Saturday, June 17, 2006

O Frabjours Day Calloo Callay He Chortled In His Joy

Most important link I have yet published.

Very many congratulations from a humble admirer.

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.

Thursday, June 08, 2006

The Wilder Shores of Arthritis: Fit the Second

Rev Stone and his predecessors adhered to the old Doctrine of Signatures, which said that every plant, being created for man's use (cf The Book of Genesis), had in its appearance or habitat something to guide one to its use. Willow, growing and flourishing in damp conditions, would naturally be a specific for diseases associated with such conditions. Felix Hoffmann later independently developed acetyl-salicylic acid for the Bayer Drug Company in 1899: aspirin. This is a synthetic form of the substance which naturally occurs in willow-bark, which had been recommended by physicians for its analgesic properties as far back as Hippocrates. A substance might be used for the wrong reasons; but the fact that it kept on being used might suggest that it did have some efficacy. Only now, driven by the need for new treatments, are medical researchers studying folk usages with an objective instead of a dismissive approach.

When looking at this early medicinal advice, it's important to remember also the Doctrine of Humours. This was a theory, going back to Hippocrates at least, formalised by Galen and still surviving unconsciously today in folk remedies. It's similar in essence to Chinese and other eastern medical theory: the body contains certain elements (the humours in this case) that can get out of whack for one reason or another; one comes to dominate over the others; disease results, and the treatment must consist of restoring balance and harmony. In Western medicine the humours were held to be: black bile, yellow bile, phlegm and blood, and each would have the qualities of cold/heat and moist/dry. So plants and, later, post Paracelsus, chemicals with these qualities were the ones to be used to sort things out. We are now drifting well into the realm of abstract philosophical theorising and to hell with what actually was wrong with or helped the patient.

Back to the story. In medieval times the situation wasn't much changed. A MS of the reign of Henry VII contains a recipe "ffor all maner ache yn senos [sinews] or juntys [joints]" which suggests that you boil thyme in wine to a concentrate, in which you then boil a red cloth. Then wash yourself with the hot herb water and cover the affected parts with the cloth. As a matter of fact, red flannel was supposed to have protective properties - the flannel certainly would be very insulating, although the colour choice is probably down to sympathetic magic - and petticoats made of it were in use well into the twentieth century in Britain.

(A propos sympathetic magic, I can't resist quoting two instances from Frazer's The Golden Bough: if your fingers are stiff, collect some long-legged spiders and roast them, then rub your fingers with the ashes. The suppleness and nimbleness of the spiders will be transferred to your fingers. Again, for a case of gout or rheumatism, rub Spanish pepper into the fingers and toes of the sufferer: the pungency of the pepper will be too much for the gout or rheumatism, which will then depart in haste.)

Our anonymous medieval scribe has a cure for sciatica also: "Take a sponnefulle of the galle of a rede oxe and ij sponnfull of the wat[er] of Culerage [water pepper] and iiij of his owne water [urine] and as moche comyn [cumin] as half a french note [nut] and as moche sewet [suet] as a small notte and breke and bruse thy cumyn then boyll all thes together tyll they be grewell [gruel]." The patient then warmed his bottom against the fire and the concoction was rubbed in and he was sent to bed in heated sheets. I don't think the heat treatment would do much for the sciatica but it would help the patient to relax and, if he had arthritis and muscle spasm, heat and massage would help those. The contents of the spice cupboard I'm not so sure about; maybe they were local skin irritants.

Nicholas Culpeper (1616-54) was an astrologer-physician (the disciplines were not mutually incompatible then) who wrote a hugely influential Herbal, firmly based in the Doctrines of Signatures and of Humours, and with the astrological qualities of the herbs conveniently specified. By which we learn that All-Heal (aka Self-Heal, Prunella vulgaris) is "under the dominion of Mars, hot, biting, and choleric.... helps all joint aches." While also effective against "the bite of mad dogs and venomous beasts", hence the name, I suppose. Oil of chamomile (Anthemis nobilis), which he says "is much used against all hard swellings, pains or aches, shrinking of the sinews, cramps or pains in the joints", is still much prized by herbalists today as an anti-inflammatory . Comfrey (Symphytum officinalis), similarly, has been investigated and found to have therapeutic qualities, particularly in wound and ulcer healing; Culpeper suggests a poultice of the fresh leaves applied to painful or gouty joints.

