Suggestions for gout (too long for homeolist)

[andyh]

Rae Jesse wrote:
Burnett, James Compton: Gout and its Cure
1895
Pages 178.
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James Compton BURNETT
1840-1901
Burnett attended medical school in Vienna in 1865, and studied anatomy an extra two years…After graduation from Glasgow, 1872, he went to Barnhill Parochial Hospital and Asylum in Glasgow. He was converted to homœopathy there by a friend, Alfred Hawkes of the Royal Infirmary. In 1876 he took his MD degree…Burnett was the one of the first to speak of the concept of "vaccinosis," that a vaccine could trigger illness…He introduced the remedy Bacillinum, along with other nosodes.
Excerpted from The Faces of Homœopathy (Julian Winston, 1999).
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GOUT AND ITS CURE.
PREFACE
For the successful treatment of gout it is necessary to have a clear idea of what constitutes its various parts; notably must we differentiate between its pre - deposit symptoms and its post - deposit symptoms, for much of the want of success in its cure is due to a mixing - up of the two sets of symptoms. The symptoms that precede and lead up to the uric acid retentions in the blood are a series by themselves; those due to the uric acid in the blood and which lead up to the gouty deposit, are a
second series. The former really spell arthritic cacopepsia, while the latter are synonymous with uric acid poisoning; in the one we deal with the producing power, in the other with the product.
This differentiation being made, we proceed on two lines with the treatment, - the one to get rid of the gouty attack and the deposits, and the other, the more important, to deal with that which leads to the production of the uric material.
The following pages are intended to set forth the writer's method of procedure.
J. COMPTON BURNETT.
86 WIMPOLE STREET, W.,
January, 1895.
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THE various conditions known or thought to be manifestations of gout lie on either side of every medical path, and most medical practitioners have to deal with them in some form or another. Gout in this country is so common, that not a few persons are in the habit of treating their gouty attacks with their family doctor's favorite preparation of Colchicum, aided, or supposedly aided, by a liver - pill and alkalies, such as lithia, potash, or soda. Most of us have our own notions of the right diet for
the gouty; and as to drinkables, a smart lady in the North once remarked to me (on hearing me tell my patient to drink Scotch whisky well diluted with water), "Oh! I see you are a Scotch - whisky doctor. It seems to me that the only difference between you gout doctors lies in the kind of whisky you order; you order Scotch, and Dr. Moore used to order Irish. I often tell papa that if I were he I would drink both, and then he would be sure to be right. " The sting of the remark lay in the fact that I had the
local reputation of being strongly opposed to alcohol in any and every form, notably in the treatment of gout, and the partial modification of my views came about in this wise: - I was once attending a country squire for an inflamed knee, when his aged father - in - law, the late Sir Edward X., then over 80 years of age, came over to see him. While there on a visit, he had a smart attack of gout, which I was called upon to treat, but my Aconite and Bryonia did not help either him or me. Colchicum I would
not give, and, moreover, I did not allow him any alcohol at all. I had been taught that alcohol made gout, and so I felt it to be my duty to get rid of the cause first, and then the feverishness was met by the Aconite, and the pains and swelling by Bryonia (pains worse from movement). All that seemed simple enough; only Sir Edward get worse, and told me very plainly that he did not believe in my new - fangled treatment of gout at all, exclaiming, "My little doctor always get me round in a week or ten days.
" Said little doctor was telegraphed for, and sure enough he had Sir Edward out driving in the park in about a week.
What was the little doctor's treatment? Port wine!
Said he to me: "You see, Sir Edward's not really a strong man and never was, although he has held on a pretty big span; still he is really a weak man, and he never could stand anything unless you stoked him up a bit. "
How long has Sir Edward been your patient
"Forty years. "
Have you always "stoked him up" as you say?
"Oh yes, always. "
Why?
"Because I found I never could get him well of anything without plenty of port wine. "
Do you treat many cases of gout?
"Oh no, very few; people in my district are too poor to get the gout; they work too hard. I get it occasionally myself. "Do you take plenty of port wine yourself?
"No, no; it would kill me. "
But you cure Sir Edward with port wine and yourself not; what do you take yourself?
"Oranges, if they are to be got. "
Oranges?
"Yes, I eat two oranges three or four times a day; drink plenty of clean cold water; avoid game and beef; live on plenty of green stuff, particularly salads; keep my skin clean and active, and I soon get rid of the enemy. "
And what about alcohol? are you a teetotaler?
"No, not a bit of it, except when I am gouty; then I go on oranges and plenty of cold water, and I soon wash out the gout, and then I go on as usual and take whatever is going; with my big country practice, long distances, and small fees, I cannot be bothered with diet; bread and cheese, beer, and bread and milk, bacon and eggs, or bread and butter and eggs, are what I usually get at my patients' homes. "
The little doctor could give me no guiding rule as to the best diet in gout, viz., when to give plenty of port wine, or when to rely upon oranges and plenty of water. But from subsequent observation I have been able to arrive at the following conclusions, viz.: -
1. People who have descended from ancestors long accustomed to the use of stimulants generation after generation, these need stimulants in their debilitating illness, and therefore in their attacks of gout. They also need a certain amount of building up. If they are dieted too severely and deprived of their alcoholic stimulants they get weaker and weaker, and their gout gets the entire mastery; whereas with a sustaining diet and a reasonable amount of stimulant, they get well and thrive on their
ancestral constitutional basis.
2. In certain brain - workers (and in their immediate descendants) whose nervous systems are exhausted, if you take away their stimulants they are apt to fare very badly.
3. This exhaustion gout, when produced by abstemiousness, can be cured by better diet and stimulants. I knew (socially, not professionally) an eminent Q. C. who had been for many years a total abstainer, lived very sparingly, but who was a martyr to chronic gout, and eventually died of it about 60 years of age. He was a great brain - worker, and of strong constitution. He was often asked to take some stimulants, but strenuously refused.
4. A gouty patient, who afterwards came under my care, was dieted by a famous anti - fat doctor, and in a week or two he developed a terrible attack of gout that completely broke his seemingly powerful constitution. During the fasting experiments of certain persons at the Royal Aquarium here in London, frequently done during the past few years, the fasters had, over and over again, attacks of gout, though water only was partaken of.
So I conclude that food and stimulants per se are not necessarily the case of gouty attacks. The things presents itself to my mind thus: - Just as in the case of a smoky chimney almost any kind of fuel will fill the room with smoke, so in gout almost any kind of food will produce gout; but the real fault lies, not in the fuel, but in the chimney; not in the food, but in the organism.
I call these cases of gout Exhaustion Gout, and certainly they need stimulants.
I have reason to believe that Sir James Paget holds a view something like this, though he may possibly express it differently; for I once ordered a gentleman who consulted me for what I considered exhaustion gout, to take two glasses of sound port daily with his dessert after dinner, but he refused compliance, and walked out of my consulting - room straight over to see Sir James Paget, telling Sir James nought of having been to see me. Oddly enough Sir James also ordered him a stimulant (though I
forget what), and on his objecting to take any stimulant on the ground that it would increase his gout, Sir James said, "Never mind your gout; get up your strength, and then you will be better able to master your gout. " Clearly in these cases of exhaustion gout we have to do with a very different affair to that which yields to oranges and cold water.
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Surfeit Gout.
I call surfeit gout that which is Curable by abstemiousness either as regards food or stimulants, or both. In such cases I have known an attack of gout to be brought on by a single bottle of beer or a pint of even the driest champagne, and on one occasion from eating goose - berries; in such cases all alcoholic stimulants, and certain foods, yet in different degrees, act like oil on a fire; they set up a blaze.
In exhaustion gout alcoholic stimulants act like oil on troubled waters; they calm the waves.
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Exhaustion Gout and Surfeit Gout in The Same Individual.
