SOME SURGICAL CAUSES OF 
RHEUMATISM. 
By JAMES A. FREER, M.D., 
Washington, D.C. 
Reprinted from the North American 
Journal of Homceopathy. 
July, 1894. SOME SURGICAL CAUSER QF RHEUMATISM.* 
By JAMES A. FREER, M.D., 
- Washington, D. C. 
FOR some time past I have been making observations on the line 
suggested by the title of this paper, but the difficulty and 
necessary slowness of discovering evidence that is conclusive 
has prevented me earlier making public the results of my observa- 
tions, and I am aware that the proof is not now adequate to place 
my conclusions beyond controversy, but I wish to present it for your 
kindly consideration and the help of your opinions. 
The need of a thorough knowledge of general medicine as the 
foundation for unprejudiced and successful specialism is made suf- 
ficiently apparent continually, not only to those disposed to criticise 
the work and opinions of specialists, but every honest specialist 
realizes continually the necessity of broadening the scope of his 
general knowledge, to avoid the danger of magnifying the relative 
importance of his particular branch. 
The necessity of the most scrutinizing conservatism has in this 
day of intense search for something new, and in this day of concen- 
trated and more than ever intelligent endeavor to discover and abort 
causes and invent remedies, been most impressively demonstrated to 
us. The urgent demand of the times, now as ever, is, ' ' prove all 
things and holdfast that which is good." I wish here to disclaim 
any attempt in what may follow to prove anything for any specialty 
in the realm of medicine or surgery, and will attempt to give only 
an unprejudiced statement of a few constantly observed facts which 
have helped me to some conclusions concerning what may be called 
* Read before the Washington Homoeopathic Medical Society. 2 
Papers in Medicine. 
some surgical causes of rheumatism, including all types, excepting 
the so-called septic varieties; concerning these, while much has been 
decided by different investigators, they are not yet thoroughly under- 
stood, the ptomaine theory not having been sufficiently elaborated to 
account for all the manifestations of this class of maladies and the 
possibility of trophic influences has not yet been eliminated. 
Acute articular rheumatism and the lithaemic state, arthritis 
deformans, and muscular rheumatism, undoubtedly are affected by 
the causes to be mentioned. 
The demonstrable general, and the remote localized effects of 
disturbance resulting from irritation of the sympathetic system of 
nerves, have with the increasing knowledge of the physiology of 
these nerves, during the past few years, been a source of astonish- 
ment to all who have pursued study on this line. Where a few 
years since there were merely surmises concerning the relation of 
abnormal states of these nerves to pathology, we now have marvel- 
lous demonstrations; and evidently the most frequent location of 
the irritation has been discovered. A mechanical means of stimulat- 
ing this system has also been employed, which is superior to any 
method that preceded it, which for years has been a desideratum 
striven after by leading minds of our profession. Resulting from the 
employment of this knowledge in my own experience, goitre has 
disappeared, tumor of the liver, diagnosed as cancerous by another 
practitioner besides myself, has been absorbed, serious heart trouble 
has been removed, inflammation and irritation of the ovaries have 
vanished, serious osteitis and bronchitis have been cured, together 
with almost innumerable abnormal mental and physical conditions; 
altogether showing conclusively the dependence upon a healthy 
condition of this system of nerves of the involuntary functions of the 
different organs and systems of the body. 
It is the observance of the almost constant association of rheuma- 
tism in its different manifestations, with some form of irritation of 
the nerve terminals of the sympathetic system, and its apparent 
dependence upon this irritation, that has given rise to conclusions to 
which I have been forced to arrive, namely, that in the majority, if 
not in all cases, this malady depends upon disturbances in the general 
system, brought about by a disordered state of the sympathetic 
system of nerves, the result of irritation caused by the pathological 
conditions, usually of the rectum or genital tract, superadded to an 
hereditary or induced condition of the system which gives rise to a 
tendency to rheumatic troubles. By this qualification I do not mean 
an hereditary or induced condition which in itself would result Some Surgical Causes of Rheumatism: Freer. 
3 
in rheumatism, but a condition of the tissues on account of which 
the disturbed state of the sympathetic system causes the different 
rheumatic manifestations, in a manner similar to which other ten- 
dencies may determine other manifestations, the certainty of which 
is not doubted. 
Gout may in some measure depend on the same causes, though 
there are other well defined reasons for its invasions. 
This is not the time or place to give in detail, if I were able, the 
chemistry of lithsemia from any cause, but a brief statement will 
show the possibility of the blood becoming overcharged with uric 
acid, as a remote result of irritation of the sympathetic nerve termi- 
nals, and the almost constant association of rheumatism with some 
demonstrable form of such irritation, together with its evident de- 
pendence upon it, as I have many times proven, is evidence suffi- 
cient in my opinion that there are recognizable surgical causes of 
lithaemia. 
