Gout: A Rich Man's Disease

As a historical romance author, one of my favourite topics to research is how to despatch a character - and at the moment I am working on killing off a rather unpleasant chap. Wealthy, narcissistic, and overly well-fed, gout seems like a promising way for him to go - though feel free to suggest others.

I'm quite excited about my little detour into death by gout. I quickly discovered that this condition (commonly called inflammatory arthritis these days - and sadly, you don't need to own a duchy or a manor house to be afflicted.)

One of the Oldest Illnesses:

The history of gout is long. Ancient, in fact. Gout, or Gout Disease, was first identified by Ancient Egyptians around 2640 BC. In fact, it's one of the earliest known diseases. Millions of people (mostly men) still suffer from it today. Fortunately, scientists have learned a great deal about this potentially debilitating condition over the past few thousand years.

Although the Ancient Egyptians were the first to recognise gout, the first clinical description came from - you guessed it - Hippocrates (460–370 BC). About a century afterwards, Aretaeus the Cappadocian proposed that gout was caused by a toxin in the blood. He was on to something there, though it was some years before this was identified as uric acid.

The Dominican monk Randolphus of Bocking was the first known person to use the word “gout” in the early 1200s. The term comes from the Latin word gutta, meaning “drop.” At the time, it was believed that an excess of one of the four “humours” (bodily fluids thought to maintain health when balanced) would flow or “drop” into a joint, causing pain and inflammation. Variations of the term are used today across many European languages - though the condition isn't confined to the Western world: 

• English - gout 
• French - goutte
• Spanish - gota
• Italian - gotta
• German gicht

What Causes Gout?

During the Regency era, the condition reached full notoriety. As gout afflicted wealthy, landed noblemen, finding out more about it - and any possible cures - became a priority. Thus, in the seventeenth century, significant advances were made. 

Englishman Thomas Sydenham recognised the chronic and acute aspects of gout (hyperuricemia and gout attacks, respectively) and differentiated it from other forms of arthritis. 

Anton von Leeuwenhoek, the inventor of the microscope, was the first to examine and describe tophi, discovering that they were made of tiny, needle-like particles later identified by Swedish chemist Carl Scheele as urate crystals. Pretty decent depictions of how sufferers experienced these 'needle-teeth' appeared in many Regency-era publications.

Physician and professor Alfred Baring Garrod made major contributions to gout research at the University of London, demonstrating the relationship between high levels of uric acid in the bloodstream and the development of gout. His son, Archibald Garrod, continued his work, advancing the science of gout into the 20th century.

Remedies for Gout:

Various methods have been used to manage gout over the years. Early treatments from Hippocrates’ time included barley water, purging - and the one that sounds almost worse than the condition itself: Counterirritation. This involved scorching the veins near the affected joint which sounds horrific and I'm not sure even my dying villain deserves this. Bloodletting was also a popular treatment for many centuries.

Colchicine

Though evidence suggests colchicine was used in ancient Greece over 2000 years ago, it was first used as a specific treatment for gout by Byzantine physician Alexander of Tralles around 600 AD.

Let's talk about the plant source of colchicine: The autumn crocus (Colchicum autumnale). This plant has a fascinating history that goes way back. The Ebers Papyrus, an ancient Egyptian medical text from around 1500 BC, mentions the autumn crocus as a treatment for rheumatism and swelling. Colchicine, a toxic alkaloid and secondary metabolite, comes from this plant.

Anything that can cure you can also likely kill you. The crocus has long been a source of medicinal remedy - and, in the right dosage, poison. Several Medici were suspected to have been poisoned in this way, and at least one pope was said to keep some 'crocus powder' in a hollowed-out ring he wore.

Fast forward to the first century AD, Pedanius Dioscorides, in his book De Materia Medica, described using colchicum extract for gout. Around 550 AD, Alexander of Tralles recommended using the bulb-like corms of Colchicum to treat gout, calling it "hermodactyl." 

Persian physician Avicenna and 16th-century surgeon Ambroise Paré also recommended using colchicum corms, and it even appeared in the London Pharmacopoeia of 1618.

Over time, colchicum fell out of favour, probably because it caused severe gastrointestinal side effects - and overdoses ending in death. Yet in 1763, it was still noted as a remedy for dropsy (now known as oedema) and other illnesses. Benjamin Franklin, who suffered from gout, brought colchicum plants to North America. He even wrote humorous poems about his gout during his time as the United States Ambassador to France.

Regency Developments:

Colchicine was rediscovered by Austrian physician Baron Anton de Storck in the mid-1700s. Colchicine was first isolated in 1820 by French chemists P. S. Pelletier and J. B. Caventou. In 1833, P. L. Geiger purified the active ingredient and named it colchicine. It quickly became a popular gout remedy. 

Figuring out the structure of colchicine took decades, but in 1945, Michael Dewar made a breakthrough by suggesting that two of the molecule's three rings were seven-member rings. Colchicine's pain-relieving and anti-inflammatory effects for gout were linked to its ability to bind with tubulin.

The full synthesis of colchicine was only achieved in 1959, by Swiss organic chemist Albert Eschenmoser.

Back to My Villain...

So what do you think? Should I make him suffer though a bout of gout - or poison him slowly via a crocus cure? You can learn more about him in my Clifton Hall romances Always a Princess and The King's Mistress: