This is a free online book published in 1777 by Dr. MacBride. He talks about “muscular rheumatism” in the chapter related to painful diseases.

(Personal note: All these old studies about “muscular rheumatism” and “rheumatic pain” are interesting to understand the history of medicine related to the study of the chronic pain, that somehow is related to what we are studying now, back mice.)

This book is free online:

//archive.org/details/methodicalintrod02macb/page/268

David MacBride (1726-1778) was an Irish medical writer. He is known for his work on the treatment of scurvy.

In page 268 of his book he talks about RHEUMATISM.

Notes about the chapter about rheumatism of this book:

-He uses the term “rheumatic acrimony” related to “muscular rheumatism” and “arthritic acrimony” related to gout. He also insisted that they are two distinct diseases.

-He says that the gout affects the ligaments, and the rheumatism affects the muscles and its membranes. In rheumatism a “rheumatic matter” fixes in the muscles and membranes.

-He relates rheumatism with the “suppression of natural discharges” that then fix in the fleshes. (Personal note: a fail with the lymphatic drainage?)

-He relates the rheumatism with “catching a cold”, “living in damp situations”, “new-built houses”, “neglect of exercise”… and other circumstances.

-He makes clear differences between ACUTE (with fever) and chronic rheumatism.

-He explains the treatments of the acute and chronic rheumatism.

-He comments on the bleeding techniques and about Sydenham.

-He mentions that the SUDORIFICS are the best to eliminate the “matter” which creates the rheumatism.

-He lists some specific types of rheumatism (dysentericus, arthriticus, scorbuticus, siphiliticus, etc.).

-He shortly mentions about lumbago, and that it should be differentiated from nephritic pain due to kidney stones.

-He shortly mentions about the sciatic pain.

Personal note: Again it seems that these old authors locate the problem with the “muscular rheumatism” in what they call the membranes of the muscles and the muscles. They talk about a kind of “noxious matter” that is a “natural discharge” that would accumulate there, and thus, cause the pain. Could this be the EDEMA that Copeman and others observed in the fibro-fatty tissue? Could MacBride’s “morbific matter” be the “serous exudation” that the French authors relate to what they named “cellulite”…?

The following text is partly written in old English.

Page 268

PAINFUL DISEASES.

C HA P. II. Of the Rheumatifm : Hiftory of the Difeafe ; different Species and Varieties ; with the Methods of treatment.

By David MacBride (1726-1778)

MacBride starts differentiating “rheumatism” from “gout” (they used “rheumatic acrimony” and “arthritic acrominy” to refer to these diseases:

[The rheumatifm is, in appearance, fo nearly allied to the gout, that they have been confidered as one difeafe, efpecially by the early writers: attentive obfervation however fhews, that they are diftinct genera, and that the rheumatic acrimony, is at leaft as different from the arthritic, as that which gives rife to the meafles, is from what produces the fmall-pox.]

MacBride states that in rheumatism the affection is located in the muscles and its membranes, and in gout it is located in the joint ligaments:

 [The morbific matter in the rheumatifm fixes on the mufcles, together with their common membrane, and the tendons; whereas the arthritic acrimony is direded to the ligaments which connect the joints: what it is that conftitutes the difference, or why the one fpecies of acrimony fhould depofit itfelf in one place, and the other fettle itfelf in another, are points of which we fhall not attempt the explanation.]

MacBride says that “catching of cold” is the most common cause related to rheumatism among others (like in new-built houses), and mentions that it is related to “SUPRESSION OF NATURAL DISCHARGES”:

 [The fuppreffion of natural difcharges, the living in damp fituations, or in new-built houfes, neglectt of exercife, and the ftriking in of cutaneous eruptions, are what ufually give rife to the rheumatifm but the catching of cold, as it is called, is what for the moft part immediately brings on the fit.]