Diminished alkalinity of the blood has been abundantly proven 
to be the condition which favors the accumulation of uric acid in 
the system. The recognition of this fact has determined the method 
of treatment by the so-called allopathic school, the aim of which is 
to increase the alkalinity of the blood, and thereby increase its power 
to dissolve uric acid, and convert it into a form to be eliminated from 
the system. This treatment consists in the administration of alkaline 
waters and remedies, together with regulation of the diet. 
The homoeopathic treatment is of course indicated by the totality 
of symptoms, and with its tendency to remove systemic causes, it is 
more rational, and consequently more successful than the mode of 
treatment above mentioned, though I believe some homoeopathic 
practitioners employ alkaline waters as adjuvants. 
One of the most commonly observed symptoms of a tired-out 
sympathetic system is disturbance of the digestive function, which 
is presided over by that system of nerves. The most common form 
of indigestion under these circumstances is the fermentative or acid. 
Hence the process is simple, the ingested food enters the stomach, 
where owing to abnormal conditions, instead of exciting a physiolog- 
ical congestion of that organ and a properly increased flow of gastric 
juice, owing to the impaired condition of the sympathetic nerves, 
this does not occur, and as a consequence, the food instead of being 
digested, ferments, generating gas and lactic acid, the gas to be 
expelled, and the acid to be absorbed with whatever peptones may 
result from the attempt at digestion, and the circulating fluid, the 
tissues, and excretions of the body become vitiated by it, i. e., the 4 
Papers in Medicine. 
blood becomes less alkaline and the secretions less alkaline or acid, 
producing the state of body most favorable for the accumulation of 
uric acid in its tissues. In this manner the way is paved from irrita- 
tion of sympathetic nerve terminals to an excess of uric acid in the 
system, which constitutes with its attendant and resulting symptoms, 
lithaemia, and composes the necessary congeries of conditions, the 
next step in advance of which, the proper exciting causes being 
added, is acute articular rheumatism. 
It would require but a small effort to recall cases in corroboration 
of the foregoing views, so but little of this sort of evidence will be 
given. 
Case I.-A young man of about twenty, a sufferer for years from 
acid dyspepsia of very severe type, presenting symptoms of lithaemia; 
urine hyperacid, saliva of acid reaction, tongue coated, bowels con- 
stipated, urine depositing an excess of uric acid. Physical examina- 
tion revealed a contracted prepuce which made constant pressure on 
the glans. Apparently indicated homoeopathic remedies administered 
by several physicians over a long time, afforded but slight and tem- 
porary relief; thorough dilating of the foreskin removed the trouble 
perfectly and permanently. 
Case II.-Lady, age sixty-two years, in circumstances which 
afforded her a life of leisure, suffering from symptoms of lithaemia and 
chronic arthritis, which was occasionally varied by subacute aggra- 
vations, came to me from the hands of an old-school practitioner who 
had given her vigorous alkaline treatment, with results in the main 
unsatisfactory. Her trouble was traced to chronic metritis, the relief 
of which, by combined local and internal treatment, placed all of her 
lithaemic symptoms in abeyance. Subsequently her general condition 
fluctuated with the condition of her uterus. 
Cases could be reported where apparently similar troubles depend- 
ing upon similar causes were treated unsatisfactorily, in my opinion, 
because treatment of the local disorder locally has been declined. 
Another common and very troublesome manifestation of rheuma- 
tism is arthritis deformans. A great amount of discomfort and 
mortification arises from this painful and deforming malady. Many 
facts concerning it have been discovered through scientific investi- 
gation relative to its aetiology and pathology, but the unanswered 
Why? still remains and invites to new attempts at its solution. 
Statistics show that about eighty per cent, of all sufferers from this 
cause are females; in this respect it is in contrast with the acute 
articular variety, in which the male is more exposed to the recog- 
nized precipitating causes. Some Surgical Causes of Rheumatism: Freer. 
5 
The explanation of the greater frequency of the deforming 
variety in the female is no doubt found in their peculiar type of 
orificial irritation, or in the possibility of the articular structures 
being more vulnerable on account of more delicate structure. 