There are, further, cases of gout that seem to partake of both qualities - exhaustion and surfeit - and here the question of stimulants is very difficult to decide; on the whole, I have obtained my best curative results by changing the kind of stimulant instead of allowing them to stick to one kind. Thus I have rather a penchant for allowing a small quantity of dry champagne for dinner once or twice a week, the same quantity of a sound claret once or twice a week, and whisky and water, or whisky and
soda - water, on other days. Allowance must always be made for hereditary proclivities, habits and modes of life. We must ever keep before our minds that in the treatment of gout we are dealing with adults and not with children; our concern is not to dictate an ideal dietary for the normal individual under hypothetically perfect conditions, but we have to do with sufferers from gout, whom it is our business to get well, and keep well and vigorous as long as possible. In other words, rearing children
requires a very different regimen and dietary to what experience may find best for maintaining gouty adults. Neither is it desirable to limit a gouty man or woman to the barest necessaries of life, and say, it is possible to live on bread, fruit, and clean water, therefore you must eat nought but bread and fruit, and drink only the ale that Adam drank.
Taken in its simple elementary forms, we may regard the exhaustion gout and the surfeit gout as respectively inherited or acquired. In the most simple form the hereditarily gouty may get gout on almost any diet. Surfeit gout is self - produced by excessive input or inadequate output; too much is put in, too little is put out, and hence the real smoke and soot which is the gouty product. A gouty father begets a child while he is actively gouty; like begets like, and hence the offspring is of necessity
gouty on any diet whatsoever; such children pass grit and gravel as soon as they get away from the pure milk diet. A milk cure for gout echoes all down through time. But active, middle - aged men in the full swing of daily life commonly find a milk diet inadequate if they keep at work "It does not seem to satisfy me, " say they; or "even when I am full of milk I seem to be empty. " The fact is, milk is food for the very young - calves, and babes.
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Goutiness.
Gout is an acute disease, and shows itself paroxysmally, though the word also expresses the constitutional crasis or state; and so frequently is this latter the case, that I have time and again heard patients exclaim. "Oh! everything is gout with the doctors now!" When we say "gout" we really mean that the individual lives goutily, whether such individual gets attacks of gout or not; thus the child of a gouty father may teethe goutily and have gouty urticaria, and here the gouty quality cannot be
eliminated by gumlancing or soothing ointments.
Assuming that both parents of a given individual are pronouncedly gouty, how should the offspring be other than gouty? In the painful menstruation of young ladies I have over and over again cured the dysmenorrhoea by treating the painful affection as of gouty quality, - in fact, as gout. It would be better to restrict the term gout to the form of disease that occurs in attacks of paroxysmal arthritis, and use the word goutiness to designate the more or less hereditary quality of the constitutional
crisis. In fact I would use the words goutiness and gout to indicate the same relation which consumptiveness bears to consumption. But in this matter of terminology custom will fix our words for us, no matter what we say or do.
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What is Gout?
It would take more time than I have to spare to enter upon the subject of what gout really is, by going over the innumerable theories that have been advanced from the year one until now. One line of thought, however, runs right through most of them, viz., some reference is made to the urine or to one or other of its constituents, according to the terminology current at the time, such as tartarus, stone, gravel, grit, urea, uric acid, urate of sodium. The names of the disease have very little interest,
because gout in its ordinary paroxysmal manifestations, quoad its habitat, will always be a podagra, a cheiragra, which says but little. Deriving gout from gutta via goutte is etymologically not without interest, but clinically of no value, whereas the names that refer to its uric or urinous nature do roughly indicate the nature of its product. My own notion of the nature of gout may be expressed in a very few words: The gouty product is the uric smoke and soot of the human economy, - that is, the pure
paroxysmal affection commonly manifesting itself as podagra, and more or less in many varieties of goutiness.
The thing presents itself to my mind thus: - Given the human organism, it takes up its food, use it, and then gets rid of the products of its vital phenomena, first by way of the bowels and then by way of the skin and kidneys. Where the renal excretion is such that some of the uric matter (urea, uric acid, urate of sodium) remains in the blood, it is deposited in certain of the tissues, and when it culminates in, say, the big toe, we get the classic gouty attack. I am for the moment not concerned with
the precise form of the urea as so deposited, nor yet whether due to one cause or another, but with the simple elementary conception of the substantive material nature of the gouty product - in other words, gout, for me, is ureal poisoning. Of course I part company with all those who regard gout as merely uric acid deposits, and who maintain that the uric acid is the disease. I grant that the uric acid produces the sufferings, but I maintain that the disease gout is that which produces the uric acid, - in
fact, the Paracelsic motto on my title - page expresses exactly my philosophy. Pretty well all the phenomena of gout square well with this conception of its nature. It seems to me, further, that gout stands in some relation to the spleen as well as to the kidneys and sweat glands. It does not appear to me that gout has so much to do with the liver or its functions, and stirring up the liver to increased action and purging the bowels do not, so far as I have been able to discover, aid in the very least in
the cure of gout, acute or chronic, unless a primary liver affection be its prime cause in the organopathic sense. Of course gout may further affect the liver and bowels as well as any other part; what I mean is, that these do not necessarily conduce physiologically to the production of gout. And why I feel so satisfied of the relatively unimportant participation of the liver and intestine in the production of gout is because I have many times had to treat severe cases of gout in which purgation had been
thoroughly carried out with no advantage whatever, but rather the contrary; and, moreover, it is by no means an uncommon thing for very gouty people to suffer from habitual looseness of the bowels, and yet the gout does not diminish. On the other hand, as before remarked, I am strongly of opinion that the spleen is very intimately concerned in the production of gout. There does not exist, to my knowledge, any treatise on the homoeopathic treatment of gout, and the treatment of gout is, I believe, not the
strongest point of the homoeopathic school. This is very likely not true of individual homoeopathic practitioners, whose successes in gout may have been many and mighty; but speaking generally, the homoeopathic literature of gout is not brilliant. And this I believe to be due to the fact that gout is very difficult to cure dynamically, because we have behind the symptoms the uric deposits; and remedies that are homoeopathic to the symptoms of the gouty patients from the deposits are not necessarily
homoeopathic to the state productive of such deposits; and it must be manifest that remedies, to be really curative of arthritis, must be homoeopathic to the state productive of such deposits of urates within the tissues. It is not enough to cure the symptoms due to the urates; to be the remedy of the case, not only the uric deposits must be included within the simillimum, but the state which produces such deposits.
Whether any one remedy can be expected to be homoeopathic to the state productive of gouty deposits, and of such deposits themselves, may be a debatable point. The production of deposits of urates of sodium in pigeons by Ebstein and others by injections of bichromate of potassium is not what I mean exactly, for the gouty state takes time to be produced, and does not consist merely in the deposition of urate of sodium into the superacid tissues. However we here need more knowledge. It is just this
point that has not received due attention in the homoeo - therapeutics of gout, and hence it has come to pass that our literature on the subject is so very poor. No doubt the clinical work of our school is better than our hereto relative literature, for some of our best clinicians do not write; still our literature ought to be the register of our best work, and in this register outsiders should be able to find ample proofs that the homoeopathic principle is useful, and workable also in such a substantive
disease as gout in its acute form. It is not enough to affirm that the principle of similars is workable: we must prove it; and this can be done.
Now, so long as I kept to the ordinarily commended homoeopathic remedies for gout, so long were my results mostly only tedious recoveries; cures they could not be fairly called. One thing only could I boast of in the simply symptomatic homoeopathic treatment of gout; my patients recovered - slowly and tediously, it is true - but still they recovered completely, with undamaged constitutions and unharmed organs, and the gentle treatment not only ended thus in integral restitution, but subsequent attacks
became milder and less frequent, so that even that was, I think, a fair record. But we can do more than that, as I will show. Not a few mighty men have expressed the opinion that the proper role of the physician is merely to pilot the patient from the sea of sickness into the harbour of health. Still, my own ambition is never satisfied with such a role; my constant strivings are ever directed to being the master of disease, and I am not satisfied unless and until I deem myself the victor, always within the
limitations of "thus far and no further. "
In genuine gout we have to deal with the attack: this is the mountain of difficulty.