MacBride makes a difference between acute (with fever) and chronic rheumatism:

 [Hence it is, that autumn and the the beginning of winter are the feafons wherein rheumatic complaints are moft frequent. There Is one fpecies of rheumatifm, attended by febrile fymptoms, and which therefore may be termed Acute ; and another, without fever, thence denominated Chronic.]

MacBride’s explanation of the acute rheumatism (what later was named rheumatic fever related to Strep A infection, with pains flying from place to place):

 [The acute fpecies generally affects fuch as are in the prime of life, and begins with a chilnefs and fhivering, which are foon fucceeded by heat, reftleflhefs, thirft, and other concomitants of a fever. In a day or two, or fometlmes fooner, there arifes an acute pain in fome or other of the limbs ; efpecially the wrifts, fhoulders, and knees, and all up the fleshy parts of the arms and thighs : thefe pains generally fly from place to place, and leave a fwelling and rednefs in the parts laft affected. Sometimes one part Is quite free from pain, while another is attacked ; at other times, many parts are feized nearly at the fame Inftant, and we fhall fometlmes fee every joint affected at once. In this cafe the patients are in a very diftreffed fituation, being incapable of moving, and dreading the attention of the attendants, as they can fcarcely admit of being touched without a fenfible aggravation of the pains ; and moreover are unable to bear even the weight of the bed-clothes, which muft be arched over the limbs by proper contrivances. The diftemper, however. Is often lefs violent, the fever being but moderate, and ceafing entirely when the pain begins, which is alfo confined to one or two places.]

MacBride explains the treatment in the acute cases: it was by then common to bleed the patient. It mentions that the blood in these cases presents “an inflammatory” sign, like a scum.

 [When called to a rheumatic cafe, we are to regulate our condud according to the ftage in which we find the difeafe : if recent, and the fever ftill high, we are to bleed ; and if the patient be of a full habit, and in the prime of life, repeat it at proper intervals, to two, three, or perhaps four times, according to the ftate of the pulfe, and violence of the fever, which are always to be our guides, and not the appearance of the blood, for the blood is found to throw up to the furface the fame kind of whitifh fcum, or inflammatory cruft, that is found in the pleurify and other inflammatory difeafes, though not fo vifcid.]

MacBride mentions Sydenham’s advices about bleeding, but insists that the bleeding should be prescribed according to the strength of the pulse. He says that sometimes “we must withhold the lancet”.

[Hence Sydenham and others have confidered the rheumatifm as a true inflammation, and treated it accordingly, depending chiefly on repeated bleedings. And fome people diredt thefe to be repeated till the cruft fhall difappear ; but it has been already mentioned, that this is a rule we are never to be governed by, but always regulate our bleedings by the ftrength of the pulfe, and by the apparent relief that they feem to give. Therefore, in the rheumatifm, if the patient is free from fever, or of a delicate frame, and if we find the pulfe begins to fink, notwithftanding the pains increafe, we muft withhold the lancet, and have recourfe to fome other means.

MacBride mentions other treatments of the acute rheumatism.

[Immediately after having blooded the patient, if he be of an athletic habit, we may begin with nitre, and give it in as large quantities as the ftomach will bear. Dr. Brocklelby fays, that thin water-gruel is the beft vehicle, and he ufually diffolved two drachms of nitre in a quart of gruel, which may be fweetened, if the patient chufes it, and a tea-cupful diredled to be taken every fecond liour. Wine-whey will, in general, be found a better vehicle ; but if the ftomach fhould rejed the nitre, then we muft fubftitute a palatable faline julep, and give it in large dofes. But both the nitre and this julep will be rendered more efficacipus by the addition of emetic tartar in a due proportion, Thefe things will feldom fail to keep the bowels open ; but if they fhould not, we muft order clyfters to be thrown up from time to time ; or, if thefe cannot be given, cream of tartar, fal poly-chreft, or Rochelle fait with manna.