Ground Pine (Ajuga chamæpitys) is, apparently, another martial plant, and is to be prescribed for palsy, gout, sciatica, rheumatism, scurvy, and all pains of the limbs. Palsy and scurvy are presumably in there because both of them can include joint and/or muscle pain in their symptoms. The root of horseradish (Cochlearia armoracia) (Mars again) is also recommended as a poultice for sciatica and joint-ache; I wonder if this would be yet another capsaicin-like counter-irritant? Raw horseradish certainly is, as is rue (Ruta graveolens) (under Leo, the sun, this time); rue causes extremely painful blistering of the skin, if gathered in sunlight. Tea made from tansy (Tanacetum vulgare) (Venus), a known, if drastic, vermifuge, if it didn't help the sciatica and joint-aches at least provided an urgent distraction.

The gardener's foe, Ground Elder (Ægopodium podagraria) (Saturn) is also significantly known as Goutweed; "it heals the gout and sciatica; as also joint-aches, and other cold pains."

Of course, Culpeper was a professional, licensed, physician. Thousands of amateurs, housewives, wise men and women of all sorts, had their own private recipes concocted in their stillrooms up till the end of the eighteenth century at least. One such, from Essex, is "Sir George Horseyes Green Ointment for Aches proceeding from a Cold Cause for Shrunke Sinews in Man, or Beast, & for Strains it's incomparably good & holds Perfection 40 years." It should; collecting the list of ingredients alone would take long enough: mallow, groundsel, strawberry, cotton lavender, birch leaves, chickweed, comfrey, parsley, sage, bay leaves, chamomile, adders' tongue [a fern], ox-eye daisy. But you haven't finished: roses, frankincense, pork lard, butter made in May and clarified in sunlight, salad oil, turpentine, verdigris. Blend and boil this lot, decant into closed containers and bury them three-feet deep in a pile of horse manure [I swear I am not making this up] for three weeks. Then boil them up again, strain, and add spike lavender oil. Apply to the affected place gently warmed. Well, it might smell nice.

This recipe illustrates what a pickle medicine had got itself into by the dawning of the nineteenth century. The professionals were increasingly distanced from reality into theories, while the laity were piling Pelion on Ossa in vain attempts to make sure that something worked, even if it was only the application of local heat and massage. Meantime the nineteenth-century arthritis sufferer found more emphasis placed on inorganic and less on herbal treatments, although the principles of heat and counter-irritant remained basically unchanged: "Rheumatic Plaster. Take one-fourth pound of resin and a like quantity of sulphur; melt by a slow fire, and add one ounce of cayenne pepper and one-fourth of an ounce of camphor gum; stir well until mixed, and temper with neatsfoot oil."

Those who rejected "chemical drugs", then as now, tended to retreat into a dream of "natural" remedies, like Sir William Withey Gull, Queen Victoria's personal physician (and one-time candidate for the rôle of Jack the Ripper); he wrote Rheumatism Treated by Mint Water, though whether he tried it on his Royal patron I don't know. She, by all accounts, preferred whisky, laudanum and cocaine. (How unlike, how very unlike, the home life of our own dear Queen.)

Tuesday, June 06, 2006

The Wilder Shores of Arthritis - Fit the Third

The eighteenth century had added the attraction of visits to spas and hot springs and sea-bathing (for the rich), and this survived until the Edwardian era at least. Hydrotherapy (hot or cold) and medicinal waters had been known since antiquity; certainly since the Ancient Greeks venerated the shrine of Aesculapius; now they were re-invented with the impetus of dubious scientific theories. Crounotherapy is the process of "drinking the waters", balneotherapy of medicinal baths, and thalassotherapy of medicinal sea-bathing (recreational sea-bathing didn't come in, in Europe, until well into the 19th century). Spa waters were usually either sulphurous, chalybeate (iron-contaminated, Sam Weller's warm-flat-irons taste) or saline (salt or brackish); the most effective for arthritic and rheumatic complaints was the saline, externally; it was the ancestor of the modern hydrotherapy pool.