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I was very early in my career warned against the use of Colchicum in the cure of gout, because of its deleterious effects on the kidneys.... "Rely upon Colchicum in gout, and you will get plenty of Bright's disease, " was the advice to me given by a most experienced clear - headed physician and hence it has come to pass that I have myself no experience of Colchicum in gout, good or bad. I do not remember ever having prescribed it a single time. And hence the gouty onslaught has always been, for me, a
difficult task. For there can be no doubt, judging by the clinical records of Colchicum, that of all known remedies used thus far, Colchicum has far and away the greatest influence over the gouty manifestations. My own suspicions are to the effect that Colchicum is homoeopathic to some of these external manifestations which it effectively gets rids of, but leaves the uric deposits in the blood and tissues. The outside symptoms are gone, the inside disease remains. Is it not an oft - told tale that "X. got
the gout; he took Colchicum and was much relieved, but - he was later on seized with great pain in the chest and died. "
Natrum muriaticum, 6 trit., has helped me in some cases of acute gout very satisfactorily; the urine thickened and deepened in color, and the attack was broken up. It is still used by me in gout pretty considerably where prominent Nat. mur. symptoms are present, and specially where the patient has taken much quinine, or is chilly, or his gouty attack is apt to be stirred up by a visit to the seaside. I use 6 grains of the 6th trituration every two or three hours, and except the urine to deepen in
color and thicken within two days simultaneously wherewith the gouty manifestations usually abate. I have no faith in gout cures unless they thicken the urine. If the heart is weak or atheromatous I commonly rely on Gold: and it is a veritable friend in need and indeed. If the skin is fairly normal I use the Aurum muriaticum 3x, five drops in a tablespoonful of water every three or four hours. If the skin is very wet and patient sweats unduly I give Aurum muriaticum naturatum 3x. in the same dose as the
simple muriate, and am generally not disappointed with the results. I have also used Jaborandi and its alkaloid Pilocarpine with good results. In the treatment of acute gout it is sound practice to keep an eye on the stomach first, the heart next, and collaterally on the reciprocal relations, topographic and pathologic, of the heart and liver and spleen respectively; and this because the heart, with liver, spleen, stomach, and kidneys, are really the "interested parties" in acute gout. When I speak of
stomach I really mean the epigastrium and more precisely speaking, the solar plexus - to which aether, zincum, and hydrocyanic acid will bring prompt and efficient help.
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Have we a remedy or remedies essentially Homoeopathic to the gouty attack ?
To this I think an affirmative answer can now be given. I propose to show that Urtica urens, the common stinging nettle, is such a one, and I think Natrum muriaticum has strong claims to be so considered also. But Nat. mur. is a classic remedy in homoeopathy; it is well known and much used by such as have gripped the true inwardness of homoeopathic drug action. As I will presently relate, I have used Urtica urens a good deal for some years in ague and spleen affections, and thus it comes to pass that
I have had ample opportunities of becoming intimately acquainted with its powers. Patients under the influence of small material doses of Urtica will often pass quantities of gravel. The first occasion of my observing this in a striking manner was in a middle - aged maiden lady, who came over from Germany to place herself under my care, who smelled so strongly of nettles that it nauseated me whenever it was my duty to examine her. She had, amongst many ailings, an enlarged spleen, and for this splenic
enlargement I gave the mother tincture of Urtica urens. I was led to use it from the burning pains as well as the odour. This lady passed a very large quantity of gravel by the urine while under its influence. I did not attach very much importance to this, as patient was in the habit of passing considerable quantities of gravel with her motions, localised abdominal pain generally preceding such an occurrence by a number of days. She was in the habit of indicating a spot just under her spleen as her "gravel
- pit". But when I observed others who, being under the influence of Urtica urens, passed grit and gravel pretty freely for the first time in their lives, I came to the conclusion that the Urtica possesses the power of eliminating the urates from the economy. And it slowly became clear to my mind that Urtica might be the very remedy I had long been in quest of, viz., a quickly acting, easily - obtained homoeopathic remedy for the Attacks of gout, or some of them, for of course we, of experience, never
expect uniform results any more than we expect all the trees in a forest to be of the same height. I subsequently became aware that Urtica urens is contingently capable of producing fever, as some subsequent experience will show. The fever of the gouty attack is not great, but still feverishness is a part of such attacks, and I should not feel sure of the homoeopathicity of a remedy thereto did it not possess the symptom "fever" in its pathogenesis.
I then proceeded to employ the Urtica urens in the classic attacks of genuine gout, and that with very great satisfaction indeed. Within a few hours after beginning its use the urine becomes fairly free, of a high colour, and the bottom of the vessel is often found more or less covered with urates in the form of grit and gravel, and simultaneously herewith the gouty attack begins to subside. (An allopathic neighbour tells me that Urtica was much used in olden times for gout - nil novi sub sole:) I
call the discovery, of this gravel - expelling power of Urtica, great: well, it has been great to me in my clinical work, and my patients are generally of the same opinion as myself, - so much so that one or two of the commercially minded among them have over and over again urged me to bring it out as my gout medicine: but I have no respect for nostrums or nostrum - mongers, and am quite content to make it known as a most valuable remedy in the treatment of acute gout, as it cuts short the attack in a safe
manner, viz., by ridding the economy of the essence of the disease product, its actual suffering - producing material.
I call it a homoeopathic remedy because I believe it to be such, though it may be just an organopathic remedy and simply act as a splenic, for Urtica is undoubtedly a powerful splenic, as I have often clinically demonstrated. The provings of Urtica have thus far been only elementary, and its mode of action has yet to be studied; but if time permit I will argue the point at length later on. It is my sheet - anchor in both gout and gravel. In gravel it facilities and accelerates its passage, and ends by
curing the colic casually. My usual mode of administering it is by giving 5 drops of the mother tincture in a wineglassful of quite warm water, frequently repeated, say every two or three hours. Only yesterday morning I was called to see a gentleman 78 years of age suffering from "his old enemy, " viz., pains in his left kidney region I prescribed Urtica every two hours, and called again late in the evening.... "Oh! the pains is gone, and I have passed a lot of gravel. " In my practice this is an oft -
told tale. In the treatment of gout and gravel it may be of importance to remember that the nettle is not an uncommon plant, and that nettle - tea acts just as well as the tincture of which I make use. The nettle is a very curious plant, that appears to follow man the world over. I have read that its original habitat is somewhere in Asia, whence supposedly started the wanderings of the peoples. As we all know, it dies down in the winter and shoots out again in the spring. Certain it is that it follows man
wherever he goes. I lately inquired of a gentleman resident in Western Australia whether there was any nettle indigenous to that region, and received a reply to the effect that he knew of no Australian nettle, but that the English nettle sprang up everywhere near human habitations. Last year, when in the country for my holidays, I searched about to find out where the nettles best throve, and found that the plant was most flourishing in and at the sides of ditches which carried off the fluid sewage from the
cottages, and thus possibly living to some extent on urinous food. This point is somewhat interesting and suggestive.
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Story of the Nettle as a Medicine.
Urtica urens.
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The gouty attack.
Two years since a middle - aged gentleman of position was down with an attack of gout that had relapsed over and over again, and he had then been in and out of these attacks for nearly six months. He had been swamped with alkalies and Colchicum, and mercilessly purged and lulled with narcotics most alarmingly. He thought he would "try homoeopathy, " and sent for the writer. I put him on Urtica urens as already described, and he was out and about in a fortnight. In a couple of days of the treatment his
urine became dark, plentiful, and loaded with uric acid gravel. His enthusiasm knew no bounds, and he declared that no remedy he had ever taken (and he had had attacks of gout over and over again, and had taken pretty well all known gout medicines) had really touched his gout like the Urtica. With him and his club intimates I became known as Dr. Urtica.
