Cælius Aurelianus considers arthritis, podagra, and chiragra, as diseases of the same genus. The usual precursory causes are intemperance, indigestion, debauchery, cold, too much or too little exercise, and external injuries. Some, he adds, are of opinion that it is transmitted from father to son. He gives the symptoms of these complaints with his wonted accuracy. They are seated for the most part, he says, in the nerves, by which term he probably means the tendons and membranes. He remarks the well-known propensity which persons attacked with gout have to attribute the swelling and pain to a sprain or some such accident. If the belly be constipated, he advises us to open it by a simple clyster. He recommends us to abstract blood from the affected part by scarifications, which, he says, will occasion less irritation than cupping or leeching. Sponges squeezed out of hot water, or oil and water, or the decoction of fenugreek, are then to be applied to the part; for he thinks these preferable to a cataplasm, as it is often too heavy. When on the decline, he approves of bathing, spare diet, emollient ointments, and gentle exercise, beginning with gestation, and proceeding to the stronger kinds of it. When they can be borne, he approves of stimulant applications, such as dropaces, heated sand, and even sinapisms. He also speaks favorably of vomiting produced by radishes, hellebore, hip-baths of oil, fomentations with hot salt water, and swimming in hot water or even in cold. He particularly commends the naturally-medicated waters, or spas (as they are now called), such as those of Albula or Cutilia, which, he says, will either cure or mitigate the complaint. He disapproves of burning the joints (the reader will have remarked his general aversion to the cautery), and the indiscriminate application of various narcotics and other such things. He also condemns the free use of emetics, (which, he says, prove injurious to the stomach, and occasion a determination to the head,) of purgatives, acrid clysters, and diuretics. In short, his practice is not unlike that of our Sydenham. His grand rule is to keep upon a spare diet, or even to maintain complete abstinence at the commencement. The formula for his diacentaureo (as Van Swieten remarks) is the same as that for the Portland powder, namely, Aristoloch. rotundæ; gentianæ; sum. chamædryos; centaur. min. p. æquales. Cælius Aurelianus, Galen, Aëtius, Celsus, Aretæus, Oribasius, Scribonius, and Horatianus make no mention of the hermodactylus. Myrepsus and Actuarius make mention of a hermodactylus, but Matthiolus and the commentator on the former think theirs a different plant from the hermodactylus of the other Greek authors. This may be true, and yet the microscopic eye of critics often fancies it can see differences which other people are puzzled to remark. We may mention further regarding the practice of Cælius Aurelianus, that he speaks of soothing the pains of rheumatism, more especially of the hip-joint, by music. On this practice see also Aulus Gellius (iv, 13); Athenæus (Deipnos. xiv, 18); Apollonius (Hist. Marab.); Pliny (H. N. xxviii, 2.)
There is nothing very important in Nonnus, Octavius Horatianus, or Oribasius. We shall now give a brief abstract of the curious treatise on the gout by Demetrius Pepagomenos. The work is dedicated to the Emperor Michael Paleologus, who flourished about the year 1260; and it was published by Morel at Paris, A.D. 1558. The author commences by explaining the nature of that derangement of the animal economy which occasions this complaint. This he does at considerable length, but in much the same terms as Macrobius, to whom the reader has been already referred for an exposition of the humoral pathology. His physiological opinions appear to us to be highly ingenious and philosophical. He comes to the conclusion that gout is occasioned by a collection of humours in the affected joint, these humours being the product of imperfect digestion and of the retention of excrementitious superfluities, which ought to have been evacuated from the system. He says the procatarctic or remote causes of arthritic affections are, long-continued indigestion, repletion with food, drinking too much wine, venery, unusual exercise, indolence, and retention of the natural secretions. Venery, in particular, is said to weaken the tone of the nervous parts. He then proceeds to explain that when crudities are formed in the system, those parts which are strong and vigorous cast them off, which those that are weak cannot effect, and hence collections of such humours take place in them. The prophylaxis of the complaint, he remarks, is easily laid down, but is difficult to follow, namely, to observe great moderation in eating and drinking, and to avoid indigestion. His grand principle of practice is evacuation, which, according to the general rule laid down by Hippocrates, is the proper remedy for repletion. He then shows that vomiting is the mode of evacuation most applicable in this complaint, because it empties the stomach, which is the fountain whence the humours are derived. His comparison of the stomach to a fountain which irrigates all parts of the system is very appropriate, and is beautifully illustrated by him. He recommends, however, vomiting by simple means; and for this purpose directs the patient to swallow meat imperfectly chewed, radishes, leeks, &c. and, having drunk some honied water, to excite vomiting by tickling the throat with a feather or the finger. He forbids the use of strong emetics. His second method of evacuation is by purging, which he recommends to be done by pills containing aloes, hermodactylus, cinnamon, and scammony. He then proceeds to the cure when an attack has come on. In this case, he recommends us to begin with letting blood, unless the stomach be loaded with impurities, when an emetic must be premised, lest the emptiness of the veins produced by venesection should cause these crude humours to be conveyed over the body. Venesection, he remarks, is particularly applicable at the commencement, when there is simply a plethora of blood, but it is rather prejudicial afterwards when the fluids become altered in quality. In such cases, as he fully explains, purging is the proper remedy, especially when performed by hermodactylus, which, he says, he had found from experience to answer well, from whatever cause the disease had originated. He directs it to be combined with various calefacients and aromatics, such as birthwort, cinnamon, and pellitory. He then makes an ingenious reply to those who affirmed that the disease is not to be cured by purgatives, but that it is sometimes exacerbated by them. In such cases, he properly remarks, it is not the remedy that is in fault but the misapplication of it. Those who cannot bear cathartics by the mouth may have clysters given them; or the preparations from elaterium, juice of sow-bread, or the like, may be applied to the navel. He afterwards gives directions about the local applications, which are nearly the same as those recommended by Alexander. We will have occasion, in the [Seventh Book], to discuss the question respecting the nature of the ancient hermodactylus; and we shall merely state here our own decided persuasion that it was a species of colchicum or meadow-saffron. It forms one of the ingredients of the celebrated Eau médicinale d’Husson. From the effects produced by the Eau médicinale we are inclined to think, however, that a certain proportion of hellebore must have entered into its composition, as we have never found the colchicum to act so violently as the eau is said to do. We have stated above that Cælius Aurelianus makes no mention of the hermodactylus. However, the great modern advocate for Methodism, Prosper Alpinus, speaks favorably of it, and says decidedly that it is the colchicum of the Greeks. It appears not to have fallen into disuse in his time. (De Med. Meth. ix, 4.)