“While the pains are extremely violent, they admit of no application, but whenever it is practicable to convey warm fteams to the affeded parts, it (hould be done, and when the patient can bear friction, we may diredt a mixture of oil, vinegar, and fpirit of hartfhorn, to be rubbed in warm, and the part afterwards covered over with flannel. A femicupium, or entire bath of warm water, after the requifite bleedings, and emptying the inteftines, frequently gives great relief. But we muft always take care that the bath be not ufed until after fufficient bleeding.

The patient’s diet all this while muft be of the thin vegetable kind ; barley-gruel with currants, roafted apples, and the like ; frefli runnet-whey, or two-milk whey, is at the fame time a grateful and a very proper drink -, but when the fever begins to fubfide, weak wine-whey may be allowed, or muftard-whey, made by adding an ounce of bruifed muftard-feed to a quart of boiling milk.

The pains are generally molt fevere toward evening, whence fome people might be tempted to give opiates ; but thefe muft be carefully avoided while the fever is high, as they will only aggravate and prolong the difeafe.]

MacBride theorizes that the diaphoretics are the best to eliminate the “matter that creates the rheumatism”.

[The matter which creates the rheumatlfm is beft carried off by the fkin ; and for this reafon, as the courfe diredled is all of the diaphoretic kind, it will facilitate the cure, if the patients lie in blankets, preferably to linen fheets. But the offenfive particles fometimes pafs off by a diarrhoea, or by turbid urine, which lets fall a large quantity of yellowifh fediment. It happens alfo, though but very feldom, that: the crifis in an acute rheumatifm is made by deporting a fharp humour on the legs, where it forms a number of little blifters, which terminate in ulcers, that ought not to be dried up too haftily. If by any of thefe means the pain fhould wear off, and the fever fubfide, the patients muft be put on a more fubftantial diet ; and, in order to diffipate the remainder of the rheumatic acrimony, we are to direct a light decodion of guaiacum, with faffafras and liquorice, to be taken in bed, morning and evening.]

MacBride mentions that in the subacute rheumatism the “acrid matter” lodges among the membranes of the tendinous and fleshy parts of the body.

[But it frequently happens, that after the fever has gone off, the pains (hall not only remain, but even increafe In violence, and continue to torment the patient for many weeks, or perhaps months : here then we are to have recourfe to fuch things as fhall ferve to attenuate, and diffipate the acrid matter, which is lodged among the memb– order to promote the cure at the fame time that we lull the pain, the opium muft be joined with ipecacoan, or emetic tartar, which renders it fudorific.

A mixture of equal parts elixir paregoricum, tinctura guaicina volatilis, and vinum antlmoniale, anfwers extremely well on thefe occafions, given, from one, to two teafpoonfuls, in wine- whey, at bed-time.

The bark is alfo found ferviceable in cafes where the pains are obferved to intermit, and where the fweatings in the beginning of the difeafe have been profufe, and the urine has depofited a fediment; it may be given either in fubftance or decodlion, according to the liking of the patient : but where there appears to be a coidnefs, and an.

Uncommon vifcidity in the blood, with a remiffnefs in the circulation, the refin of guaiacum is the medicine on which we are to place our chief dependence. The common fpirituous tindlures of the (hops are inconvenient forms for adminiftering this refine as it always parts from the fpirit the moment the tindlure is diluted in any watery vehicle, therefore it will be beft; to order the proper dofe, of a fcruple, or thereabouts, to be rubbed up with a little of the yolk of an egg, and diffolved by that means in an ounce or two of any pleafant diftilled water, to which we may add thirty or forty drops of the fpiritus vclatilis aromaticus, and a drachm or two of fyrup of fafFron or orange-peel j the whole making a draught to be taken at bed-time.

But a ftill more elegant way of adminiftering this refin is, by diffolving it in lime-water, by the addition of quick-lime : the refin and quick-lime, equal parts, are to be rubbed together, then the lime-water poured on, and when the mixture has flood till it becomes fine, filter the clear tindure. The volatile aromatic fpirit may be added in due proportion to this folution, and then it makes an elegant volatile tindure of guaiacum, which mixes in any watery vehicle.