Because bathers float better in a strong salt solution, they can mobilize inflamed joints and muscles gently and safely, freed of much of the pull of gravity. The "brine baths" at Droitwich were four times as salty as the Dead Sea and were much in vogue in the early 19th century.

St Ann's Well, at Buxton, goes back to Roman times. Thomas Cromwell tried to close it as a Papist shrine during the Reformation, but evidently did not succeed; Mary Queen of Scots, who had rheumatoid arthritis, paid several visits, and in the 17th century some anonymous poet wrote

Old men's numb'd joints new vigour here acquire;
In frozen nerves this water kindleth fire,
Hither the cripples halt, some help to find,
Run hence, their crutches unthank'd left behind. (1662)

It is perhaps necessary to remark, that the same waters were used for internal and external treatments, occasioning some temptation to the more economically-minded spa owners and risks to their clients, as one Christopher Anstey pointed out in 1766:

You cannot conceive what a number of ladies
Were washed in the water the same as our maid is...
So while little Tabby was washing her rump
The ladies kept drinking it out of the pump.

Not that that possibility deterred the arthritics, who will try anything once: Madame de Sévigné treated her aching joints to the cure at Vichy, which consisted of drinking water tasting of saltpetre and then being hosed down by hot douches of the same (which she describes as "a good rehearsal for Purgatory"). Jane Austen's brother Edward took his gout to Bath in 1799; "I fancy we are all unanimous in expecting no advantage from it," she wrote.

Cold hydrotherapy, reasonably enough, was much less popular with arthritics, although Sir John Floyer of Lichfield (Samuel Johnson's family doctor, incidentally) in the 18th century did build a cold bath for his rheumatic patients, accompanied by the standard bleeding and purging, just to make unpleasantly sure.

Homeopathy was also formally discovered in the eighteenth century, 1790 to be precise, by a German physician, Samuel Hahnemann (1755-1843). It remains a contentious subject, even today, with many ardent adherents and bitter opponents. The basic principle, which Hahnemann, a humane practitioner, developed in reaction to the increasingly aggressive and toxic treatments being inflicted on patients by his fellow doctors, was similia similibus curentur, "let likes be cured by likes": so that if you have a symptom, say, fever, you give a little of something which promotes fever, in order to stimulate the body into producing its own reaction. Like immunisation, in fact.

(Actually it was all based on a misunderstanding of a disease process. Hahnemann had observed that quinine "cured" malaria. He found that when he, not having malaria, took some quinine, he developed, and then recovered from, symptoms which he assumed were the same as those of malaria - they were not, they were his idiosyncratic reactions to the drug, which were alleviated as the drug wore off. Not for another hundred years would people know that the symptoms of malaria are caused by a parasite in the blood, and that quinine kills one stage of the life cycle of this parasite.)

Unfortunately the elaborations and rationalizations which have accrued to justify his theory have thoroughly discredited homeopathy in the minds of most mainstream scientists. Put brutally, the physical and physiological bases of these theories are nonsense. They are based on eighteenth-century knowledge and theories, pre atomic theory, pre microbiology and germ theory itself, pre any notion of the endocrine system, the lymphatic system, the immune system....

Nevertheless, homeopathy can work. I say that because I have seen it work, in people and animals, just as I have Bach Flower Remedies, and I don't know any reason why they should succeed either. For arthritis, some of the remedies used in homeopathic doses include Rhus Tox, Poison Ivy (Rhus toxicodendron), Bryonia, White Bryony (Bryonia alba), Ledum, Wild Rosemary (Ledum palustre), Ruta Grav, Rue (Ruta graveolens) and some non-organic compounds Calc fluor and Causticum. Take at your own risk; they are diluted so far that not one molecule of the active ingredient remains, anyway.

