The Prognostics of Hippocrates will be admitted at the present day to be correct. Those who are old, or who have chalk-stones formed in their joints, or lead a laborious course of life, or have dried bellies, cannot be cured by any human means. Young persons not having tophi formed in their joints, and who live guardedly, and whose bowels will bear the proper treatment, may be cured. These complaints are best removed by dysenteries or other evacuations downwards. His principal remedies are purgatives administered by the mouth or by injection, and local applications of a cooling nature, and even pouring cold water on the foot. When the pain of the gout becomes fixed in a joint, he directs us to burn it with crude flax.
Seneca mentions it as a monstrous example of the depravity of his age, that the women, by their luxurious habits, had become subject to gout. (Epist. 95.)
According to Galen, gout and arthritic complaints are occasioned by a collection of some humour in the affected part. This humour may be blood, phlegm, or a mixture of phlegm and bile, or of blood along with these, or simply a crudity. This crude humour, he remarks, sometimes concretes into tophi. The first indication in attempting the cure is to evacuate the offending humour by bleeding or purging; and then repellent and discutient applications are to be used. He has given a great many prescriptions for these. He disapproves of the warm bath in rheumatic attacks; for, he says, although it appears at first to give relief, it ultimately aggravates the complaint. (Therap. ad Glauc. ii.)
For an able and full explication of the ancient theory of the humours, and the manner in which they give rise to arthritic complaints, we refer the reader to Macrobius (l. c.)
Unfortunately the chapter of Aretæus on the treatment of arthritic complaints has come down to us in a mutilated state. It appears however, that he trusted to hellebore as the great remedy in such cases. His local applications are wool dipped in rose-oil and wine; a sponge soaked in oxycrate, or such like cataplasms. When the disease is hereditary, he says it is generally incurable.
Celsus recommends various refrigerant and anodyne applications to the affected part, such as a sponge soaked in cold water, or in oil and vinegar, or the same soaked in hot water having poppies boiled in it, or a mixture of pitch, wax, and alum. The other points of his practice deserve attention, but we shall not enter upon them, as we wish to afford room for a fuller abstract of the doctrines of Alexander.
Gout, according to Psellus, is occasioned by an atony of the nutritive faculty, whereby a thick humour is collected in the system.
Scribonius Largus recommends his favorite remedy for local pains, namely, the application of a living torpedo to the part affected.
Alexander begins with noticing the common opinion that gout is irremediable by the art of medicine, which he affirms not to be the case provided proper attention be paid to the different varieties of it. There are, he says, many causes of the disease; for sometimes a hot blood flows into the cavity of the joint and occasions violent pains; and, in like manner, a defluxion of bile getting between the tendons and ligaments occasions pain by burning and stretching the parts: phlegm likewise, by producing cold and compression, becomes the cause of violent pains; and in like manner the melancholic humour, not only by its coldness and pressure but also by occasioning a sense of heaviness, brings on no ordinary paroxysms. Sometimes a simple quality of the humours, such as heat, cold, dryness, or humidity, will cause a defluxion. The prevalence of a bilious humour is ascertained by the absence of swelling; from the pain being rather a fiery heat than distension; and from the colour being red. The proper remedies in this case are cholagogues, which must not be of a heating nature nor offensive to the stomach; for when the stomach is deranged the nerves sympathise and rheumatism is the consequence. He gives prescriptions for a variety of such compositions containing scammony, agaric, and the like, mixed with pepper, &c. He particularly commends pills of scammony and wormwood. He also recommends cooling and anodyne applications to the affected parts, such as rose-oil with the yelk of an egg, and the like. He enjoins particular attention to the diet, in order to avoid such things as have a tendency to form bile. He recommends moderate exercise rather before than after a meal, but forbids to carry it to excess. He speaks favorably of baths of common water. He concludes this part with minute directions about the local applications: but, as we have already stated his principles, we shall not enter upon the detail of his practice. When gout is