Rhododendron. Rheumatic pains worse during rest, in the warmth of bed, and with every unfavorable change of the weather, especially during the prevalence of east winds. It has cured cases in which there were swelling and redness of both the large and small joints, tension, and rigidity.
Ledum Palustre. Predominant chilliness, associated with Rheumatism of the small joints.
Dulcamara. Rheumatism from exposure to damp, with oedematous swelling, somewhat relieved by rest.
Pulsatilla. When the knee, ankle or instep is affected; and when there are fugitive rheumatic pains in various parts of the body; especially in women with scanty period.
Cimicifuga. Local forms of Rheumatism, lumbago, pain in the side; also affections of the heart from Rheumatic fever. Wandering rheumatism is also within the role of Cimic.
Phytolacca. Very useful in chronic cases with stiff joints, and even loss of the use of the limb. When the periosteal covering is implicated, phyto. is strongly indicated.
Arnica. Stiffness in the large joints; tearing pains in the small, with pricking; sensation as if the parts were bruised; Rheumatism associated with a previous injury.
Causticum. has been found useful in Rheumatism of the joints, with swelling and stiffness, contraction of tendons, shooting and tearing pains, especially in tubercular patients.
Mercurius. Puffy swelling of the affected parts; the pains feels as if seated in the bones or joints, and are increased by warmth, and at night; there are also chills, and profuse perspiration, which do not give relief.
Sulphur. Either before or after the above remedies, as an intercurrent, or to complete the cure. It is especially useful in Rheumatism associated with skin eruptions.
Kali bichromicum, Belladonna, Coloc., Ranun. Bulb., Mangan., and Colchicum may also be required. As a rule chronic Rheumatism is best treated with infrequent doses of high potencies.
ACCESSORY MEANS. Patients who are much afflicted with this complaint should if possible reside in a warm, dry climate. At any rate, such patients should wear flannel or other warm clothing, and guard against atmospheric changes. The feet should be protected from cold and damp. Wet compresses, covered with dry flannel, over the affected joints, are always useful. Sometimes warm baths. especially of salt water, vapour, or hot air, air most useful. To these means may be added friction with Liniments medicated with Arnica, Rhus. Tox., or other remedy indicated.
The best mineral water treatment for Chronic Rheumatism is to be had at Aix les Bains abroad, and at Bath and Strathpeffer in his country.
Lastly, the diet should be easy of digestion, as attacks are often occasioned by disorders of the stomach. Beer and strong wines and indeed all alcohol should be avoided. Cod liver oil or its preparation may be given. See Chronic Intestinal Infection.
56. Acute Gout.
DEFINITION. A specific febrile disease, usually occurring in paroxysms at longer or shorter intervals, characterized by non suppurative inflammation, with considerable swelling and redness of certain joints chiefly of the hands and feet, and, frequently in the first attack, of the great toe. The disease if often hereditary, and an attack is always associated with derangement of the digestive and other organs.
SYMPTOMS. As an acute attack of Gout is often occasioned by an excessive debauch, or over fatigue, impairing the digestion, its onset commonly commences an hour or two after midnight, when Indigestion from a supper or late dinner arrives at its acme. Ordinarily a patient retires to rest in his accustomed health, but awakes early in the morning with severe pain, chiefly in the metatarso phalangeal joint of the great tow, which on examination is found red, not, swollen, and so exquisitely tender that the mere weight of the bed clothes is intolerable, and even the vibration of a heavy footfall in the room causes great discomfort. The veins proceeding form the toe become turgid with blood, and the parts more or less oedematous. On the first accession of the pain there is generally cold shivering, which gradually subsides as the pain increases, and is followed by symptomatic fever. The patient is perpetually shifting his foot from place to place, and from posture to posture, finding no relief. At length, if suitable precautions are taken, and the foot kept in a horizontal posture, the pains subside in the early part of the; but at evening an exacerbation takes place which persists during most of the night, and subsides again towards morning, when sleep, with gentle perspiration, takes place. Sometimes the pains remit so suddenly that the patient attributes the relief to his having at last found an easy posture. The same series of symptoms recur, in a less severe form, for some days and nights, varying considerably in different cases, and being greatly influenced by the treatment adopted; and then the attack passes off, not to return for one, two, or after a first attack, perhaps for three years. After the lapse of years, however, the intervals between the attacks are liable to diminish, until the patient can scarcely ever calculate upon being free. The joints of the fingers and toes become enlarged and disorganized by deposit, within and without the synovial cavity, of a white matter, commonly called chalk stones, but really consisting of urate of soda.
