sound. At night his arms, head, and most of his body were covered with bandages.
In three weeks, patient’s whole body covered with an eruption; recourse again had to the packing-sheet and tepid bath twice a day. From this time health improved daily.
D——, a gouty subject, forty-five years of age. Priessnitz, called up in the middle of the night, found the Baron labouring under an attack of gout in his chest and stomach, which almost prevented his breathing. He was immediately put into a packing-sheet for from five to ten minutes, and out of that into a tepid bath, where two men rubbed him for a quarter of an hour; cold water being continually thrown over his head and shoulders; this effectually put an end to the attack, and the patient afterwards slept soundly until the time for his usual treatment next morning. This case shows that the fear of this treatment driving gout to the stomach, is groundless and it combats a dangerous attack, and quicker than it can be done by any other means.
Hereditary Gout.—E——, a Polish nobleman, fifty-four years of age, suffered two winters from hereditary gout, which had existed in his family for upwards of forty years.
He was attacked in his feet and arms, which confined him to his bed several months.
Treatment:—In the mornings, packing-sheet and tepid bath; noon, rubbing-sheet followed by sitz-bath, fifteen minutes; afternoon, rubbing-sheet.
In eighteen days he had boils on his feet and arms, from which matter continued to exude for three or four weeks; at the expiration of which Priessnitz said, “Now we will increase the treatment, to see if any more bad matter remains in the system.”
The sweating process and cold bath were now resorted to three or four times a week; the packing-sheet and cold bath other days; and the douche every day for three minutes. This treatment was continued for several weeks, during which no change of any kind was produced, a confirmation of the cure being effected.
On leaving Gräfenberg, Priessnitz advised him to return the next year, to see if the cure was a radical one.
In 1845, the Count returned, when he was subjected to a most vigorous treatment, such as sweating, douche, etc., for a month, without any return of gout.
On leaving Gräfenberg he assured me, that he was not only cured of gout; but that his digestive powers, which for years had been deranged, were in perfect order, and that his general health was completely restored.
Sixteen years previous to the Count’s going to Gräfenberg, he had his elbow wounded by a ball in a duel, which occasionally caused him great pain. For the cure of this, he, at the time, rubbed in a yellow ointment. Singular to say, after a lapse of sixteen years, during a crisis, this ointment re-appeared on the elbow and arm, so thick as to be taken off with the finger. The exuding of this ointment lasted about eight days. Since the cure of his gout was effected, the arm has been pliant, and the elbow has been free from pain.
Gout in Head and Feet.—F——, a German professor, aged sixty; a small delicate man, with gout in both hands and both feet: all were contracted, he had been a martyr to gout for years and upwards, when a paroxysm of gout came on the following morning.
The following treatment was resorted to. Morning, packing-sheet until thoroughly warm; then tepid bath 64° for two hours, during which time 200 cans of cold water were thrown over his head and shoulders.
Twenty-five cans were first thrown; then great friction for some time; then twenty-five cans more, followed by friction; and so repeated until two hundred cans had been thrown over him.
Heating bandages were applied to all parts afflicted, and kept there day and night.
The above treatment was resorted to again in the afternoon.
One paroxysm that I witnessed, lasted three weeks. It was astonishing to see the courage displayed by this patient.
Each operation afforded relief for the time; but the enemy had strong hold upon the system, and was ejected with difficulty.
During all the time the patient had a good appetite and slept soundly at night.
He was still under the cure when I left Gräfenberg. Priessnitz said, to effect this cure, it would require at least four years’ treatment, which the patient said he would prefer to a renewal of the suffering he had already undergone, previously to coming to Gräfenberg.
Calcareous Deposit in the Knees, and high state of Inflammation.—The last case shews how the human body may be exposed to the action of water, with friction, for any length of time. The present case is that of an English Gentleman, well known to all visitors at Gräfenberg.
G——, aged between 50 and 60, gouty for the last twenty years, with contraction of the limbs, chalk stones having formed in the joints. This patient travelled from Italy to Gräfenberg during the heat of summer, and, on arriving, had a most painful attack of gout in his lower extremities.
Priessnitz, without the least preparation, put him into a tepid bath, and he was rubbed by three men for nearly three hours, occasionally throwing pails of cold water over his head and shoulders. This so reduced the inflammation, that, towards the end of that period, the afflicted part might also be rubbed with the wet hand.
Heating bandages were then applied to those parts and the waist.
Water was drunk plentifully during and after the operation.
Patient was able afterwards to get out of doors with the use of sticks, and slept well at night.
Next morning he began the regular treatment, which was as follows:—
Packing-sheet until warm; then the bath as before for about two hours; noon, rubbing-sheet and sitz-bath, fifteen minutes; afternoon, morning process renewed.
Mr. Priessnitz told this patient that, by the following means, he might always ward off a violent attack of gout:—
On feeling the slightest sensation of gout, he should instantly be put into a tepid bath, 62 deg., replenished with cold water, and be therein rubbed for a couple of hours.
This gentleman’s general health is perfect: he very seldom has any attacks, and they are slight; but the calcareous deposit in his knees, up to the present, resists all attempts at removal.
Acute attack of Gout.—A patient being attacked with gout was put into a tepid bath, 68 deg., up to the neck, and rubbed by himself and two men. By particular injunctions, the process was not to be discontinued until all pain subsided. The original temperature of the bath was maintained by fresh supplies of cold water. In seven hours the patient was completely relieved. His after-treatment was:—
Morning, packing-sheet and plunge-bath, bandage round the waist and on part afflicted; at noon, douche, and afterwards a rubbing-sheet; afternoon, rubbing-sheet; the simplest food. On a return of the acute attack, patient was ordered to perform the bath operation again; but, not persevering in remaining seven hours in the bath, the attack was not overcome: the patient was then ordered cold bath every morning before breakfast (temperature kept always as cold as possible), from fifteen to twenty minutes, which effected the cure. This patient was allowed a little weak chocolate, and was ordered to drink abundantly of water.
A—— had a most violent attack at Gräfenberg, for which he was put up to his neck into a tepid bath, 64 deg., and there rubbed by two men for seven hours. Priessnitz gave particular orders that the patient should not leave the bath until all pain had completely subsided. Cold water was frequently added, to keep that in the bath at the original temperature. By these means the attack was completely subdued. Daily treatment:—
Morning, packing-sheet and cold plunge-bath; bandage to be applied to parts affected; noon, douche, and sitz-bath, fifteen minutes; afternoon, as in the morning.
Instructions:—Eat plain food; and in case of a return of gout, faithfully perform the first operation.
Gout in the Foot and Ankle.—A lady awoke in the morning with pain in her foot and ankle, which were both swollen.
Treatment.—Packing-sheet for an hour, followed by a rubbing-sheet; after which a foot-bath, up to the instep, for a quarter of an hour; and the foot and leg, up to the knee, well rubbed all the time.
Bandages were then applied from the toes to the knee.
At noon, and in the afternoon, the foot-bath was again applied, and the bandages were changed.
This simple treatment put an end to the attack in two days. If it had not done so, it ought to have been repeated.