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During the first century of the Christian Era, the rheuma was a term used to refer to a humour that flowed. This flowing humour was typically considered to be phlegm or water. It was a clear to whitish substance expelled by the nasal cavities according to Hippocrates, who called it catarrhos rather than rheuma. The association of rheuma to clear to white fluids wouldn’t happen until the late Renaissance period, when a little known student in medicine Balonius used it to refer to the painful joint condition which he called ‘rheumatism.’ This rheumatism Balonius and his successors tried to differentiate from other diseases joints related to phlegm, with pain and swelling as the primary symptoms to consider. Still later, during the 17th century, a joint condition associated with the common and well know disease consumption, known as tumor albus (white tumor) was described. This was followed by some important work by physician Thomas Sydenham, who first proposed the means to differentiate common arthritis from other forms of arthritis was associated with the rheuma.
Sydenham himself was suffering from another very common disease of the upper class–gout. Gout is brought on by the collection of uric acid crystals in the joints spaces, resulting in its own form of arthritis often not differentiated from the other joint pains. This gout was a medical term coined in turn due to another very ancient name for this sort of arthritis–guttae–which refers to “drops.” In anatomy terms, this related mostly to the dripping of phlegm or water from the nostrils. But in the years ahead, by undergoing changes in the popular nomenclature for common diseases like arthritis, a differentiation between gout and rheumatism could be better defined and established as an acceptible interpretation of these two similar forms of diagnoses. It would be until the late 17oos that a very distinct difference between rheumatism and gout could be established, the result of work performed by J. Haygarth, whose very early epidemiological work on several thousand people with acute and chronic rheumatism cases enabled him to develop a more acceptible method fr categorizing and diagnosing these diseases.
For this reason, it is assumed here that Dr. Osborn’s conception of rheumatism and gout were not as advanced as one of the primary references noted in his vade mecum–Thomas Sydenham. Nevertheless, in terms of producing effective treatments, the differences between gout and rheumatism were unimportant to Osborn. One of the primary symptoms for each, arthritis, acute or chronic, compelled Osborn to treat both in the same fashion–treating the rheuma responsible for this diagnostic symptom. This is also be the reason Osborn did not include a page in his vade mecum devoted specifically to the very common disease gout, as suggested by Osborn’s seventh recipe in which he defines a treatment for “sciatic, or Hip Gout.”
Osborn’s treatments for rheumatism (and perhaps gout?) consist of the use of external applications common to modern treatment of painful joints such as liniments, unguents, plasters. The inclusion of a Prickly ash tonic in the recommended therapies suggests some sort of cleansing process perhaps being recommended (cleansing the blood of bad humours that collect in the joints). Notice the tendency for heat to be a major component of the joint therapies. This heat is produced by such things as a unguent of turpentine (with oil of terebinth), the mustard seed and whey formula, a hot clay soil pack, and a combined mustard-horseradish plaster. For severe cases, an emetic is recommended, to more aggressively purge the body of its bad humours.
The most interesting part about these formulas is the use of cupping (recipe 1) and issues (recipe 7). The cupping involves the use of a small hand-sized glass chamber, under which air can be trapped. When a lit object is placed beneath the glass cup, the air is “removed” thus extinguishing the fire and causing blood to be pulled through the capillary bed. A discoloration is then seen of the skin (a “hickey”). This method was design to draw the humours responsible for an illness from deep within the afflicted tissue, up to the surface of the body, facilitating its movement and diffusion elsewhere, both inside and outside the human body frame or corpus.
The use of issues is another technique used with intentions of driving away the humours. [For a definition of “issues”, Merriam-Webster.com has “a small globular object (as a dried garden pea or a wooden bead) formerly placed in an abscess or ulcer so as to induce or increase a suppurative discharge”.]
This method however is somewhat different than using cups to move the bad or stagnated humours about. For the issues, an open site in the body or skin has a pea-sized mass of medicine placed in it; this pea usually consists of a fine to slightly granular powder as its base, with ingredients designed to cause the open site to continue to swell and emit humors. Sometimes these humours are simply infectious material indicative of an abscess or impostume located beneath the skin, which is now being cleared of its bad phlegm and biles. Other times the pea itself causes pustulence to follow and to be emitted from the site. Either way, the philosophy for this method of treatment is maintained–the phlegm or rheuma responsible for rheumatism is expelled from the afflicted joint and ultimately removed from the body.
Applying this ideoogy to the two other diseases for which Osborn’s treatments may be applied–gout and sciatica. The sciatica in modern medicine is lower back pain, usually related to increased pressure or compression of the sciatic nerve which passes from the lower back on each side into the corresponding leg. With true sciatica, the nerve is irritated, and pain and other sensations can be felt radiating from where the nerve is being compressed, down along the lower body parts (legs), including the development of sensations in the skin. Other lower back related maladies can cause similar symptoms, including strains of the lower musculature due to strenuous activity, tendon-ligament stresseswith pain induced by abnormal twisting and turning, long term neuropathy conditions brought about due to chronic diabetes, obesity-induced lumbar muscle strain, and the herniation of vertebral disks, and other age-work-stress related injury. Any of these conditions may have sufficed as additional examples of gout or rheumatism for Dr. Osborn.
One of the more severe forms of gout, mentioned specifically by Osborn, is hip gout. This presents as arthritis-like lower back pains in association with other hip pains. For this condition, uric acid crystals have sequestered in one of the largest joint spaces in the body, so the results are not only extremely painful, but also quite debilitating in terms of ambulation (walking).
In general, gout is associated with high meat or protein consumption. Several of the amino acids in protein are responsible for uric acid formation following their breakdown at the cell and tissue level. Gout and several other diseases are typically associated with a high meat diet during the Colonial Period. In this way, poverty was less a cause for such diseases than being well endowed with both money and numerous high cost dietary items.
One of the materia medica footnotes on the above pages is in need of an update. In the third recipe, Osborn mentions the use of “poppel”. This term was originally identified as an old English term used in reference to one or more Poplar or Populus species. This was my preferred identity back in 1994 when I produce the above notes. However, poppel, spelled as Popple, refers to another more likely candidate–Tulip Tree (Liriodendron tulipifera). The popularization and ongoing documentation of this tree and its value by botanists residing in the Mid-Atlantic colonies suggests Osborn may have used this for much the same reasons that he chose other local herbs for his remedies–their availability, low cost, and most importantly, their impressive local natural history.
Brian Altonen, MPH, MS 