The Arabians follow the Greeks closely in the general principles of treatment, only substituting certain articles introduced into the Materia Medica by themselves. Thus Serapion strongly recommends purging with myrobalans, prunes, and tamarinds. He, Avicenna, and Rhases, join in praising the virtues of the hermodactylus. Their local applications are similar to those of the Greeks. When the pain is violent, Serapion even approves of pouring cold water upon the affected part. Rhases approves of burning the joint in certain cases. Avicenna directs us to cover the part with oil and salt, and thus to apply the cautery gradually. Avicenna speaks more favorably of bathing in thermal waters than any of the other authorities. According to Haly Abbas, arthritic diseases are collections of superfluities of the system in some joint which is labouring under debility. These superfluities are said to be produced by repletion and indigestion. The debility is generally occasioned by immoderate exercise, intemperance, debauchery, or some such cause; and a joint having become weakened, all the impurities of the system are collected into it. He says that young persons and women who menstruate regularly are scarcely liable to the gout. He agrees with the authorities already mentioned in holding it to be hereditary. When the humour in the joints concretes into chalk-stones, he pronounces the case to be incurable. When the disease is produced by a sanguineous plethora, he recommends us to begin with bleeding, and then to use cooling lotions, or even to pour cold water on the joint. When these do not succeed, anodyne applications, containing opium, mandragora, lettuce, saffron, and the like, are to be used. When the pain has abated, any swelling which remains may be discussed by applying to the part a decoction of marjoram, melilot, chamomile, and the like. When the defluxion is connected with bile, he recommends first emetics, and then drastic purgatives, such as aloes, scammony, colocynth, and hermodactylus. But, if the patient’s stomach be weak, he recommends milder laxatives. When the defluxion is of a phlegmatic, that is to say, of a serous nature, he directs us to give the active cathartics already mentioned, especially hermodactylus; and, if it be the summer season, he advises us also to give emetics. He cautions us against using local applications of too stimulant a nature at first, lest they dispel the more fluid parts of the defluxion and leave the grosser behind. This is but a meagre sketch of his interesting account of arthritic diseases. Alsaharavius calls these complaints collections of phlegm, bile, or blood. He holds that they are often hereditary. Like all his countrymen, he approves of hermodactylus, which he gives in the form of pills, with myrobalans, colocynth, turbit, castor, opopanax, &c. When fulness of blood is present, he recommends bleeding.
The hermodactylus is recommended for the cure of arthritic diseases by the earlier of the modern writers on medicine. See Lanfrancus (ii, 3.)
Among the ancient treatises on gout, we have mentioned the tragi-comic poem entitled ‘Tragodopodagra,’ usually ascribed to the famous Lucian. It ridicules, with much humour and severity, the many pretended nostrums for this complaint. Among the remedial articles mentioned, we remark hellebore, nitre (soda), henbane, poppy, fenugreek, and galls. The ridicule thus bestowed upon the use of specifics for the cure of a complaint so complicated as gout, is no doubt well founded; but we ought not to be deterred, by the ill success of such a practice, from attempting to afford relief upon general principles, as ably laid down by Alexander, Demetrius, and Haly Abbas. We would fain impress upon the physician and his patient, that more than is usually believed might be accomplished in all arthritic diseases, by correcting the disorder of the digestive functions by means of a suitable diet and regimen; and that it is only when the constitution is radically unsound—when the joints are deformed by concretions, and the vital powers have been worn out by a long-continued course of debauchery—that we need adopt the discouraging opinion of Ovid, as expressed in the following line:
“Tollere nodosam nescit medicina podagram.”
(Pont. i, el. 4.)
SECT. LXXIX.—ON CHILBLAINS AND AFFECTIONS OF THE FEET AND HEELS.
Chilblains are ulcerous affections forming about the fingers and toes in the season of winter. They should be bathed with tepid sea water, or the decoction of beet, or of lentil, or of bitter vetch, or of the root of kingspear. After this, triturate boiled lentils with wine, and apply in the form of a cataplasm; or, apply figs triturated with oil; or, triturate equal portions of alum and barley-flour in wine, and apply; or use a cataplasm of dried lees of wine or of fresh bulbi triturated with wine; or boil garlic in oil, and having thrown away the garlic, melt a moderate quantity of wax with the oil, and apply; or boil pomegranate-rind in wine, and having triturated, add to the rose-cerate, and use, having previously fomented the part with the decoction of lupines; or apply manna and native sulphur with boiled honey. The juice of henbane rubbed frequently into the part removes the inflammation and pain.