Aspirin is a useful anti-inflammatory, thrombolytic, analgesic, and febrifuge. The chemical basis was first synthesised in the 1850s but in that form it was dangerously irritating and it was not until the 1890s that, as I have said, it became available to the general public.Moreover, it's cheap and available off-prescription in the UK. Unfortunately, and this is a quality it shares with all subsequent arthritis treatments, it is also a gastric irritant. Take a lot of it regularly and you will probably not die, but you will have one hell of a bellyache and bleeding, ulcerated gastric mucosa. This is why it should always be buffered by enteric coating, food, or at least milk.

(An interesting sidelight on patient psychology: aspirin has no sedative or hypnotic action whatsoever, but in the first half of the twentieth century, it was very commonly taken as a sleeping-pill. Why? Presumably because, when taken by someone with some kinds of chronic pain, it eased the pain and allowed the person to sleep. So does morphine, but morphine does also have a sedative effect. The assumption must have been that aspirin works in the same way: the power of placebo illustrated.)

Sunday, June 04, 2006

The Wilder Shores of Arthritis - Fit the Fourth

Before leaping into the twentieth century, a word about painkillers in general, not just anti-arthritis drugs. (We'll get to the NSAIDs one day, I promise.) Pain is only a symptom that something has gone wrong. If you have acute pain from a single reversible cause, such as a fracture or an abscess, you can hope to relieve the pain by curing the cause. If, however, you have a chronic condition, such as arthritis, where the pain is due to multiple irreversible tissue changes and damage, you could, excluding surgery, relieve the pain only by (a) physically interrupting the sensory nerves which supply the information to the brain (b) distracting the patient physically (by counter-irritant) or psychologically (by analgesic, antidepressant, sedative or hypnotic) (c) continually damping down the inflammatory response which is causing the pain.

For most of history, option (b) has been the only one available. The daddies of all analgesics are, of course, opium, and alcohol. Opium goes back long before Hippocrates (fourth century BCE); it has been recorded by the ancient Assyrians, Sumerians and Egyptians, and appears in ancient Greek legends as well. Alcohol probably dates to when the first man ate a bit of rotting, fermented fruit and liked the sensation of getting high. The problem with them is that they are both potent CNS (central nervous system, ie the brain) depressants and they both cause habituation. A weaker ancient alternative to opium is lactuarium, extracted from the juice of wild lettuce.

Mandrake (Atropa mandragora) was used by the ancient Egyptians 1400 years BCE; it is one of the Solanaceae (potato family) as is henbane (Hyoscyamus niger). Cannabis (Cannabis sativa) was known to the ancient Chinese as an analgesic but seems to have been used recreationally by everyone else. Hemlock (Conium maculatum), the poison that killed Socrates, was used by the Romans and in medieval times in poultices and as "sleeping sponges" - a form of analgesic glue-sniffing.

Opium dissolved in alcohol became the basis of many analgesic/sedative tinctures, the most well-known of which is laudanum, the favourite tipple of Samuel Taylor Coleridge, Wilkie Collins, Branwell Brontë and many other unfortunates, who became insidiously addicted. In 1805 morphine was refined from raw opium. When its addictive properties were realised in turn, diamorphine was developed as a further, safer, refinement; ironically, although it is a much stronger painkiller, it is also many times more addictive. After the first world war, in the UK and many other countries, the opiates (except for codeine in the UK) were declared to be Dangerous Drugs and their use strictly forbidden without prescription; cannabis followed in the 1930s and the barbiturates in the 1950s.

Also in the 1950s came a Wonder Drug, the first of all the synthetic steroids - cortisone. Its discoverer, Tadeus Reichstein, and his co-scientists, got the Nobel Prize for its discovery. Corticosteroids are produced naturally in the body by the adrenal cortex; they are essential hormones involved in the stress response, immune response, and inflammatory response amongst other functions; the immune and the inflammatory are the ones that concern arthritics. They revolutionised the treatment of intractable disabling inflammatory and autoimmune conditions like Crohn's, ulcerative colitis, asthma, lupus, sarcoidosis, psoriasis. They also had horrendous and often irreversible side-effects, as may any drug, but this was not realized until quite some time later.

