This page, history of gout, biographical sketches of famous gout sufferers, and how they tried to deal with it, was last reviewed or updated on 14 July 2017.
Benjamin Franklin is one of gout's most famous sufferers. For non U.S. readers, we should say that Franklin was one of the leaders of the American revolution. His is the face on the US$100 banknote (bill).
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The portly, and actually a very reluctant revolutionary, penned a humorous essay where he imagined a conversation with Madam Gout, his tormentor. You can download a freeMP3 audio book of this essay here, courtesy of Project Gutenberg. It's just an essay, not an ebook or Kindle book. You will be listening for 3 - 4 minutes. Or you can read it at this URL., courtesy of Bartleby.com.
In this essay - A Dialogue between Franklin and The Gout - Franklin disclosed that he understood his diet and sedentary lifestyle could be the causes of his gout. But not exactly.,and it seems he never bothered to diet and exercise, nor give up any of his favourite foods, and especially wine. Neither did he say in this essay that he knew about uric acid.
In the last 15 years of his life up to his death in 1790, his gout attacks had become longer and fiercer. They usually do. Ironically, during these years, something of uric acid's role was learnt. The MSU crystals had long been discovered by this time.
The discovery of uric acid, a significant development in the history of gout, happened in 1776. The Swedish-German scientist Carl Wilhelm Scheele found it in kidney stones and urine. If Franklin had learnt about uric acid from Scheele's discovery, he would probably have mentioned uric acid in his dialogue with gout essay. He wrote this essay four years after Scheele's discovery, so there had been plenty of time to learn about uric acid.
So it's not likely that Franklin knew about uric acid, which means he didn't know about purines, nor which foods are high in them. He knew his gout was something to do with his diet, but not exactly what.
Franklin seems to have done little about his gout. He drank copious amounts of wine (at least two bottles a day, perhaps per meal, according to one biography) during the many years he lived in London, and later in Paris.
His gout may have developed into the kidney stones which also caused him pain. About 20% of gout sufferers, who do nothing about their gout, will develop kidney stones made from uric acid. The main cause of kidney stones is calcium oxalate but in some cases they are made from uric acid, especially in gout sufferers.
As is often the case, Franklin's gout worsened as he aged - it seems attacks became longer and fiercer. In 1780 he had a six week attack, considerably longer than usual. He is known to have dealt with one serious attack by taking laudanum, which the 18th century botanist Carl Linnaeus also wanted to take for a gout attack.
What caused Franklin's gout? He was certainly overweight, sedentary and drinking too much alcohol. It seems like the classic case of excess purines causing gout. Franklin was a printer for many years and would have handled lead type daily. Lead and gout have been linked - there has long been a suspicion that lead exposure can cause gout by inhibiting uric acid excretion. But there is as yet no study proof that there is a causal connection, although lead exposure may lead to something else, which leads to gout.
Laudanum and gout These days laudanum means tincture of opium i.e. alcohol mixed with a form of opium. In Franklin's time it may have been this, but it could have been opium plus another substance,as mixed by the prescribing physician. In the 18th and 19th centuries laudanum was widely used for pain relief and a variety of ailments. Franklin's decision to use it would not have been considered unusual.
KING HENRY VIII Life 1491 - 1547. Reign 1509 - 1547
In the history of gout, England's King Henry VIII is one iof the most famous sufferers. He was very fond of a type of eel that's thought to be high purine. He was also fond of at least two other high purine foods. Read more about Henry VIII and gout in the October 2008 edition of The Gout Dugout newsletter and find out what were these favourite foods.
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KING GEORGE IV Life: 1762-1830. Reign: 1820-1830
"Who's your fat friend?" flippantly asked the early 19th century British "dandy" George (Beau) Brummell. A dandy was a highly fashionable male. Brummell, for example, recommended polishing boots with the froth of champagne. The fat friend was Britain's Prince Regent, later to be crowned King George IV. He overheard the remark, and never spoke to Brummell again. Brummell, who invented the stiff cravat and who was once rich and feted, died in poverty. George died with gout.
The Prince Regent, Later George IV in His Garter Robes, 1816
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George IV may have been "The First Gentleman of Europe" (as he was sometimes known) and highly artistic, but he was also an epicure, a lover of fine foods and wines, to the point of gluttony. He hired the famous French chef Marie-Antoine Careme who cooked in the Great Kitchen at the Royal Pavilion, the palace George
built at Brighton on England's south coast. By the age of 52, he had a waist of 50"(127 cms). Almost an inch for every year of life. And when he died he weighed 22 stones (308 lbs).
So if you know anything about gout you won't be surprised to hear that George IV suffered it - from the age of 54 (and maybe younger) until his death at 68 in 1830. What did he do for his gout? Did George assiduously study the large literature of the history of gout? Probably not. Take colchicine? Maybe. Colchicine went into a well known gout remedy at the time called L'eau Minerale.