Or, the refin may be diffolved in aether, in the fame proportion as directed in the London Difpenfatory for making the volatile tindure : this conftitutes a moft penetrating medicine, and has been found very efficacious, the dofe is from thirty, to fixty drops, dropt on a lump of fugar, and this diflblved in fome agreeable vehicle. So much for the acute fpecies of rheumatifm.]

MacBride’s notes about the chronic rheumatism. The affected parts DO NOT become RED or SWOLLEN as in the acute rheumatism. Bleedings are improper. Blistering is of great use. He mentions other treatments as opiates. He mentions that the best is to sleep with a “flannel shirt”.

[The chronic is moftly found to invade people who are rather advanced in life ; the pain feldom attacks fo many places at a time as in the acute fpecies, neither are the parts aflicted fo liable become red or fwoln. Repeated bleediiigs in thefe cafes are improper ; but bliftering is often of great ufe, and they require frequent purging, and fudorifics, fuch as have been juft now direded.

It is of fervice to add refin of guaiacum to the cathartics and opiates may be given with fafety, when the pains are fo fevere as to hinder the patients from getting the necessary proportion of fleep. Nothing anfwers better to fecure againft relapfes of the chronic rheumatifm, than wearing a flannel fhirt, which is alfo of ufe, in fome inftances, to alleviate the pains and lliorten the difeafe.

In thefe chronic cafes, topical applications are fometimes found to be of ufe, fuch as rubbing with equal parts of the volatile and foap-liniments ; and laying plafters to places where the pain is fixed, compounded of the gumand foap-plafters, with a little of the emplaftrum veficatorium.]

MacBride comments about the “obstinate rheumatic cases”. Some advices.

[Obftinate rheumatic cafes require change of climate, and the ufe of the natural hot baths and in perfons not too far advanced in life, the cold bath is an excellent prefervative againft returns of the rheumatifm. Both the acute and chronic fpecies of rheumatifm are liable to be complicated with other complaints, which render it neceffary to diftinguifti fome varieties of the difeafe. ]

MacBride presents distinct forms of RHEUMATISMUS.

1. Rheumatifmus dyfentericus. There are cafes wherein the morbific matter has been obferved, by turns, to affedt the inteftines with fevere griping and violent purging, and the flefhy parts of the body with acute pains : when the belly is at eafe, the limbs are excruciated with pains ; when thefe abate, then the griping and purging begin and thus go on tormenting and exhaufting the patient for weeks in fucceffion. The method of treatment which fucceeded in a cafe of this fort was, fmall dofes of ipeeacoan with opium, mild dofes of rhubarb being occafionally interpofed but the recovery was flow, and not complet, until the warmth of the fummer months came in to the phyfician’s aid.
2. Rheumatifmus arthriticus ; when the pains occupy the joints, and at the fame time fpread to the flefliy parts, fo that it is hard to fay whether the difeafe be gout or rheumatifm. Thefe cafes particularly require, and feldom yield to any thing but the natural hot baths.
3. Rheumatifmus fcorbuticus. which affeds people who have fuffered from the putrid fcurvy, and been long confined to garrifons, or at fea. Courfes of goat’s whey, or of common whey mixed with, freih vegetable juices 5 new brewed fpruce-beer, or frefh infulion of malt, taken in the way that fhall be mentioned hereafter, with vapour-bathing, are the moft likely means of eflablifhing health in thefe circumflances. The loofe rotten gums, fwelled legs, and livid fpots,. will ferve to diftinguifh the fcorbutic rheumatifm.
4. Rheumatifmus fphiliticus. When there is teafon to believe that there is a complication of venereal virus with the rheumatic acrimony, the ufe of vapour-baths, and a courfe of mercurials,, combined with feme convenient preparation of antimony, together with the decodion- of farfapariila, will bid fair to eradicate the difeafe.
5. Rheumatifmus hyftericus. When pains of the frheumatic kind diftrefs perfons of the hyfteric temperament, the cold bath, and a courfe of the cortex macerated in lime-water, as before directed, will be found the moft likely means of giving more ftrength to the folid texture, and abating the extraordinary degree of fenfibility. The fmall of the back is the place where hyfteric people are moft apt to feel fevere pain. We formerly mentioned the complication of the rheumatifm with an intermittent fever, whereirj there is alfo a neceflity for giving the cortex. 