Meanwhile, over-prescribing ("Let's see what other conditions it will cure") and overdosage ("If one milligram works then two milligrams must work better") had done their damage: the loss of bone, the thinning of skin, damaged gastric mucosa, diabetes mellitus, behavioural changes, notably aggression and delusions.

When the side-effects of steroids became apparent, many alternative painkillers were developed: good old over-the-counter paracetamol, phenacetin (long-since banned); the NSAIDs: mefenamic acid, ibuprofen, indomethacin, naproxen, diclofenac sodium; the opioids: tramadol, pentazocine, buprenorphine....they all have their disadvantages to the continual user. Those that aren't gastric irritants or addictive tend to be hepatotoxic (paracetamol) or nephrotoxic (phenacetin).

But steroids were the first class of drug to tackle the problem of arthritis at a stage more sophisticated than just masking the symptoms. Everyone ever since has been hoping for the philosopher's stones: why does osteo-arthrosis occur in the first place, in some individuals and not in others (rheumatoid is certainly an autoimmune reaction); how exactly does it do its damage; and thus, what can be done to prevent, or if not that, reverse it?

These are still largely unanswerable questions in the 21st century.

Let's say there's going to be a genetic predisposition: even if (when) we can identify the gene(s) responsible, and if (large presupposition) it turns out that these genes don't also have a benevolent function as well which we can ill do without: what are we going to do about it? Is the arthritis gene to be added to the growing list of ills that flesh is no longer going to be heir to because they are going to be screened out at the pre-implanted embryo stage or by abortion?

It is now possible to detect the bony changes of arthritis much earlier and more easily. There is now a recently-developed technique called acoustic emission which can be used by any GP in his local surgery, to actually hear the noise made by the moving joint, before any symptoms of pain or stiffness have even become noticeable. Fine; but what do you do then, if you can neither limit the damage (because you don't know the why) or reverse it (because you don't know the what)?

Friday, June 02, 2006

The Wilder Shores of Arthritis - Fit the Fifth

In the face of this mainstream helplessness, alternative therapies have burgeoned. Some people swear by acupuncture, not just as a treatment but as a cure. Acupressure can also work, but for a while only; as soon as the pressure is released, back comes the pain.

People with rheumatoid have a list as long as your arm of food they should, and should not, eat. Studies show that fish oils, for example, have a beneficial effect, on both rheumatoid and osteo, so we all gulp cod-liver-oil until another set of studies casts doubt. Partly, of course, this is the fault of the modern media intrusion into areas of scientific interpretation they are just not competent to dabble in. For instance, I recall an excited news report a couple of years ago that some component of green tea had found to be useful in preventing/reversing the degeneration of osteo. So of course, I pricked up my ears. The truth is rather less dramatic. It is likely, that if you drank green tea every day for about forty years, you might slightly reduce or delay the damage to the joints. That's all. You might well also suffer some side-effects, such as hallucinations, from the green tea, which itself is mildly toxic in quantity, if you overdid it.

The media also never seem to be able to distinguish between osteo and rheumatoid; it never seems to occur to them that, if the causes and effects are quite distinct, the preventatives and treatments might be so as well.

Aromatherapy apparently traces its origins back to Ancient Egypt, specifically the use of spices and essential oils in embalming. Erm, yes, though I can't imagine an allopathic clinician would seek to win confidence for his ars longa by claiming skills and practices honed in the undertaking trade. Anyway, it is a branch of phytotherapy, or herbal medicine. I had not realised that it can be internal as well as external in application. It boasts an impressive list of essential oils that can be used externally for arthritis (which type? it doesn't distinguish), gout, and rheumatism, from Angelica, via Eucalyptus and Nutmeg, to Thyme. This means, of course, massage with rubbing alcohol or sweet oil; a treatment in itself. Internally, Garlic, Juniper, and Onion are among the oils recommended.