A gentleman of 50 odd years of age, now resident in London, consulted me for gout in the fall of the year 1890. He had long lived in India and suffered much from malaria. After a few weeks of Urtica, 10 drops in a wineglassful of water night and morning, he was free from gout, and "My diarrhoea has gone, my gout also; my digestion is better than for long, and my skin is much cleaner. "
At the end of the year 1893 the wife of a country square in Northumberland wrote me in great haste that her goodman was down with a severe bout of gout, and would I send him medicine forthwith. I ordered him ten drops of the tincture three times a day, and this rather large dose as he is a very big man, of a somewhat thirsty disposition. I heard no more of the matter; but three or four months later the lady consulted me on her own account here in London, and incidentally remarked. "That medicine soon
cured my husband's gout, and he has not had any since. " As before remarked, there is fever with the gouty attack, and a remedy to meet it homoeopathically should show its power of producing fever. Urtica urens, in my hands, has produced fever over and over again. In most cases in which its administration was followed by febrile symptoms there was, at least, an antecedent history of malarialism, or actually of recent or remote ague, but this was not invariably the case. Moreover the same thing obtains in
regard to China. Hahnemann had had ague before he proved the bark on himself and found out its fever - producing power, on which such a huge superstructure has been so solidly erected. - i. e. homoeopathy.
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The pathogenetic fever of Urtica urens.
Urtica urens.
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Urate of Sodium in the Treatment of Gout.
I have used Urea, Uric acid, and Urate of Sodium in gout, and they are of distinct value; they have helped me most and best where the deposits persist: they stir up the lazy deposits, so to speak, and help to eliminate them.
Daphne, Mezereon and Physalis alkekengi have been used by me in gout off and on with a certain amount of benefit. So have Bryonia, Rhus, Pulsatilla. and Bacillinum, and many others, each in its own sphere, in accordance with the indications and data of homoeopathic pharmacology, as well as with my own clinical experience. And Aconite has helped me up to a certain point many times: notably in the stiffnesses that remain after gout, have I found Aconite 3x or 3, given night and morning, of positive
avail.
Bellis perennis does distinct good in the after - gout debility of the limbs; and Cypripedium pubescens (and also the powder Cypripedium 3x) is its equivalent in the sphere of the nerves in the after - gout adynamia and neurasthenia. Where there are actual calculi that require solution before they can be passed, Piperazinum purum bulks up very imposingly, and I think no therapeutist can afford to ignore it after the record following. I take it from the Therapist, July 14, 1894: -
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Differences Between the Cure of the Gouty State by Mineral Water and Alkalies and by Homoeopathic Remedies.
Essentially the cure of the gouty state by mineral waters and alkalies is mainly chemical, viz., they set up a condition of alkalescence, and the uric concretions are thus rendered soluble, and the mass of fluid drunk washes them out, while in the homoeopathic treatment the organism itself becomes its own sweep and thus them out. In the former case the urine becomes clear, while under the homoeopathic action of the remedies the urine becomes dark and visibly charged with gravel. This difference is
essentially great and important, for while both end in the washing out of the deposits, the same begin forthwith to accumulate almost as soon as the remedies are left off; on the other hand, under the homoeopathic remedies the organism has itself done the work, and at least a certain time elapses before new deposits take place, so that one has time to enter upon a real cure of the diathesic quality. Only in the case of large portions of gravel, and in the case of actual calculi, does the Piperazine and
Gichtwasser treatment seem to me to be preferable, inasmuch as in this latter case the organism itself cannot possibly do the work until the concretions have been dissolved. In ordinary manifestations of gout it is the organism itself that requires to be called up homoeopathically to do its own work; usually there are no concretions of any great size present, as, for instance, in the acute attack of gout. I have previously stated that Homoeopathic literature, so far as it is known to me, has not won any
great laurels in the matter of gout. Moreover, I formerly felt the homoeopathic treatment of gout to be very tedious and unsatisfactory, and now I will proceed to explain why that has heretofore been the case; at least, so it seemed to me.
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The True Homoeo - Therapeutics of Gout.
In a given case of gout the symptoms are not those of the individual himself, but of the gouty matter, of its material presence in the individual: the pain, the swelling, the redness, the tenderness, the fever, the restlessness - these are produced by the gouty material, which we see from the fact that they disappear as soon as this material is washed out; so that what we require are remedies that are homoeopathic to the state of the patient which preceded the gouty deposit into the tissues, inclusive
of these deposits. In fact, the pathology of gout must be considered, in prescribing adequately, homoeopathically. Our anti - arthritic remedies must be capable of producing a state that leads to a deposit of gouty material, and not be merely homoeopathic to the symptoms produced by the material itself. The process, together with the product, must be within the pathogenesis, or else a real totality of the symptoms is not obtained. In fine, the gouty material is the stop - spot of the action of the remedies
thus far mostly employed in the homoeopathic treatment of gout. I have been severely taken to task for claiming that pathology must be considered in a homoeopathic prescription in order to ascertain the stop - spot of the action of each remedy, but I beg these esteemed colleagues to note that I did not say morbid anatomy, but pathology two widely different things. Morbid anatomy we study in the deadhouse; that may or may not have to be considered as throwing some light on a given subject, but pathology is
the doctrine of the disease in the living, - the actual pathic biology of the diseased individual, which ends where the morbid anatomy begins. Do my esteemed colleagues really mean that this pathic biology of the patient enters not into the homoeopathic equation?
I trow not.
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Gouty Ophthalmia.
A very gouty city gentleman, just turned 50 years of age, came on 21st October, 1892, to consult me for a slight attack of gouty ophthalmia of this left eye. I ordered Urtica urens 0 ten drops in water, night and morning, and this cured the ophthalmia within a week, amelioration setting in already within twenty - four hours. I have been in the habit of seeing this gentleman for a number of years for gouty manifestations, amongst which was a very obstinate gouty eczema.
Dr. Holtz (Das. Wesen und die hygienische Behandlung der Gicht. Detmold. 1894.) maintains that the fever of gout, as observed by him in hundreds of cases, rarely exceeds about half a degree, whereas the fever of rheumatism commonly runs high, and this he regards as an essential difference between the two processes. This is, no doubt correct; still there is some fever, and at times there are distinct rigors. There is often, as Tanner points out, uneasiness in the left rib region, with inability to lie
on that side, so that, with this symptom added, I think I may fairly claim that Urtica is a true simile to gout.
It has -
1. Fever, heat and cold, flushes.
2. Passage of grit and gravel.
3. Uneasiness of left rib region.
4. Great restlessness.
We will now go on to the next point in the treatment of gout. That much of the gout we meet with is more or less produced by alcohol, is amply manifest. It becomes, therefore a question worth considering whether the effects of alcohol per se can be homoeopathically antidoted, and if so, by what remedies.
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On a Remedy Homoeopathically Antidotal to The Effects of Alcohol.
For some years past I have been acquainted with a remedy that antidotes the effects of alcohol very prettily, as I will now proceed to show. I enter upon the subject in this place, because it deserves to be made widely known, and also because, in the treatment of gout, the alcoholism not infrequently bars the way. The remedy I refer to is the distilled spirit of acorns - Spirits glandium quercus. My first account of it will be found in "Diseases of the Spleen, " where this Spiritus glandium quercus is
dealt with as a spleen medicine. I speak of set purpose of the homoeopathic antidote, because alcoholism is a disease, and as such must be met by specific medication.