Laudanum for gout again But one substance we do know he used to deal with the pain of his gout was laudanum. George either mixed it with cherry brandy or took both together. The result was of course that he was frequently too dopey to conduct government business - he couldn't see his Ministers. And it definitely wasn't the best way to take cherries, which might have helped his gout.
BENJAMIN DISRAELI Life: 1804 - 1881.
As a politician and statesman you could put Benjamin Disraeli (Lord Beconsfield) on the same platform as that other Benjamin…...Franklin. Disraeli rose to become a celebrated British Prime Minister in the nineteenth century, still remembered today more than most.
Benjamin Disraeli, 1st Earl of Beaconsfield
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Disraeli is the only British P.M. to be a novelist, with the exception of Churchill who wrote just one novel; the only to have begun life Jewish, although he converted to Protestantism (Anglican/Episcopalian). And he had a sartorial style unrivalled by any other. He is remembered too for his masterly speech making, and pithy one-liners. His nickname for his Colonial Secretary (Minister for the Colonies) was "Twitters." He may have thought of it first.(2)
But like Franklin, he seems to have been pretty hopeless at dealing with his gout.
Disraeli had his first gout attack probably in 1863, when he was 59. He already knew a lot about it, and how sufferers suffered, because his political partner, the Prime Minister Lord Derby, was frequently absent with very chronic gout in several joints. These absences increased Disraeli’s work load since he became acting Prime Minister. In 1868, Derby’s gout became so bad and frequent that he had to resign the Premiership, and Disraeli took over. By age 68 his gout was so bad that Queen Victoria said to him: " To think you have the gout, all the time ! How you must have suffered." Because of his gout she allowed him to wear slippers in his audiences with her, as he did in the House of Commons."
Disraeli was aware of the new gout medicine that arrived in the 1860’s – lithia (lithium), the substance the discoverer of the true cause of gout, Sir Alfred Garrod, thought so highly of. In a letter to a colleague (1) Disraeli describes asking a retired judge of British India about lithia. What he heard from the judge was “inspiriting” (heartening).
Disraeli never succeeded in controlling his gout, and he was plagued by it for the last 18 years of his life. One suspects he was too keen on politics to devote enough time and effort to finding permanent relief. He suffered gout throughout his longest period as Prime Minister 1874 – 1880. He suffered a lengthy gout attack just four months before he died in 1881. And an attack of knee gout on his deathbed (3), although he died from an attack of bronchitis, not gout. The progression of gout to his knees is a strong sign that his was a well-entrenched case of gout.
So why did Disraeli fail to deal with it? His choice of doctors wasn’t the best. His first doctor doesn’t seem to have had a clue. He even recommended Disraeli use port as a remedy! Eventually Queen Victoria persuaded Disraeli to switch doctors after she heard he was being treated with arsenic for his gout. She got him a homeopathic doctor, a Dr. Kidd, who attended to Disraeli until he died. But Kidd didn’t succeed either. Kidd learnt that Disraeli had Bright’s disease (kidney diseases) which of course frequently accompany gout. He suggested Disraeli give up the port and drink claret as a medicine. Disraeli liked claret; this must have been music to his ears, but not to his gout.
You might have thought that since the world’s greatest gout expert of that time, Sir Alfred Garrod, was alive and practicing in London that Disraeli must have heard of him. But it seems that Garrod was never consulted which suggests a lack of vigorous application to this task on Disraeli’s part. Anyone who knows something about gout, and who has read Garrod’s book The Nature and Treatment of Gout and Rheumatic Gout, knows Garrod had some good remedies.
In fairness to his doctors, Disraeli was not a good gout patient. He was popular with hostesses – zipping off to dinners, banquets, parties and receptions just after recovering from gout attacks, where he would guzzle wines and eat the huge meals so beloved of prosperous British Victorians. This, as any successful gout campaigner knows, is out of the question. The doctors attempted to persuade him to exercise – at least the 30 minutes of vigorous daily walking that’s required - but when Disraeli did walk (not often), his pace was too slow for the walk to be considered exercise. And after his wife died in 1869, he lived, for much of the time virtually alone in a huge country mansion, which was probably not kept as warm as it should have been.
Disraeli can’t be blamed for not knowing about high purine foods, since they weren’t known at this time as a major source of uric acid. He was fond of many of the wrong foods from his estate in Buckinghamshire or gifts from aristocrat friends – venison, grouse, pheasant, (all game/game meat), which is high purine and not advisable and trout, a fairly high purine fish. On one occasion he accepted a gift of 20 pheasants and ate the lot.
So Disraeli carried on with his same old habits, and gout carried on its same old habits with him.
Disraeli and gout references
(1) The Letters of Benjamin Disraeli 1860 -1864, the University of Toronto Press Inc., 2009, courtesy of Google books.
(2) Disraeli by Robert Blake. Publishers: Methuen & Co. Ltd. London 1974.
(3) British Medical Journal, 9 April 1881.