It is not uncommon, even in a first attack of Gout, for both great toes to be implicated, generally alternately, the inflammation rapidly subsiding in one joint to appear in the other, but sometimes simultaneously. In many instances, after first attacks, other joints the instep, the ankle, the heel, or the knee are affected at the same time; in rarer cases, some joints of the upper extremities.
DIFFERENCES BETWEEN GOUT AND RHEUMATISM.
GOUT.
1. In the earlier attacks, the small joints are affected, the metatarsal joint of the great tow being chiefly implicated.
2. Rarely occurs before puberty, and generally not till from thirty five it fifty years of age.
3. Is more frequent in men than women, and in the latter rarely till after the cessation of the menstrual function.
4.?It is often the punishment of an idle, luxurious, and intemperate life.
5. Is strongly hereditary.
6. Is associated with chalk stones in the external ear, on the tops of the fingers, and other situations.
RHEUMATISM.
1. The large joints are chiefly implicated, several being affected at the same time.
2. Generally occurs in the young, from twenty to thirty years of ago, and often earlier.
3. Affects men and women equally.
4. Is the lot of the poor, the hard working, the exposed, and the ill clad.
5. Is but slightly hereditary.
6. Is never associated with chalk stones.
SYMPTOMS PRECEDING AN ATTACK. Flatulence, Heartburn, Acidity, relaxed or confined bowels, and other disorders of digestion. In some patients the function of breathing is implicated or the liver deranged; in others the nervous system is involved, with Palpitation; or there my be alternation of the urinary secretion, or a crampy condition of the muscles. Such symptoms are no doubt consequent on the altered state of then blood, which always exists prior to the development of a gouty paroxysm. Should any organ or function be specially implicated, it is then termed irregular gout.
CAUSES. The bodily condition which predisposes to Gout is undoubtedly hereditary, but it may be acquired. The experience of physicians largely engaged in treating the disease proves that more than half the gouty patient can trace the disease to hereditary influence; and if the wealthy portion of the community only were included, the proportion would be much greater. Larger built men, of a luxurious mode of life, particularly if addicted to indulgence i wine or malt liquor, and too much animal food, combined with too little exercise, are very liable to the disease, whether a predisposition has been transmitted or not. That wine and malt liquor have a greater tendency to the production of Gout than distilled spirits, is proved by its prevalence in those countries or cities in which these beverages are largely consumed, and its relative absence where distilled spirits a almost exclusively made use of. Thus Gout is more frequent in London, where porter and beer are largely partaken of, than in Edinburgh, where the favourite beverage is whisky. Gout is very common amongst brewers, men; also amongst ballast men employed on the Thames, who, it is stated, frequently drink from two to three gallons of porter daily. Gout prevails largely in Germany, and in most countries where beer is the ordinary beverage of the people. Port wine has a marked reputation for causing Gout; and sherry is by no means a harmless beverage. It is chiefly a disease of the male sex, although occasionally women of a robust and plethoric habit suffer from it, after the cessation of the catamenial function. That luxurious living and an inactive life are at least exciting causes of Gout seems evident from the exemption of working people in rural districts from the disease. ( It has also been observed that in a regiment of soldiers scarcely a case is found among the oft drilled privates; whereas after attaining the rank of quartermaster, diminished exercise and stimulating diet induce the disorder ).Even when the disease does occur in poor people, it is chiefly in persons who have previously lived fully and inactively, such as the servants of wealthy families butlers, coachmen, etc. men who, as Sir Thomas Watson remarks, often live more luxuriously and idly than their masters. Gout i in fact a disorder of metabolism. There is a failure to deal full and normally with all the products of digestion, a failure which may be due to inherited disability or to excessive and harmful ingestion of unsuitable food. The resulting waste products accumulate in the system giving rise to a variety of mental and bodily symptoms from attacks of ill temper and depression to asthma or headache. If these symptoms are neglected an attack of obvious joint gout will probably supervene.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."