Some of Rademacher's patients complained to him that while taking his acorn medicine they felt in their heads somewhat as if they were drunk; but as Rademacher did not believe in the law of similars - indeed, knew but little about it - their complaint had no ulterior significance to him, but still it struck him as worthy of record; and he accordingly did record it in the following words (see Erfahrung sheillehre, p. 209, i.): - "Einige, aber wenige Menschen, bemerken gleich nach dem Einnehmen ein
eigenes, kaum eine oder zwei Minuten anbaltendes Gefuhl im Kopfe, welches angeblich der Berauschung aehlich sein soll. " Turned into English: - "A few, but not many, of those who take it, immediately feel a peculiar sensation in the head, which they say is like they feel when they are drunk, the sensation lasting only a minute or two. " Now, in the light of the homoeopathic law this symptom is eminently suggestive, but whether anyone besides myself has ever noticed this symptom I am not aware. But it made
a lasting impression on my mind years ago. Rademacher had previously related the following brilliant cure.... He says that in order to get a clear idea of the action of the remedy, he caused to be prepared a tincture of acorns, of which he gave a teaspoonful in water five times a day to an almost moribund brandy toper, who had long been suffering from a spleen affection, that at times had caused him a good deal of pain, and who, at the time in question, had severe ascites, and whose lower extremities were
dropsical up as far as the knees. Our author was of opinion that the affection was a primary disease of the spleen, and reasoned that if the tincture of acorns cured the spleen, the kidneys would duly resume work, and the ascitic and anasarcous state would disappear. He soon found he was right; patient at once began to pass more urine, but he complained that every time he took a dose of the medicine he got a constriction of the chest, and this Rademacher ascribed to the astringent quality of the acorns,
and to avoid this he had the tincture of acorns distilled. The administration of this distilled preparation was not followed by any unpleasant symptom, the quantity of urine passed increased still more, the tension in the praecordia slowly lessened, and this inveterate drunkard got quite well, much to the amazement of everybody, Rademacher included, for he did not at all expect him to recover.
Now, in must be admitted that a remedy that can cure an old drunkard of general dropsy and restore him to health deserves closer acquaintance. And when we regard it from the pathogenetic side as producing, of course, contingently, a cephalic state resembling alcoholic intoxication, and then from the clinical side as having cured an abandoned drunkard, it looks very much as if we had a remedy homoeopathic to alcoholism, I may add that Rademacher nowhere hints that the Spiritus glandium quercus stands
in any relation to alcoholism; he regards it merely as a spleen medicine, specially indicated in dropsy due to a primary spleen affection. At first, I regarded it merely in the same light; but when I really gripped the significance of the pathogenetic symptoms just quoted, I thought we might find in our common acorns a notable homoeopathic anti - alcoholic.
Now let me give some of my clinical experience on this point, so that my readers may be able to judge for themselves whether this be so.
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The Hot - Water Cure of Cadet De Vaux.
The cure of gout by drinking quantities of hot water was much in vogue in the early part of this century, and it has been revived again within the past few years, and at the present time is again much in vogue. It went out of fashion long ago, because of its real or supposed ill - effects upon the constitution. So far as my own experience goes, the hot - water treatment is indicated in the aged, and in those whose tissues are tough, dry, and cold. In the young and middle - aged, in the tender and in
the sappy, the hot - water treatment is distinctly harmful. It attacks and hurts the tender tissues, and may not be used by the young at all. The middle - aged may use it occasionally, when there is much acid in the intestines, and digestion is at a standstill. At the present time, the Salisbury treatment - living on hot water and finely minced meat - is quite the rage, notably since a noble duke has stood godfather to it. So far as I have been able to judge, it is only a disagreeable way of starving. A
lady tried it for some time - I think seven weeks - and from being a comely person, only somewhat stout, yet in full vigour, she lost most of her flesh and all her strength, and the uterine tumour, for which the treatment was undertaken, alone throve, and waxed greater; the patient herself became so weak that she frequently fainted. She was unable to stand from weakness, and would certainly have died had it not been given up. The case was observed by myself, and is not heresay. I know a gentleman, about 50
years of age, who has been doing the Salisbury treatment for some months past; he is naturally thin and wiry, and he is very enthusiastic about the cure, although he confesses that he is very weak, and can only just drag himself slowly about. He adopted the treatment for oxaluria and great depression of spirits, and maintains that he now passes no oxalates, and is light - hearted, and feels wonderfully well, so far as his feelings go, notwithstanding the bodily debility. "The Salisbury treatment, " said he
to me the other day, "is a grand thing to get rid of all superfluous tissue. " Of course; no one questions that we all can get rid of our tissues by starvation. The art is to keep plenty of good tissues, and therewith remain in good health and vigour. I have tried many dietetic experiments on myself, and thus have often lessened and increased my bulk almost at will, and what I have invariably found is this: you cannot make big fire with a small quantity of fuel; that is impossible. Consume, as a general
thing, very little, and you can only spend a very little in energy; you cannot get much out of little. Of course, you may get too bulky, and thus waste much energy in mere locomotion. That is a question of being overweighted; and when some of this overweight is got rid of by diet, there is, apparently, more energy developed on less food, but this is only apparent and not real. For here we have two factors to consider: - First, the overweight is lessened, and less energy is required for locomotion; and,
secondly, the overweight that is got rid of must be added to the food taken, inasmuch as the dieted individual has himself consumed a portion of himself: his organism has used up some of its stored fat. But if the diminished import of food be continued too long, deterioration and debility must ensue. This is where the fallacy comes in stored food is used, and so the quantity of fuel is not less, whereas the bulk to be carried is less, and so the initial state of the spare diet process is very commonly
accompanied by a feeling of well-being and lightness; they feel so much lighter, and get about so much more easily. Of course they do. But as soon as the stored - up food is gone, weakness supervenes if a too spare diet be persisted in. Therefore, in all dieting we must stop a little before the fatty reserve store is all used up; for if we go on we just consume ourselves and as far as this goes it is death. This brings us along to the question of diet in gout and diet for the fat. Fat people are not
necessarily gouty, and gouty people are not necessarily fat; still gout and obesity touch one another so closely that they in a certain number of cases, are not easily separated in practice.
Let us consider, first, food and work, and then height and weight.
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Food And Work.
In considering the question of diet we rarely find people take due cognizance of the mode of life of the individual who is to be fed, and yet in the case of horses, for instance, every horse - keeper feeds his horses according to what he expects them to do. I formerly, very frequently, went to a country house, four miles from the railway station, to see a patient suffering from a grave malady. For some weeks the ordinary carriage horses were sent to take me to the patient's abode, and so long as this
was the case the hills offered no impediment, and I found myself transported rapidly; and this was very satisfactory to me, for doctor's time is his capital. Patient's malady was, as before stated, a grave one, and his belongings were very anxious to get me to the house as quickly as possible, so good - conditioned horses were put in to the carriage. But after a while patient got better, and then I found that fat old pony was sent to the station to meet me, and it took us nearly an hour to reach the
squire's mansion. On the way back to the station I inquired of the coachman how it was that "Shaggy" seemed so pumped out with such a short journey. Said he: "Well, you see, Sir, she is out at grass in the home - park, and gets no oats or dry food at all. "
Now, the coachman's explanation of "Shaggy's" weakness gives us the clue to what I desire to say in regard to diet in general. When anyone asks - What am I to eat and drink? the answer must duly reckon with the mode of life of the questioner, and the amount of work which is required of him. As a rule no work whatever was required of "Shaggy: " she just ran about in the home - park, thriving beautifully on grass and water and on this diet she seemed exceedingly happy and plump and sleek, and when
spoken to would gallop away in fine style, the picture of health, strength, and happiness. Yet a three or four miles', run in a very light cart, was a severe trial for "Shaggy. " It is not different with human being; if they do nothing but just loll about - turned out to grass, so to speak - bread and water, with fruit and vegetables, amply suffice; but if they work, they need the equivalent of oats and dry food. I am here not giving expression to mere theory, for I have tried numerous experiments on my
own person and proved the point over and over again; and I emphatically affirm that you cannot get much work out of little food, any more than you can make a very big fire with a very little fuel. Whether the authority be Salisbury, Canterbury, or York, I care not; you cannot get much work out of a square diet.
And now as to
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Height and Weight.
I go a little out of my way to point out the common fallacy underllying almost all the data given as to what the normal weight of a person of a given height should be. If my reader will consult the tables, he will find that the assumed basis is faulty in a very important particular. Let me explain. Place a dozen persons of a given height - say 5 ft. 9 in. - side by side in a row, and as they are all the same height, the tops of their heads will be in a line, but their hips will be at a very different
heights. In fact, it will be seen that the height of an individual is no sure guide to his bulk, and therefore not to his weight. In some a long neck makes an inch or more difference, in others it is a very long thigh bone that gives the greater height; but in both cases the weight is not determined by the length of the neck or of the legs, but rather by the relative length of the trunk.
