Saturday, June 10, 2006

The Wilder Shores of Arthritis: Fit the First

I would like to thank The Goldfish without whose patient expert advice this blog would have no pictures.

Non-steroidal anti-inflammatory drugs. The very phrase is like a bell, to toll me back to my arthritic self. For reasons with which I won't bother anyone, I've been off my usual intake for a while now, with the result that I am slowly but surely stiffening up, especially in the mornings. Where would we be without them?

Arthritis is as old as mankind, huddled miserably in damp pigskin loin-cloths and dripping mammoth-hair overcoats around the cave fire. Bones showing arthritic changes go back millennia. Oetzi the Iceman had not only bones with arthritic changes, but also tattoo-like puncture patterns suggesting that he might have been treating the pain by acupuncture*. So, although it seems to have been accepted as part of life's rich tapestry to a degree - there are not nearly as many old recipes for arthritis or rheumatism cures and treatments as there are, for example, for the pox, or even mad dog bites - mankind put their heads together and observed that some things made it easier, some worse.

The ancient Egyptians certainly knew about arthritis. Ramses II (1279-1213 BCE) suffered from it, as evidenced by his mummy. There is nothing like a royal connection to concentrate the doctors' minds on an illness; look at porphyria and haemophilia.

The Ebers Papyrus, from 3,000 BCE, deals with gout, and also with neck stiffness: "Another remedy: When you see a man in whose neck is mucilaginous matter and he suffers from the joint of his neck, he suffers from his head and the vertebrae of his neck are stiff, his neck is heavy. it is impossible to look at his belly or very difficult.
Then you shall say: someone having mucilaginous matter in his neck.
Then you shall cause him to anoint himself and to apply ointment, so that he will improve at once."

The diagnosis of sciatic pain was described with precision in the Edwin Smith Papyrus (1700 BCE): "If thou examine a man having a sprain in a vertebra of his spinal cord, thou shouldst say to him: extend now thy two legs and contract them both again. When he extends them both, he contracts them both immediately because of the pain he causes in the vertebra of his spinal column in which he suffers. Thou shouldst say concerning him: One having a sprain in a vertebra of his spinal column".
- This method of examination is what medical students today know as Lassauge’s test.

Painful joints were treated by ointments which had, as a base fat, oil, bone marrow, gum or honey. To this they added flour, natron, onion, cumin, flax, frankincense or pine. (Flax seed (linseed) or animal fat is still used today in Egyptian and European folk medicine as an ointment or poultice for rheumatic pains). Poppy and thyme were noted as analgesics. Myrrh was the treatment prescribed for backaches, whether internally or externally I don't know.

Twenty-five hundred years after the Ebers scribe, Hippocrates wrote an entire and very sensible, practical treatise (On the Articulations) about treating all varieties of fractures and dislocated joints, but seems to have lost it a little when it comes to "pains of the back, the loins and of the hip joint". Observing that these come on with walking, the good doctor suggests that they are therefore caused by the walking, so you should stop it, thus ushering in immobilization therapy for arthritis, which only well into the latter half of the twentieth century has been conceded to do more harm than good.

Hippocrates, unfortunately, also roundly declared that "All diseases are resolved either by the mouth, the bowels, the bladder, or some such other organ. Sweat is a common form of resolution in all these cases." (On Regimen in Acute Diseases) Again, these words were treasured by his successors down the ages and we shall meet something very like them published less than fifty years ago.

The Romans carried on the Hippocratic tradition. Dioscorides (c.40-c.90 CE) and then Galen (130-200 CE) were mostly concerned with preserving and transmitting the Greek theory and practice as they understood it; they even wrote in Greek, in preference to Latin; they were not innovators (although Dioscorides does advocate the use of gentian against muscle cramps, which I haven't seen elsewhere). Galen took Hippocrates' notion of illness being an expression of an imbalance and formalised it thoroughly into what became known as the Doctrine of Humours (see below).

Some of the things our ancestors tried - usually on the belt-and-braces principle that if two things helped a bit separately, they must be even better when combined - make the treatment seem worse than the condition, at least to modern eyes.

