Doctor Franklin's Medicine

Chapter 17. The Gout as Your Friend?

C H A P T E R 1 7 The Gout as Your Friend? I continue well, except for a little Gout, which is perhaps not more a Disease than a Remedy. —Benjamin Franklin, 1783 Gout is a metabolic disorder characterized by sodium urate deposits in the joints. Typically, the joints of the extremities are most affected, and the great toe is usually the worst off of all. The result is a succession of localized pains with swelling and redness, which can make walking difficult and, in severe cases, almost impossible. Benjamin Franklin, like so many people in the eighteenth century, knew the clinical manifestations of gout firsthand. AN ANCIENT DISORDER Gout received considerable attention in classical antiquity.1 The Hippocratic physicians believed that it resulted from a humoral condition, usually too much bile or an overabundance of thickened phlegm. They had different names for gouty accumulations in different parts of the body. When the disorder involved the foot, as it often did, it was called podagra, a term meaning “foot-grabber.” Celsus, Arataeus, and Galen were among the numerous authors to write about gout in the Roman period. Celsus pointed out that many Roman emperors , with their rich diets and propensity for excessive drinking, suffered from gout. Arataeus suggested that the condition might be inherited, and added that a gout sufferer could still win an Olympic race, but only during a period of remission. Galen contended that venery, in addition to overeating and overdrinking,mightcauseit.Thus,inancienttimeswehavetheideathatgout may result from rich foods, too much love, and excessive wine drinking. The Greeks imagined Aphrodite being seduced by Dionysis, whereas the Romans changed the names of gout’s parents to Venus and Bacchus. Notably, both agreed that the joint swelling and pain could be kept at bay by limited wine intake, less love, and bland diets.2 THE GOUT AS YOUR FRIEND? 277 Colchicum was one of the many herbals used to treat gout in antiquity. It gets its name from Colchis, a temperate region on the Black Sea where Colchicum autumnale (meadow saffron) was harvested.3 But neither the Greeks nor the Romans suspected that this plant had specific anti-gout properties. To the ancients, colchicum was just another purgative for ridding the body of harmful matter. The subsequent idea that colchicum might have specific properties for fighting gout and other arthritic diseases seems to have emerged with Alexander of Tralles, a physician from the mid-sixth century . He recommended it to gout sufferers along with less wine and fewer “dainty dishes.” Its popularity, however, decreased over the ensuing centuries , in part because it could upset the stomach and even prove fatal. When it was “rediscovered” in the sixteenth century, gout sufferers with the means to buy colchicum, strangely enough, preferred to wear it around their necks. The word “gout” was first used in its modern sense by Randolfus of Bocking , a Dominican monk of the thirteenth century who suffered from gutta quam podagram vel artetican vocant (“gout which is called podagram or arthritis ”).4 Because Randolfus seemed to be helped when he wore the boots of a bishop, he recommended bishop’s boots as his treatment of choice. A related cure from this period of deep religious convictions was a pilgrimage to a church or a shrine, such as the tomb of Thomas à Becket, the destination of the pilgrims in Chaucer’s Canterbury Tales. Gout was thought to affect men more than women, adults more than the young, and the rich more than the poor well before and through the Renaissance . The tale of the spider and Mr. Gout, an early personification of the disorder, has been told from the ninth century on. Adopted by Petrarch in 1338 and by Jean de la Fontaine in 1668, it deals with gout’s predilection for the rich.5 Richard Hawes, a Cambridge graduate and “useful preacher,” included one version of the story in The Poore-Mans Plaster-Box, his popular medical handbook from 1634.6 It begins with Mr. Gout meeting a spider. With night falling, they came to a poore man’s house, which the Gout took up for his lodging, for he being always a lazy companion, would not go further; but the spider being more nimble, went to a rich man’s house, and there took up his lodging for the night. The next day they met again and discussed how the night went. “Mine,” said the gout, “was the worst as ever I had, for I had...