There are many big people who stand at 5 ft. 6 in., and there are a good many small people who stand about 6 feet high.
There is a saying amongst the people that little women make the best mothers; but these so - called little women are really big women, only they are on short legs. When examined very closely I find they are large in the trunk and have fine pelves, while big women (so - called) are really smaller in the capacity of their trunks and pelves, and hence less adapted for the duties of motherhood.
The neck carries the head, the legs carry the trunk, and certainly heavy heads and heavy trunks are more safely carried on supports not too long in the perpendicular. This being so, all the data given in our tables of how much you ought to weigh if you are of a given height require to be revised; for any one whose attention has been called to the subject can readily see that there are many little people who are tall, and very many big people who are short. There are, of course, a few people - very
few, really - who are both big and tall. As a rule, very tall people are not of great constitutional power, though some tall thin people are very tough and wiry, and exceedingly vital.
What have height and weight and their relative merits to do with gout? Just this: every little medico thinks he knows all about the diet suitable for this ailment and that, and is so very sure that a person of a given height should only weigh so much, and that big gouty individual may be safely and profitably starved till his height and weight proportion tallies with the table published in his text - books, but which tables are based entirely on false data.
In fine, in judging of the diet suitable to a person, keep in view the amount of work he has to do; and before you determine the proper weight of an individual, do not merely consider his height from crown to sole, but rather have greater regard to the diameters of his trunk.
What first led me, twenty odd years ago, to think more closely of what should be the criterion of a person's weight, was the fact that a friend of mine, commonly called little, i. e. short, sat at table higher than another friend who was usually considered a big i. e. tall, man. And from many observations, I have long since come to the conclusion that the big may be short and the tall small. Also that the power of an individual is in proportion, not merely to his height, but to all his measurements,
and these must be carefully considered before a true conclusion can be arrived at.
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Hohenheim on the nature of Gout.
Paracelsus' conception of the true nature of gout is true to Nature, and tallies exactly with my own. He says (Tact, iv., De origine morb. ex tartaro; and in Erfahrungsheillehre, p. 95): - "Each organ has the power to separate the hurtful from the harmless, and when in this faculty it goes astray, there we get tartarus; " and thus, for Paracelsus, tartarus is that which ought to have been excreted, but is not, and remains in the body as hurtful material, producing mechanical irritation. Thus stone in
the kidneys, bladder, liver, lungs, intestines, under the tongue, or in other regions, is tartarus, and also acidity in the stomach and bowels. Now, put the word gout in the place of tartarus, and we clearly see that Paracelsus knew as much of the true nature of gout as we of to - day who talk of the uric acid diathesis and the like. Moreover, he knew how to dissolve stone in the living body, at which the scholastic wiseacres have been laughing all my life, and yet they know howl at those who question the
power of the much advertised Piperazine to do the same.
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Rademacher's Treatment of Gout.
Our author claims that gout may be caused by a primary disease of any given organ or part, or of the entire organism, and maintains that in the former case it is curable by the appropriate organ remedy, while in the latter case it is curable by one of the three paracelsic universal or catholic remedies i. e., nitre, iron, or copper. So that in this latter case gout may be of nitric, cupric, or ferric quality.
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The Treatment of The Constitutional Basis of Gout: The Uric Acid Diathesis.
The gouty attack being disposed of, we now come to the real problem viz., to the cure of that in a given constitution which ends in the deposit of the urate of sodium in the tissues. The problem is very complex and varied, and it is not easy to explain to the uninitiated that you constitutional anomaly, which we now call the uric acid diathesis, may require very different remedies according to the individual patient. And here it is not a question of the comparative merits of homoeopathy and of
allopathy, for allopathy offers us no help, even in theory, for the diathesis. When it is merely a question of the morbid product of the gouty attack, allopathy has a pretty big word to say, either with the Gichtwasser, or the alkaline treatment, of whose temporary efficacy there can be no doubt, just as there can be no doubt that allopathic remedies open people's bowels; but the alkalies do not cure the gouty constitution any more than do opening medicines cure constipation. To cure constipation, we must
have homoeopathy, and so we must correct the gouty diathesis.
The only efficacious plan is to begin by making a diagnosis of the constitutional wrong, and curing that. It may lie in the liver or spleen, or in the kidneys or bowels. (See Rademacher.) The hepatics often render the very greatest aids: Chelidonium, Chelone, Carduus, Myrica cerifera, Diplotaxis tenuifolia, Cholesterinum; often pancreatics render eminent services, such as Iris versicolor, Nux vomica, Pulsatilla, Mercurius, Iodine, Jaborandi, and Pilocarpine, used as they may be called for.
Bryonia, too, is often indicated, as also Sulphur and Hepar sulphuris.
We also find, as very frequently indicated, the commoner splenics, such as the already many times mentioned Urtica urens, the Persicaria urens, the Rubia tinctoria, the Spiritus glandium quercus, and the like.
In the renal sphere we may need Coccus cacti, Coccinella, Solidago virga aurea, etc. going over the notes of some of my cases I find that Sulphur, Thuja, Sabina, Pulsatilla, Bryonia, Rhus tox. Lycopodium, and Antisycotic nosodes are most commonly to the fore.
But, which of all these?
In ultimate court of appeal there remains the priceless Repertory to lead us to the correct choice of the remedy. With me, personally, the Repertory has always been my reserve force, to be called out only in case of need; but, for all that, I feel and know full well that, with my Repertory in reserve, I am never quite beaten.
The acids in the treatment of gout I have used much and often - of course in repeated doses - Uric acid itself (and also Urea, Urate of sodium), Citric acid, Nitric acid, Hydrochloric acid, and Lactic acid,
Acids are almost universally condemned in the treatment of gout; but, for all that, acids and not alkalies are capable of curing certain cases of gout, only, of course, they must be homoeopathically administered, or you merely add fuel to the flames, and this simple lesson is so hard to learn. Most medical authors, in treating of oxaluria, were against the use of sorrel, rhubarb, and gooseberries, as containing Oxalic acid. But these authors might readily observe that although the consumption of a
dish of stewed rhubarb is followed by a notable increase in the oxalates, a very notable decrease in the same immediately follows.
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Is Fruit Good or Bad For the Gouty ?
I have myself cured gout over and over again with grapes taken in bulk; and several of my patients, who were formerly sorely plagued with gout, have entirely cased to be troubled so long as they have partaken freely of grapes.
I may say the same of oranges. In fact my standing advice to my gouty friends runs thus: - Eat plenty of fresh, ripe, uncooked fruit, and drink plenty of fresh cold water. But this advice needs to be somewhat elaborated, for a violent attack of gout may be produced by fruit, particularly where it has been long eschewed; and severe gouty headaches and bilious attack may like wise be called forth by partaking of fresh fruit.
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How, then, can we commend fruit to the gouty?
It is in this wise: fresh fruits stir up the gout and often render its manifestations more active; but, at the same time, its tendency is to diminish gout, and, finally to get rid of it, in some cases, altogether.
A very little fruit, in a very gouty individual who is unaccustomed to it, will punish the patient very severely, as the numberless stories related by the gouty amply testify.
"If I eat one gooseberry only, my inside is like a hot cauldron, and all my gouty joints smart fearfully. "
"I ate half an apple, and writhed in agony half the night. "
And so forth.
All this is quite true, and is indeed within my own professional experience, but at the same time I emphatically state and maintain that fruit is very good for the gouty, for the more fruit they eat the less gout they will (by - and - by) have. Only I will recommend the fruit - eating to be begun with caution, and slowly increased till it becomes not only a harmless but a most beneficent anti - gout habit.
The same remarks apply to gouty eczema, which I have often cured; and I am in the habit of telling my patients that I do not consider a case of gouty eczema wholly and radically cured till they can eat fruit freely with impunity. How often do we hear, "Oh, I dare not touch fruit, or I immediately get eczema?" Fruit does not produce gout, it stirs it up and drives it out; fruit does not produce eczema, it stirs it up and drives it out; and, pray, where is it safest to have gout and eczema? Surely not
inside.
