RHEUMATIC diseases are the most common and crippling ailments of our time. They constitute a serious economic and social problem. A few figures may illustrate this statement.
American statistics covering the years 1935-6 disclose the fact that 5 per cent. of the population suffer from some form of rheumatism. There are two cases of rheumatism to every one of heart diseases, seven to every one of cancer and ten to every one of tuberculosis.
Dr. Kemsleys figures for 1927 show that out of 1,000 insured people unfit for work for more than three months, over 14 per cent. were rheumatic cases. Moreover 16 per cent. of all rheumatic patients are gradually developing disease of the heart.
The annual death rate from heart diseases in England and Wales is 95,000 of which 40 per cent due to rheumatic fever.
Further statistics of Dr. Davidson and Dr. Duthrie prove that in Scotland the annual figure of rheumatic disease is more than 30,000. 75 per cent. of these patients suffer from fibrositis (rheumatism of the muscles, nerves of tendons).
Faced with this grave problem, Dr. Davidson quite rightly called rheumatism “Public Health Enemy No. 1” and for this reason the Governments of nearly all civilized countries have formed committees to enquire into the causes, nature and cure of rheumatism.
Many attempts have been made to classify the various rheumatic ailments according to their causes and clinical symptoms. All these groupings are, however, of no practical value to the homoeopathic physician, who prefers to consider the rheumatic patient as a single problem in spite of the many different symptoms.
I therefore restrict myself to mentioning the classification advocated by the English Rheumatism Committee, which differentiate between the following nine groups:.
1. Rheumatic fever or acute rheumatism.
2. Sub-acute rheumatism.
3. Muscular rheumatism.
4. Lumbago.
5. Sciatica.
6. Rheumatic arthritis.
7. Osteoarthritis.
8. Gout.
9. Various chronic joint changes.
I should like to add a special kind of rheumatism in children which may easily be overlooked, namely “growing pains”, which are often associated with specific rheumatic nodules, varying in size from tiny peas to good sized beans. They most frequently occur on the head, the edges of the shoulder bone and on the forearm. They also collect round the elbows and knuckles. In some children they are painful and tender. These cases require our most careful attention, because all these children, if not properly and constitutionally treated, may develop, sooner or later, heart diseases.
In the limited time at my disposal, I can only deal with rheumatic fever (acute rheumatism of the joints) and even here I must restrict myself to a few more important points.
Acute rheumatic fever (rheumatic arthritis) is an inflammatory process, more frequently found among under-nourished, anaemic patients. As a rule, the disease starts suddenly with fever, profuse perspiration, swelling and pains in the affected joints, with more or less inflammation of the covering skin. Sometimes the pain is so severe that the patient is afraid to move.
He shrinks from being touched and even dreads the shaking of his bed or the slamming of the door. When several joints are affected, as they usually are, the patient lies with his hips slightly flexed, the knees and elbows bent, the fingers spread and extended.
Acute rheumatism often moved from one pair of joints to another, a symptom responsible for the name “Rheumatism”, which is derived from the Greek word “rheo”, meaning running. The simultaneous affection of corresponding joints differentiates rheumatic arthritis from other cases of acute arthritis.
Here I am referring to those frequent cases of acute arthritis associated with other infectious diseases, such as typhoid fever, pneumonia or blood poisoning etc. Also there are cases of acute arthritis secondary to diseases of the central nervous system, such as locomotor ataxy. All these and many other such cases, although they display the same clinical symptoms, have nothing to do with properly so called rheumatic diseases. They are never symmetrical.
Whilst rheumatic arthritis always starts in the synovial membrane, osteoarthritis begins in the cartilages. Osteoarthritis is a chronic degenerative process, more frequent among rather well-nourished fat people during or after middle age. The cartilage surfaces decay and wear away and there is a change in the bone-structure or formation.