MacBride’s notes about lumbago and Sciatica: He says that lumbago and sciatica are types of rheumatic pain and that the “Suvages” have described many types.

[The lumbago or fixed pain in the fmall of the back, and the ifchias vulgarly termed Sciatica, or fixed pain in the hip, do not appear to be diftinct genera, but may be confidered as fpecies of the rheumatifm or gout : of both thefe there are feveral varieties ; no lefs than feventeen of the lumbago, and eleven of the ifchias, being diftinguifhed by Sauvages.]

MacBride comments that it is important to differentiate the “real lumbago” from the “nephritic pain”. By then, they knew about the “stones of the kidney”. He differentiates the treatment of the lumbago that presents in acute rheumatism vs. the chronic form.

[The lumbago may be confounded with the nephritis, or nephralgia, wherein the pain arifes either from an inflammation of the kidney, or from ftoney concretions lodged there but in the two laft-mentioned difeafes there is generally a naufea or retching to vomit, and a numbnefs or uneafy fenfation all down the thigh ; whereas in the true rheumatic lumbago the pain of the loins is not fo attended, and there is a greater increafe of pain upon ftirring, or endeavouring to raife up the body, than when the cafe is nepiiritic.

When the lumbago partakes of the nature of an acute riieumatifm, we muft bleed repeatedly, give faline purges, and throw up clyfters, with turpentine dillbived in the yolk of an egg ; nitre willalfo be required, with plentiful dilution.

But in cafes of the chronic kind, it will be proper to apply a ftimulant plafter to the fmall of the back, or to rub the fame part with volatile liniment, and alfo give a folution of the capivi, or Canada balfamso.]

MacBride names the sciatic pain Ischias rheumatica. He mentions certain common treatments by then.

[The fciatica fometimes appears to belong, more to the gout than rheumatifm and in fuch cafes the pain is more deeply feated than wehen it arifes from rheumatic acrimony. The former is termed Ifchias Arthritica the latter Ifchias Rheumatica, the treatment of both niuft be regulated according to what has been already laid down for the two primary difeafes, Bliftering the thigh, or cutting an iffue in the proner place, either above or below the knee, have been found to relieve the pain of the hip.

Dr. Fothergill finds that calomel in fmall dofes, joined with fudorifics, is remarkably efficacious in this difeafe, which generally baffles every other attempt to relieve the pain, He gives pills of one grain, and wafhes them down with a draught compofed of feme grateful diililled water, thirty drops pf the vinum antimon, and twenty-five of tindura tljebaica, thefe are taken every night fucceflively for ten or twelve times ; and if after that the pain does not abate, he increafes the dofe of calomel to two grains, one night, and one the next, alternately as the pain wears off, the anodyne is gradually difcontinued. He fays that he has feldom met with a genuine fciatica, that has not yielded to this procefs, in the fpace of a few weeks. See his paper in the 4th vol. Med. Obfervations, page 74.

It has fometimes happened in cafes of inveterate fciatica, that fuch a flow of humours hasfallen on the joint as to relax the ligamentum rotundum, which connedts the femur with the focket whence an imperfedl or even complete luxation has enfued. An abfcefs has alfo been known to form in the fame place ; and in lying-in women, who have agreat flow of milk, if this be fuddenly fupprefled, there are cafes where a fevere pain has begun in the groin, and fpread itfelf to the hip, attended with an (edematous fwelling of the leg and thigh)

This difafe has been already mentioned, and will be further confldered in its proper place.]

Published in May 2019 by Marta Cañis Parera

Reference:

A Methodical Introduction to the Theory and Practice of the Art of Medicine. David Macbride (1729-1778). Published in 1777 in Dublin.