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Do Vegetables and Fruit Conduce to Longevity?
I am much disposed to answer this question in the affirmative, though my experience and knowledge are not sufficient to supply me with facts and arguments to prove the proposition.
Some years since I knew a gentleman who regarded all fruits and vegetables as poison. He died of pure senile decay at 60 years of age. For many years he had eaten neither fruits nor vegetables, but plenty of meat.
A few years previously I knew a West End physician who likewise condemned fruits and vegetables as rubbish. He died suddenly about 60 years of age.
And altogether, I have long been of opinion, from observation, that those who partake of, no vegetables or fruit do not, as a rule, attain to any great age. Oddly enough, I was arguing this question only a few weeks ago with a gentleman of 62 years of age, who had remarked to me that he never ate either fruit or vegetables. Two days thereafter he suddenly expired in hansom cab while driving across London. His tissues were in a sad state of senile decay.
That the tissues of those who eat neither fruit nor vegetables show grave signs of senility already at or about middle life is, for me, almost beyond question; but whether the want of the vegetable causes the decay, or whether the decay is due to a morbid cause resulting in a dislike for fruits and vegetables, as well as in senility, I am unable to say.
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Idiosyncrasy.
In all questions of diet certain personal peculiarities are to be respectfully regarded. We do not know everything. I have lately been told of a gentleman who gets severe glossitis from even a spoonful of oaten porridge; certain people cannot eat mussels, apples, strawberries, pork, and so on. Those idiosyncrasies must be regarded.
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On The Influence of Gonorrhoea On The Production of The gouty Diathesis.
The question of the influence of gonorrhoea upon the constitution has often occupied the minds of thoughtful physicians. At the beginning of this century the Tripperseuche, in the German medical thought world, was fairly in the enjoyment of medical citizenship, and it really constitutes the third member in the tripartite pathology of Hahnemann - viz., his sycosis; and Grauvogl's Hydrogenoid Constitution is another way of putting the same thing. With the advent of the area of Ricord in venereal
affections, the Tripperseuche was entirely banished, covered with ridicule. However, it survived in the homoeopathic school more or less waningly till a few years ago, when it came very near death, except with a certain few of the Hahnemannians. Then all at once, not so long ago, the Tripperseuche was rediscovered by a New York German physician, who took it back with him on his return to the German fatherland, whence it has spread afresh in thin lines the world over; and in France the view that gonorrhoea
is a grave constitutional disorder is at the present time fashionable. The fact is, Eisenmann's Tripperseuche will be quite orthodox again shortly if the present - day rediscoveries go on much longer. I have held with Eisenmann, Hahnemann, Grauvogl, Wolf, Goullon, these twenty years, and I will just say here that I believe the malady in question has a very decided influence on the organism, being contingently capable of generating a constitutional state which cannot be distinguished from the uric acid
diathesis. My conception of the thing is that the gonococcic virus so poisons the organism that acid dyspepsia is set up, and then we have what cannot be distinguished from the uric acid diathesis. So often have I seen this state set up in the wake of the gonorrheal infection, that I have almost come to the conclusion that the typical gouty attack is a child of gonorrhoea. Thus, I explain to myself the curious fact that it is principally men who get the typical gouty attack. And it is in this line of
thought that I have met with my greatest success in the medical eradication of the uric acid diathesis. But this is a subject by itself which I may one day work out; however, in case I should not do so, let my advice to the initiated be to this effect: - Regard the uric acid diathesis as originating (at least very frequently) in the Tripperseuche, and in its medicinal treatment stick to the antisycotics, and always remember its autoison in very high potency at considerable intervals. Let it be well
understood that I am here speaking of the uric acid diathesis, and not of the uric acid deposits. It is of the very highest importance always to keep in one's mind the diathesis separate from the gouty attack and the gouty tophi. The homoeopathicity of the remedy to the diathesis is mainly historic; the homoeopathicity of the remedy to the attack is mainly present and actual. It is just because these two are considered together that the homoeopathic literature of gout is so poor. And that others have
thought of the sycotic nature of arthritis may be inferred from the fact that Thuja occidentalis has been recommended as an anti - arthritic; but clearly it was so recommended for the arthritic dyspepsia, and not for the arthritic attack; and hence we are not surprised to find that, having used it in the attacks without benefit, they have written of Thuja as useless in gout. In the attacks it is indeed useless; in the arthritic dyspepsia it is a princely remedy.
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Case Of Chronic Gout in the Feet and Ankles.
In the spring of 1891, I was requested to go some distance into Surrey to see a lady of 60 years of age who was bedridden for many months from gout in her feet and ankles. It had started, so it was said, from a chill caught while sitting at a railway station waiting for a train. The feet were swelled, very hot, reddish, stiff, and so painful that the patient swooned when I pressed them but gently. There was persistent insomnia and great depression of spirits. After a year's treatment she was
discharged quite well, and has since so remained, and with rather unusual activity of limb. The fact is, having been for a time deprived of the use of her feet, and recovered the same only by slow degrees, she set greater value on her power of locomotion then ever before in her life. She had the following remedies, in the order named - Urtica urens 0, Cypripedium pub. 0. Apis mel. 3x, Menyanthes trifoliata 3x, Bellis perennis 0, and Viscum album. 1, and after the use of the last named, patient walked from
two to four miles a day, with comfort, pleasure, and satisfaction. And the cure holds good to date.
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Gouty Insomnia.
A gentleman, 80 years of age, formerly in the army, came under my observation on February 17, 1893, for insomnia, distinctly due to his being full of gout. "I cannot get any sleep without chloral; as soon as I lie down at night I get hot, burning, and itchy. " His gouty eczema he had got a little under with the aid of sulphur baths. I ordered him Urtica urens 0, 10 drops in water, three times a day.
March 3. - "This medicine has done me immensity of good, but has given me nettle - rash!"
And apropos of nettle - rash, everybody knows that the name of the rash is due to the power of the nettle to produce just this kind of rash; those who question this can readily put into the test of practical scientific experiment by handing a few nettles with gloveless hands. I have very often cured nettle - rash with the nettle - tincture, as so many others have done before us.
It seems to me that if any honest enquirer is really desirous of putting the truth of homoeopathy roughly, yet readily, to the test, he need only handle a few nice nettles with gloveless hands, when he will find that nettles really do produce nettle - rash; and then if he will treat a few cases of nettle - rash, occurring as a disease, with some nettle - tea or tincture, he will find that the nettle really does cure the disease nettle - rash;... and, if that is not homoeopathy, pray what is it?
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Gouty Fistula.
Although fistula is not frequently primarily due to gout, still I have met with some cases of fistula distinctly of a gouty nature.
In the month of January, 1893, a gentleman, 30 odd years of age, sought my advice in regard to a fistula in ano - external and incomplete - that had started with an abscess about a year before. After treating him for some time on the same lines which I commonly follow in the treatment of fistula, I found there was a something present barring progress towards a proper constitutional cure. And just when I thought we were at the end of our task, the fistula suddenly inflamed, and it was not until patient
had had a course of Urtica for a while, and finally, after taking Spiritus glandium quercus for some six months with interruptions, that he reported himself as quite cured. He had what might very properly be called fistulitis from indulgence in drink, and each time it yielded very speedily to Quercus. Patient himself soon found out which of the remedies did the good, for on one occasion, being at a distance, he telegraphed for this particular medicine. The fact is, the bouts of acute fistulitis followed
immediately on certain champagne breakfasts and lobster suppers.
The Spiritus glandium quercus has helped me promptly in several other cases of fistula in which the fistulas had become constitutional issues for the excess of alcohol taken into the economy. There are certain cases of fistula that are due almost solely to alcoholism, and these fistulas are simply issues. Woe to the patients if these fistular issues are cured (?) by operation.
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The Heart and Kidney Affections Following in the Wake of Gout.