A recent report on osteopathy and chiropractic has concluded that the benefits they bestow, as far as these diseases are concerned, are no better than placebo, much to the predictable outrage of their professional associations. This seems to me to miss the point with admirable precision: if you have no effective treatment or cure, then placebo is what you use, allopath, homeopath or whatever. It may even help. I myself have got much benefit from reflexology, which the BMA doesn't even deign to recognise, much less assess; I am quite sure that the benefit is placebo-derived but what the hell? It relieves the pain for a while without giving me an ulcer, blood dyscrasia, or liver damage, and that, these days, is something to be thankful for.

Urtication, TNS and capsaicin therapy all work essentially on the counter-irritant principle. TNS is derived from the "gate theory" of pain transmission. The idea is that the spinal cord can transmit only so much sensory (pain) information; fill the fibres up with the impulses generated from the TNS machine, and there is no room for the signals from the complaining skeleton. It's a bit of a circular argument: TNS works because the gate theory is correct, and the gate theory is proved to be correct because TNS works. (It does, incidentally, but not for every kind of pain.)

Urtication (nettle-stings) and capsaicin (derived from capsicum peppers) are local skin irritants just like Ralgex. Probably it's the rubbing-in, the massage, which gives as much relief as anything. St John's Wort oil (Hypericum perforatum) is another rubifacient with a good reputation. They can all cause local skin allergic reactions.

In some people, for example the late actor Jack Warner, bee-sting therapy has worked dramatically; the poison seems to stimulate the innate antiinflammatory response just right, and the stiffened, aching joints are released and move freely. Nobody knows how exactly it works.

(Incidentally, it was hoped that a dermal plaster of paracetamol preparation would be just as effective an analgesic as an oral dose while avoiding the gastric irritant effects; sadly, longer trials have revealed that any but the briefest usage reduces the user's response to the drug to the point where pain relief is inoperative.)

Herbal remedies, of course, persist, many of them never having been updated since Hippocrates, either in their materials or in the theory behind them. A sentence such as "constipation is almost always a factor in rheumatic disease, causing toxic overload" and recommending purgatives and diaphoretics, would have commended itself to all those ancient practitioners who thought that disease was down to mysterious malignant entities who must be physically expelled - by any orifice available - before curing could take place. I am considerably pro herbalism, but only if it is conducted in a properly scientific manner, accompanied by at least some knowledge of anatomy, physiology and disease processes, not a regurgitation of a couple of millennia's worth of exploded theories born of nothing but ignorance.

The book I am quoting from - I won't be so cruel as to name it, because it's only typical - cheerfully conflates rheumatism, fibromyalgia, osteo-arthrosis and rheumatoid arthritis as if they were all one and the same, then states "in all forms of rheumatic disease there are two main causes: stress, tension, and personality problems....and a poor, inadequate diet." We-ell, up to a point, Lord Copper. Stress and tension and personality problems generally are certainly factors in autoimmune inflammatory conditions, in that they make them worse, but cause....? Diet, again, can exacerbate these conditions by inadvertently providing allergens or excluding needed nutrients, but cause....? Face it, nobody knows precisely what triggers off such conditions, least of all the authors of popular herbals.

Willow, of course, is recommended, so are nettles (taken internally, as tea); and soothing rubs of chamomile; so far, so traditional. Other remedies include cowslip, onion, lemons, celery (seed) and seaweeds; more exotic are Devil's Claw (Harpagophytum procumbens) from Africa, which has been clinically investigated, mainly in Germany, and Guiacum (Lignum vitae) from the West Indies. Devil's Claw needs to be treated with care; I don't know how effective it is in treating rheumatism or the arthritises, but it has a potent effect on insulin metabolism, so diabetics beware. Guiacum, curiously enough, has a long history as a specific for syphilis; there is a form of acute inflammatory arthritis which is secondary to untreated syphilis, so perhaps that is the connection: it doesn't cure that either.