Bald's Leechbook is an Anglo-Saxon text which dates from about 950 CE. Bald didn't write it; he commissioned scribes to compile it from much earlier Mediterranean and English sources, now lost. He has an interesting cure for "healswærce" (pain in the neck): the lower part of a nettle boiled in ox fat and butter mixed with ox gall in vinegar. Interesting, because "urtication" is still used today as a sort of herbal TNS, akin to capsaicin therapy. Memo: don't try either of these yourself except under medical supervision. Mind you, I much prefer the idea of that to another of his ointments: pigeon's and goat's droppings dried, crushed, and mixed with honey and butter. Shoulder and arm pain are to be treated with betony boiled in ale (drunk) and an ointment made of wenwort, which was probably much safer than the recipe for a painful knee: "cnua beolenan & hemlic, beþe mid & lege on." (Grind henbane [active principle: hyoscyamine] and hemlock [active principle: coniine] [both powerful poisons], bathe with it and lay it on". It would certainly more than take care of the pain.

The Lacnunga, an 11th century collection of Old English recipes, suggests for "liðwyrce" (limb pain) an ointment made of elecampane, radish, wormwood, bishopwort, cropleek, garlic, holleek, celandine, and red nettles, ground and boiled in butter then stored in a bronze vat until it turned blue (?mouldy). Alternatively, you could say a charm Ad articulorum dolorem constantem malignantem: "diabolus ligauit, angelus curauit, dominus salutauit, in nomine, amen." (The devil bound, the angel cured, the Lord saved, in [His] name, amen." History does not report what you were to do when that didn't work either.

The Herbal of Apuleius was translated into Old English from Latin and isn't any the more appetising; it suggests you take six ounces of greatwort (?) and six of goat's grease together with eighteen ounces of oil of cupressus, grind and mix them together and use as an ointment. Alternatively, for "stiðnes on lichoman" (body stiffness) you could try wood dock and old pig's grease and breadcrumbs crushed and made into a poultice. People would certainly know that you were present.

When considering Anglo-Saxon remedies, it's important to remember that their theories of disease were not quite like modern ones. They certainly believed in restoring balance and harmony as a cure for some disorders, but also in the activities of malign supernatural entities: flying venom (fleogende attor),worms (wyrmas, burrowing entities), dwarfs (dweorh, no, not Tom Shakespeare, more like what we would call gnomes or trolls), and elves who were believed to shoot darts into humans and animals (ylfa gescot), the shot causing, especially, rheumatism, arthritis and stitch. The existence of tiny stone arrowheads (Neolithic or Mesolithic in origin) was held to prove this, and as late as the twentieth century, such arrowheads were also used in folk medicine to "cure" such conditions, as like cures like (an usage that would have appealed to Hahnemann himself - see below).

Pause for a rant here: the treatment of folk remedies by the medical establishment highlights one of the most irritating facets of a discipline that claims to be ruled by scientific thought: their persistence in throwing the baby out with the bathwater. In deriding and dismissing the old herbalists and wise women, doctors never seems to have grasped that it is possible for the former to be right for the wrong reasons. Just as Dr Withering gets all the credit for digitalis (extract of foxglove) as an effective treatment for heart failure (for which it is still used, incidentally, in its synthetic form, digoxin), despite the fact that it had been so used by wise women for centuries, so the Reverend Edward Stone's reporting of the anti-rheumatic and febrifuge properties of willow-bark was disregarded by the medical establishment for a hundred years.

*I am indebted to Sally for this information.


Blogger Sally's Life said...

Charles - informative and entertaining post as usual, and pictures !!

Your reference to gnomes firing arrows, set me thinking about acupuncture and Oetzi, who was not a gnome but a Neolithic with a pouch of arrows.

I had a course of acupuncture on the NHS for chronic head pain years ago; it didn't solve the problem, but gave me a huge release of energy - I returned home and painted the garage after the second treatment. I still have the head pain.

Do you remember reading about the 5,200 year old ice man Oetzi found in the Tirol glacier ? He had tatoos at modern day acupuncture sites for arthritis and digestive problems and ct scans showed arthrosis.

I am not suggesting acupuncture as a treatment or cure; just that this is another instance of old wisdom lost to modern science.

I have sent you an email on Oetzi.

3:18 pm  
Blogger Charlesdawson said...

Many thanks, Sally, haven't received the email yet. I didn't know about Oetzi, that's great. Beats Ramses by over 2000 years!

5:20 pm  
Blogger Sally's Life said...

Sorry it didn't arrive, try this which I found googling:
enter search: Oetzi The Tyrolean It should come up with page from 9.2.03

6:01 pm  

<< Home