Having gone over some of the main points in the treatment of the gouty attack and the gouty diathesis, we come now to a consideration of these affections of heart and kidneys that follow in the wake of gout; and indeed it is here that we have the most difficult duties to perform and the most complicated problems to solve. I mention the heart and kidney affections as being of primary and vital importance; but in truth there is no single part of the economy that remains in a really sound condition, for
with cardiac deterioration there is, pari passu, also a degraded state of the arteries certainly, and perhaps of the veins, and in equal step with this the liver is inadequate, the digestion is painful and laborious, the bowels constipated, the throat may be relaxed and catarrhal, and attacks of angina, pectoris, gastralgia, and "spasms" are far from infrequent. The skin, too, is almost sure to show signs of malnutrition, eczema being very common; and vascular naevi, senile warts, and the like are very
often met with. It necessarily lies beyond the scope of this volume to discuss the treatment for all these ailments, but a short glance at the main medicines will not be out of place.
A very frequently indicated remedy is gold - Aurum, either the Aurum metallicum, the Aurum muriaticum, or the Aurum muriaticum natronatum. And this remedy is all the more frequently called for on account of the past history of some of the worst cases of post - arthritic heart affections.
Strophanthus - I generally use the first centesimal dilution - helps much, notably where the mischief lies as between and concerning the liver and the right side of the heart.
Where fatty decay is a prominent feature Phosphorus does good, but Vanadium is here my sheet - anchor - it meets the atheroma of the arteries of brain and liver to a nicety, and thus fills a unique place as being a real remedy of this organic change, and, as an alternate remedy, Bellis perennis is a princely medicine. Vanadium 5 and Bellis 0 month about (with an intercurrent hepatic or two) have in my hands, time and again, restored veritable physical wrecks to health.
Digitaline 2X (Keith's) ever holds its own as a cardiac tonic. Convallaria majalis, too, is a sure friend in the gouty heart, and the same may be affirmed of Cactus glandifloris. The liver, pancreas, and spleen lie physically between the heart and kidneys, and must be concomitantly considered in some cases. The gouty dyspepsia having had its hearing, the kidney troubles proper loom large in the graver cases, and need the very greatest attention, as in them lie the ground causes of so many
constitutional upbreakings. Above all things in this regard we must take into account the state of the arteries as leading up to the shedding of the epithelial cells and the exudation of albumen.
Where there is grit and gravel present, I have had cause to be satisfied with Urticus urens 0 and Coccus cacti 0 in alternation at the beginning of the treatment, but their action is not very deep - going. Where the urine is muddy, peasoupy, the ancient Solidago virga aurea 0 soothes the kidneys gently - I had almost said sweetly - 5 drops in a tablespoonful of water is my usual dose. But Solidago is also a not very deep - going remedy. Coccinella septempunctata acts very like it, but goes down a
little deeper and stands midway between it and Cantharis, which fits the hot congestive quality of nephritis, but the dose must be infinitesimal. Where there is renal bleeding, Terebinth (not lower than the 3x) has classic claims on our attention. Phosphoric acid - about no. 1 - is very soothing to the kidneys when the urine is notably phosphatic. In Bright's disease a past grand master in therapeutics has all his work cut out, and he will need all his knowledge, however great, of climate, diet, raiment,
and therapeutics. The remedy which, taken by itself, has done most in my hands in chronic Bright's disease is Mercurius, about the third trituration. A tincture of cloves, in the same strength, will bring down the quantity of albumen excreted very frequently, and concomitantly there - with there is a rise in patient's feeling of well - being. Considering that cloves cause albuminuria, their use as a condiment should be condemned and forbidden. But the more gentle renal remedies, such as Solidago,
Coccinella, and Coccus cacti, are very soothing and helpful in alternation with these deeper - going remedies capable of inducing, and curing, organic change. It is often very helpful in chronic gouty kidney to consider the patient in his or her entirely, and not forget the patients while studying their kidneys. We shall often find that the kidneys are spokesmen for themselves first certainly, but for the liver, heart and arteries, and skin, and, indeed, I would affirm of the organ which we call the kidney
and of the organism, that the organ speaks for the organism and the organism speaks for the organ, each one "for self and partner. "
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Gouty Eczema.
This is an affection on which I claim to speak with authority, as I have seen a good deal of it, and know how to cure it. For my general views of the nature of cutaneous affections I refer my readers to my small book, entitled Diseases of the Skin.
In general, it will be found that gouty eczema is of a twofold nature, and, not infrequently, of a threefold nature, which can be very prettily demonstrated during one's clinical work, provided the sufferers are patient, which is not always the case, for patience is not commonly an attribute of your gouty person. Your thoroughly gouty individual may have himself well in hand, and always stop to dot his i's and cross his t's and make no use of unscriptural expletives, but he is at best a pent - up
volcano. He may be very suave and gentle, yielding and complaisant, but that is from principle, or training, or pride; aunaturel he is a wild creature, and his subject state is the result of taming. He particularly wants his gouty eczema cured quickly; the nasty thing must be got rid of right away, and hence he falls a ready prey to the skin doctors, who know so little and are so dangerously shallow that they can confidently and conscientiously tell you that the skin affection is a merely local affair,
which lanoline or ichthyol, with a due proportion of carbolic, will readily cure. These medicators really believe that a new fat is a medical discovery of the first magnitude, and yet, in very truth, neither ichthyol, nor lanoline, nor vaseline is one whit more of a cure of skin diseases than the good old pig's lard or a tallow candle.
We have had a vaseline era in dermatology, then came the era of lanoline, and at present we are basking, and at present we are basking in the full glory of the era of ichthyol, and it is all as inane as we can well imagine.
To cure gouty eczema we require patience and perseverance of no ordinary kind, and all the resources of a scientific pharmacology. Thanks to one Samuel Hahnemann, we have a scientific pharmacology, and its data may be found in Allen's Encyclopedia of Materia Medica Pura.
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How long does it take to cure gouty eczema?
Speaking for myself, I may say that I rarely succeed under a year or a year and a half, and it is often longer, and sometimes much longer, but then I really cure.
The first principle in the treatment of gouty eczema is negative: Use no external applications whatever, for the affection is not only constitutional, but it is also mostly compound and complex in its nature; and, I declare most emphatically, that the external treatment of gouty eczema is most dangerous - nay, I would say that it is positively idiotic. Surely, if we have a disease it is better outside than inside, and it, in the end, does not help us to lay the flattering unction to our souls that our
family blood is faultlessly pure when it is not. "There is no disease in our family, " one often hears; but is it so? Certain breeds are stronger than others, and given families in their blood - lives are relatively less impure than certain others, but people of absolutely clean, pure blood I have never known. Our family taints are printed in our skins in very bold type indeed, - only, happily, not every one can read the record.
Where the gouty eczema has become the cutaneous outlet for the constitution, its uric nature has to be borne in mind, and, in such cases. Acidum uricum 6, Urea 6, and Acidum lacitum 6, render notable service.
Where there is much irritation I have used Persicaria urens 6, 12, 30, with much benefit.
Where the whites of the eyes are dirty - looking and lusterless, Euonymus taropurp., Diplotaxis 0, and other hepatics are great favourites of mine in gouty eczema.
Where there is a demonstrable sycotic taint, I use all the antisycotics - such as Thuja, Sabina, Acid. nit., Cupressus, Medorrh. - with a free hand, but mostly in high and higher potencies at infrequent intervals. And every organ disease must be put right by its appropriate organ remedies.
Mercurius, Hepar, and Rhus ven. are also frequently indicated. Occasionally, when the wetting ooze dries up in layers, Castor equi has helped me When the skin is brown, on had brown patches, Sepia, Iodium, and Bacillin and Cholesterin are friends in need and indeed. The ultimate court of appeal is the Materia Medica Pura; and the Repertory shows the way to discover the right remedies. As a very needful check on aimless wanderings in this field, however, we find an accurate knowledge of the pathology -
the morbid biology - of the case in point, and if to this we add the fundamental principle, that in scientific therapeutics the curative range of a given remedy is fixed by its pathogenetic powers and possibilities, we are pretty sure to reach the goal. You cannot, however, hit the target a mile off with a gun that only carries fifty yards - no remedy is therapeutically grater than is the drug pathogenetically.