occasioned by phlegm the part is neither hot nor red; is benefited by calefacients and injured by refrigerants. For this variety he recommends particularly a combination of purgative and attenuant medicines, such as the Julian oxymel, which contained white hellebore, agaric, polypody, thyme, cumin, &c. After purging he greatly commends hot and attenuant medicines, in particular the composition from coral, which, among other ingredients, contained birthwort, spikenard, cloves, myrrh, &c. (Birthwort formed one of the principal ingredients of the celebrated Portland powder.) He describes various other antidotes containing bitters, attenuants, and calefacients. His local applications in this case are pounded cabbage, parsley-seed, or fleabane, if the pain is moderate; but otherwise he recommends anodyne cataplasms. Should these, however, rather produce an increase of the pain, he directs us to substitute instead of them discutient and repellent applications, such as decoctions of thyme, mint, &c. with vinegar. He also recommends various cerates with the same intention. Some, he says, have been benefited by stronger applications, such as blisters of cantharides, sinapisms, or the like; but he does not approve of the barbarous practice of burning with the substances called iscæ (see Aëtius and Paulus), nor of the above-mentioned rubefacients, but prefers a combination of emollients with discutients. When it is suspected that the gout proceeds from an overflow of blood upon the joint, he recommends us to have recourse to bloodletting, unless otherwise contra-indicated. He proscribes such articles of food as engender much blood, as all sorts of flesh, especially pork; also sweet wines and intemperance of every kind. He says he has known some cured by simply refraining from wine. He then gives directions for the formation of several topical applications which are of a repellent and discutient nature. He speaks very favorably of a sponge soaked in an astringent wine or oxycrate. He then gives ample directions for discussing Tophi or chalk-stones. He lays it down as a general rule that such applications should contain ingredients of a moderately calefacient, discutient, and solvent nature. Among the articles which enter into these compositions we remark litharge, old oil, sanguis draconis, nitre, turpentine, ammoniac, &c. He then states, that as some do not choose to submit patiently to the methodical plan of treatment, but insist upon getting medicines to allay at once the violence of the pains, he, although he did not in general approve of this practice, would now give an account of such remedies. For this purpose, he says, hermodactylus is particularly trusted to by some; and he admits that it seldom fails to remove a paroxysm, but affirms that it occasions more frequent returns of it. Some, he adds, have endeavoured to correct its prejudicial effects by adding to it cumin, mastich, or ginger, thinking that its action is narcotic; but this he affirms to be a mistake, for in that case it could not prove cathartic. He admits, however, that these things may prove useful by correcting its bad effects upon the stomach. He then gives various receipts for mixtures containing hermodactylus. As a specimen of them we may mention the first, which consists of hermodactylus, myrrh, pepper, and anise, to which scammony may be added. He recommends it, however, in general, to be given in the form of pills with aloes, scammony, elaterium, and colocynth. But, as mentioned by our author, instead of it he prefers the coronopodium. It is the same, we presume, as the coronopus of Dioscorides, or our buckthorn plantain (plantago coronopus L.), although the commentators are not agreed upon this point. (See Matthiolus.) Gesner supposes it a species of ranunculus, which he calls polyanthemon. Alexander then gives directions for various local applications of an anodyne nature, containing opium, strychnos, ceruse, wax, &c. We regret to say that so admirable a treatise should conclude with some frivolous directions for curing the disease by means of amulets of approved efficacy! However, the advocates of the Mesmerian system of animal magnetism do not hesitate to admit their remedial powers. On the periapta or amulets of the ancients, see Andreas Laurentius (de Marab. Strum. Sanat, 85.)
Our limits will not permit us to do justice to the account of the gout given by Aëtius. Like Aretæus, he maintains that the disease is hereditary. His general views of the nature of the complaint and his treatment are very plausible. He says it is occasioned by weakness of the part and a redundance of humours; that the proper treatment therefore consists in evacuating the humours by bleeding and purging, and afterwards in strengthening the part.