It is an observed fact by all writers on this subject, that the vic- 
tims of this disease are almost always those suffering from some 
abnormal nervous condition, which apparently may have been pro- 
duced by emotions or overwork. It is hard to conceive of such an 
issue being possible, if the nerves were originally in a normal con- 
dition; mankind was not created to succumb in this manner either 
to emotions or to work, and in the vast majority of cases which do 
so succumb it is not the load of work or emotion alone that is respon- 
sible for the tired-out nerves, but the far more burdensome load of 
some constant irritant to the sympathetic system, usually located in 
the genital tract. Hence, it is the physical!'s duty to look beyond 
what is termed nervousness, nervous prostration, etc., for causes, 
keeping in view the fact, that possibly there may be some cause 
assignable for the depraved nervous condition itself other than the 
somewhattaverworked one of heredity. Doubtless, the joint lesions 
observed in this disease are of neuro-trophic origin; by just what ulti- 
mate process the lesions are produced, it is beyond the power of 
human means of investigation to determine, which is true of any 
vital or pathological process. The starting point in the cases which 
it has been my province to observe, has apparently been in some 
local irritation of sympathetic terminals; the equilibrium of this sys- 
tem of nerves becomes disturbed, subjecting the numerous functions 
of the body over which it presides to irregularities. While the exact 
process by which the joint affections are produced cannot be explained, 
in gross it is as follows : first from disturbed innervation there takes 
place a disturbance in the secretion of the synovial membrane, both 
in quality and quantity-the quantity being diminished, and in 
quality it is abnormally fibrous-simultaneously with the change in 
the synovial fluid; the motion in the joint being continued, changes 
are set up in the synovial membrane itself, inflammation supervenes, 
still further influencing the secretion of synovial fluid, until finally 
the joint becomes spuriously anchylosed by the organization of the 
fibrinous secretion or it becomes dry, in which state the friction of 
ordinary motion soon destroys the unprotected membrane. In this 
issue the joint surfaces become eburnated by constant attrition; if 
motion is kept up the inflammatory process now attacks the perios- 
teum and excites its osteogenic function, giving rise to the deposit of 
bone salts and to the formation of new bone in the region of the joint 6 
Papers in Medicine. 
causing, if the process be continued, locking of the joint; but in all 
of its stages the process is subject to modification by properly 
administered treatment. 
The frequency of the existence of this form of joint disease, with 
some form of sympathetic irritation, usually uterine, impressed me so 
often when I was not looking for it, that it suggested a possible 
dependence of it upon some trophic disturbance originating at the 
location of the irritation, and a more careful investigation of cases 
has convinced me that this is true, for I find every case of the affec- 
tion associated with other characteristic symptoms of disturbance of 
the sympathetic system, and some local cause of irritation always 
present. The result of treatment affords additional proof ol the indi- 
cated relationship. 
These conclusions are the result of observing not a great number 
of cases, the detailing of which here is unnecessary; suffice to say, 
that I have not yet found any clinical evidence, conflicting with that 
upon which my conclusions are based. 
Just what muscular rheumatism is in its ultimate pathology, 
including its different types, has not yet been fully deteripined, but 
it is necessary only to follow our course to throw at least some addi- 
tional light upon its aetiology and nature. The causes of acute 
myalgia or muscular rheumatism are sufficiently obvious to require 
no comment arising from sprain, chilling or traumatism, and subsid- 
ing usually within a few days, but what of the chronic variety which 
causes such a large proportion of human ills? Concerning it, writ- 
ings are both meagre and vague. It has been intimated that possibly 
there is some relation between the cause of muscular and articular 
rheumatism, that is, that uric acid in excess is the cause of the for- 
mer; however, concerning this I have been able to find nothing 
definite in text-books. Clinical evidence leaves no doubt that an 
excess of uric acid in the system can, and does produce in some 
cases typical myalgia, sometimes of an acute, but more often of a 
subacute or chronic type. The following is a case of acute myalgia 
from the cause in question : 
Case III.-Married woman, age forty-three years, under my 
observation for several years, during which time she has occasionally 
been attacked by acute myalgia of the right psoas muscle. A diag- 
nosis of chronic metritis and rectal irritation was rendered in this 
case by a gynaecologist who is an authority. Urinary analysis 
showed that the system was overcharged with uric acid; general 
irritability, loss of strength, constipation and digestive disturbance 
were present. Some Surgical Causes of Rheumatism: Freer. 
7 
In this case acute attacks of myalgia always affecting the same 
muscle occurred with varying degrees of frequency, and were always 
relieved promptly by alkaline treatment. In this and in several 
other observed cases quite as typical, myalgia was evidently due to 
the lithsemic state and the uric acid to the causes above indicated. 
Whether this is the explanation of all cases of muscular rheumatism 
of the subacute and chronic types, or all cases not evidently due to 
the exciting cause of the acute varieties above referred to, is yet a 
question, but apparently there is a class of cases where the disturb- 
ance is due entirely to disturbed nerve conditions, in distinction from 
those caused by changes in the blood, but due to similar primary 
causes; the manifestations in this variety differ in severity in differ- 
ent individuals, and may attack almost any muscle or set of muscles; 
the symptoms are the most uniform and constant of any of the 
varieties named. By just what the discord is produced, in these 
cases, is not within my power to say-whether by terminal neuritis, 
by inflammation of the muscle fibre, or by malnutrition of the muscle 
cells, but whatever the process may be concerning its origin, indub- 
itable clinical evidence relates it as an effect to some form of sympa- 
thetic irritation.