|Fig. 1 A decrepit man screaming in pain from gout, rheumatism and catarrh; represented as three tormenting devils. Coloured etching by J. Cawse, 1809, after G.M. Woodward. Credit: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)|
The recent reproduction of G. Cruikshank’s A self-indulgent man afflicted with gout by a demon burning his foot reminded me of many memorable remarks made by sages of various disciplines (several themselves victims of gout) on the subject. That the excruciating pain of gout (Figs 1 and 2) provokes mirth and ribald comments perhaps reflects man’s capacity for sadistic humor. There used to be a widespread notion that gout was a just punishment for luxurious high living, drinking too much port or wine: “The Disease of Kings.”1
Hippocrates linked gout to an intemperate lifestyle, “arthritis of the rich.” He observed that a woman did not take gout unless her menses stopped. Galen associated gout with debauchery and intemperance, but recognized a hereditary trait, also mentioned by the Roman senator Seneca. Long lists of famous people afflicted by gout are well known.1 Gout has aroused many accounts, pictures, comments, metaphors, and similes, some cruel but many amusing.
An expensive shoe does not rid us of the gout, nor an expensive ring of a hangnail, nor a crown of a headache.
Plutarch, On Tranquillity, c. 95 AD
Women rival men in every kind of lasciviousness . . . why need we then be surprised at seeing so many of the female sex afflicted with the gout?
Seneca 1st century AD
Falstaff: A Pox of this Gout, or a Gout of this Pox; for the one or th’other plays the Rogue with my great Toe . . . A good Wit will make use of any thing; I will turn Diseases to commodity.
William Shakespeare, Henry IV, Part II. I, ii.
Yet am I better Than one that’s sick o’ th’ gout; since he Had rather groan so in perpetuity than be Cur’d by th’ sure physician death.
Shakespeare, Cymbeline, V, iv.
Gout, unlike any other disease, kills more rich men than poor, more wise men than simple. Great kings, emperors, generals, admirals and philosophers have all died of gout.
After a time this comes to a full height . . . Now it is a violent stretching and tearing of the ligaments . . . So exquisite and lively meanwhile is the feeling of the part affected, that it cannot bear the weight of bedclothes nor the jar of a person walking in the room. . . .The old saw is that “if you drink wine you have the gout, and if you do not drink wine the gout will have you.”
Thomas Sydenham (himself a victim) 1683.
|Fig 2. The Gout. James Gilray 1799. Via Wikimedia|
People wish their enemies dead—but I do not; I say give them the gout, give them the stone!
Lady Mary Wortley Montagu (1689-1762)
Be temperate in wine, in eating, girls, & sloth;
Or the Gout will seize you and plague you both.
Benjamin Franklin, Poor Richard’s Almanack, 1734
It is by health that money is procured; but thousands and millions are of small avail to alleviate the protracted tortures of the gout.
Samuel Johnson 1750, “The Rambler,” Vol. XII-XIII
On observing the autumn crocus in flower: “There!” he said, “who would guess the virtue of that little plant? But I find the power of colchicum so great, that if I feel a little gout coming on, I go into the garden, and hold out my toe to that plant, and it gets well directly . . . Oh! when I have the gout, I feel as if I was walking on my eyeballs.”
Sydney Smith (1771–1845)
We are in fact, tho’ perhaps unconsciously, moved at the prospect of our own End for who sincerely pities Sea-sickness, Toothache, or a fit of the Gout in a lusty Good-liver of 50?
Samuel Taylor Coleridge (1773-1836)
All you that are too fond of wine,
Or any other stuff,
Take warning by the dismal fate
Of one Lieutenant Luff. . . .
Full soon the sad effects of this
His frame began to show,
For that old enemy the gout
Had taken him in toe!
Thomas Hood (1799–1845), “Lieutenant Luff”
Screw up the vise as tightly as possible—you have rheumatism; give it another turn, and that is gout.
Popular jest, c.1823
The gout is a complaint as arises from too much ease and comfort. If ever you’re attacked with the gout, sir, jist you marry a widder as has got a good loud woice . . . I can warrant it to drive away any illness as is caused by too much jollity.
Charles Dickens, The Posthumous Papers of The Pickwick Club, 1836
The rich ate and drank freely, accepting gout and apoplexy as things that ran mysteriously in respectable families.
George Eliot, Silas Marner, 1861
GOUT A physician’s name for the rheumatism of a rich patient.
Ambrose Bierce (1842–c.1914), The Devil’s Dictionary
Gout is the foe that may be lying in ambush amid the sauces, the bottles, the sweets, and the fleshpots.
George H. Ellwanger, Meditations on Gout, 1897
First used by the Dominican friar Randolphus of Bocking c.1200 AD, the word gout came from the Latin gutta, “a drop,” from the notion of a drop of morbid material from the blood into the joints. Before this, the Egyptians in 2640 BC had identified podagra, which was later recognized by Hippocrates (fifth century BC), as “the unwalkable disease.” Celsus (c.30 AD) related it to alcohol.
Antonie van Leeuwenhoek described the microscopic appearance of uric acid crystals in 1679, and in 1847 Sir Alfred Garrod (1819-1907) discovered excess uric acid in the blood of gouty patients. Henri Huchard pointed out the role of hyperuricemia in the genesis of atherosclerosis in 1884: “la goutte est aux artères ce que le rhumatisme est aux coeur.”2 Apart from colchicine and established symptomatic NSAIDs, the xanthine oxidase inhibitor allopurinol was synthesized in 1956 by Roland K. Robins as an effective preventive.
Of many texts two are of outstanding historical interest: Thomas Sydenham’s Tractatus de podagra et hydrope (London: G Kettilby 1683), and Sir Alfred Garrod’s Observations on the blood and urine of gout, rheumatism and Bright’s disease (Med Chir Trans 1848). A wonderful collection of cartoons and caricatures was published by Rodnan and repays inspection.3
- Jacobson A. The “English Hippocrates” and the disease of kings. Hektoen International Journal. Fall 2017.
- Huchard H. 1884) Traité Clinique des Maladies du Coeur et de l’Aorta. Paris; p.174.
- Rodnan GP. A gallery of Gout. Being a Miscellany of Prints and Caricatures from the 16th Century to the Present Day. Arthritis & Rheumatism: Journal. 1961;4:27-46
JMS PEARCE is a retired neurologist and author with a particular interest in the history of science and medicine.