CHAPTER XII. ON ARTHRITIS AND SCHIATICA.
ARTHRITIS is a general pain of all the joints; that of the
feet we call Podagra; that of the hip-joint, Schiatica; that of
the hand, Chiragra. The pain then is either sudden, arising
from some temporary cause; or the disease lies concealed
for a long time, when the pain and the disease are kindled
up by any slight cause. It is, in short, an affection of all
the nerves, if the ailment being increased extend to all; the
first affected are the nerves which are the ligaments of the
joints, and such as have their origin and insertion in the
bones. There is a great wonder in regard to them; there is
not the slightest pain in them, although you should cut or
squeeze them; but if pained of themselves, no other pain
is stronger than this, not iron screws, nor cords, not the
wound of a sword, nor burning fire, for these are often had
recourse to as cures for still greater pains; and if one cut
them when they are pained, the smaller pain of the incision
is obscured by the greater; and, if it prevail, they experience
pleasure in forgetting their former sufferings. The teeth and
bones are affected thus.
The true reason of this none but the gods indeed can truly
understand, but men may know the probable cause. In a
word, it is such as this; any part which is very compact is
insensible to the touch or to a wound, and hence it is not
painful to the touch or to a wound. For pain consists in an
exasperated sense, but what is compact cannot be exasperated,
and hence is not susceptible of pain. But a spongy part is
very sensible, and is exasperated by an injury. But since
dense parts also live by their innate heat, and possess sensibility
by this heat, if then the exciting cause be material,
such as either a sword, or a stone, the material part of the
patient is not pained, for it is dense by nature. But if an
intemperament of the innate heat seize it, there arises a
change of the sense; the heat therefore is pained by itself,
being roused within by the impression on the sense. The
pains then are from nature's being increased, or a redundance
thereof.
Arthritis fixes itself sometimes in one joint and sometimes
in another; sometimes in the hip-joints; and for the most part
in these cases the patient remains lame in it; and the other
joints it affects little, and sometimes does not go to the small
joints, as the feet and hands. If it seizes the greater members
which are able to contain the disease, it does not go beyond
these organs; but if it begin from a small one, the attack is
mild and unexpected. The commencement of ischiatic
disease is from the thigh behind, the ham, or the leg. Sometimes
the pain appears in the cotyloid cavity, and again extends
to the nates or loins, and has the appearance of anything
rather than an affection of the hip-joint. But the joints begin
to be affected in this way: pain seizes the great toe; then the
forepart of the heel on which we lean; next it comes into the
hollow of the foot, but the ankle swells last; and they blame
a wrong cause; some, the friction of a new shoe; others, a long
walk; another again, a stroke or being trod upon; but no one
will of his own accord tell the true one; and the true one
appears incredible to the patients when they hear of it. On
this account the disease gets to an incurable state, because at
the commencement, when it is feeble, the physician is not at
hand to contend with it; but if it has acquired strength from
time, all treatment is useless. In some, then, it remains in the
joints of the feet until death, but in others it spreads over the
compass of the whole body. For the most part, it passes from
the feet to the hands. For to the disease there is no great
interval between the hands and the feet, both being of a
similar nature, slender, devoid of flesh, and very near the external
cold, but very far from the internal heat; next the
elbow and the knee, and after these the hip-joint; which is the
transition to the muscles of the back and chest. It is incredible
how far the mischief spreads. The vertebræ of the
spine and neck are affected with the pain, and it extends to
the extremity of the os sacrum: there is a general pain of all
the parts of the groin, and a pain peculiar to each part thereof.
But likewise the tendons and muscles are intensely pained; the
muscles of the jaws and temples; the kidneys, and the bladder
next in succession. And, what a wonder! at last the nose,
the ears, and the lips, suffer; for every where there are nerves
and muscles. A certain person had pains in the sutures of
the head, and not knowing why he was pained there, he
pointed out the shapes of the sutures--the oblique, the straight,
the transverse--both behind and before, and stated that the
pain was narrow and fixed in the bones; for the disease spreads
over every commissure of the bones, in the same manner as
in the joints of a foot or of a hand. Callosities also form in
the joints; at first they resemble abscesses, but afterwards they
get more condensed, and the humour being condensed is
difficult to dissolve; at last they are converted into hard,
white tophi, and over the whole there are small tumours, like
vari and larger; but the humour is thick, white, and like hailstones.
For it is a cold disease of the whole (body), like hail;
and there appears to be a difference in regard to heat and
cold; for in certain cases there is delight in things otherwise
disagreeable. But, I fancy, that the cause is a refrigeration
of the innate heat, and that the disease is single; but if it
speedily give way, and the heat re-appears, there is need of refrigeration
and it delights in such things; this is called the hot
species. But if the pain remain internally in the nerves, and
the part not becoming heated subside, nor get swollen, I
would call this variety cold, for which there is need of hot
medicines to restore the heat, of which those very acrid are
most necessary. For heat excites the collapsed parts to
swelling, and calls forth the internal heat, when there is need
of refrigerants. In proof of this, the same things are not
always expedient in the same cases, for what is beneficial at
one time proves prejudicial in another; in a word, heat is
required in the beginning, and cold at the conclusion. Wherefore
Gout does not often become unremitting; but sometimes it
intermits a long time, for it is slight; hence a person subject
to Gout has won the race in the Olympiac games during the
interval of the disease.
Men then are more readily affected, but more slightly the
women; women more rarely than men, but more severely.
For what is not usual nor cognate, if from necessity it gets
the better engenders a more violent ailment. The most
common age is after thirty-five; but sooner or slower according
to the temperament and regimen of every one. The pains
then are dreadful, and the concomitants worse than the pains;
fainting even upon touch, inability of motion, loss of appetite,
thirst, restlessness. But, if they recover partly, as if escaped
from death, they live dissolutely, are incontinent, open-handed,
cheerful, munificent, and luxurious in diet; but partly, as if
they would (not?) again escape from death, they enjoy the
present life abundantly. In many cases the gout has passed
into dropsy, and sometimes into asthma; and from this succession there is no escape.