Both types of arthritis develop progressively and eventually affect the surrounding tissues as well. An excessive amount of fluid may or may not be present. The capsule and ligaments of the joints as well as the over-laying wasting of the muscles, which is a common symptom of all forms of rheumatism.
All rheumatic patients, however different the clinical symptoms may be in the individual patient, have the following symptoms in common:.
1. The character of the pains; they are always of a drawing and tearing nature.
2. The pains are located where there are joints, ligaments or stronger nerves.
3. The clinical symptoms are rapidly moving; they afflict in a periodic way the various sensitive parts of the body.
4, The patients are very sensitive to wind and weather.
5. The affected joints and limbs are extremely stiff and painful.
6. All rheumatic patients suffer from disorders of perspiration. It might be increased or diminished.
7. All symptoms are relieved by dry heat. They are, on the whole, aggravated at night.
It is by these symptoms that we can differentiate between rheumatic and gouty patients. The rheumatic patient feels always better by dry heat, whilst the gouty patient feels easier in cold weather and by applying cold compresses. Moreover gout is more common with elderly people. The gouty attack is mostly complicated by digestive disorders and affects, as a rule, one joint only, especially the big toe or thumb. Gouty pains are more violent, even if the patient does not move; they diminish, on the whole, in the morning, whilst in rheumatic fever the pains are permanent.
The diagnostic difficulties, however, do not end here. The greatest difficulties arise from the fact, that the pains are often due to the involvement of a nerve and are felt at the end of the affected nerve rather than at the actual location of the disease. For instance in a case of rheumatism of the hip, the pain is felt at the knee. In cases of rheumatic arthritis of the spine and of the neck, the pains radiates along the spinal nerves to the arm and fingers. These so-called radiculitis pains lead to the most serious diagnostic failures.
Take the case of rheumatic arthritis of the dorsal part of the spine: in such a case the only symptom may be pains in the chest. These pains are identical with pains due to heart disease, or, when they are felt in the right side, they might be mistaken for the symptoms arising from gall-bladder diseases.
Again, in cases where the rheumatism affects the lower portion of the dorsal spine, the only symptom may be burning pains in the pit of the stomach, coupled with flatulency and all those symptoms which are characteristic of an ulcer of the stomach, whilst in cases of rheumatism of the lower lumbar of sacro-iliac joints the patient complains about sciatic pains.
The implications of a wrong diagnosis are self-evident. It the symptoms are wrongly attributed to gall-bladder disease or to an ulcer of the stomach, an unnecessary operation may be performed.
Only a thorough examination and taking into account the family history and all previous diseases of the patient will enable us to arrive at the right diagnosis and treatment. In quite a number of patients we find a tubercular inheritance. Here a few doses of Tuberculinum will in many cases achieve a cure. In other cases acute infectious diseases, such as scarlet fever or gonorrhoea preceded the rheumatic disease, or ill affects of vaccination may be responsible.
Again exposure to wet or injury may in some patients be the causing factor. Although all these and many other factors play an important part in the development of rheumatism, its real cause is not known yet. Many theories have been propounded. Professor Lichtwitz regards all rheumatic diseases as allergic conditions. This theory is strongly contradicted by Dr. Hay, whose theory will be explained in connection with the question of focal sepsis.
Septic spots are most frequently found in the tonsils, the nasal sinuses around the teeth and in the mucous membrane of the intestines. Less frequently in the prostate, the womb or the gall-bladder.
There is no general agreement among the physicians whether or not in all these cases an operation is necessary. Personally I should like to stress the point that indiscriminate removal of diseased tonsils or wholesale extraction of teeth is unjustified and does not in the least prevent the recurrence of rheumatism.
Certainly, there are cases in which an operation may be necessary, as every chronic focal sepsis lowers the general resistance of the patient. This is especially true of a closed abscess around a tooth or in a tonsillar cavity. Pyorrhoea, however, should never be an indication for extracting all the teeth. Many cases of pyorrhoea can be cured by constitutional and local treatment.
