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.)


Blogger Sally's Life said...

Good morning Charles.
My appreciative comment on Fit the Second also applies to Fit the Third - interesting, thank you.

9:46 am  
Blogger Gimpy Mumpy said...

Love the recent posts :)

12:04 am  

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