Gout is one of the first chronic diseases to be described for posterity. According to an article in “Explore,” the Egyptians had identified gout in approximately 2,500 BC. And while today gout is considered a rather pedestrian condition, for most of recorded human history gout dominated the field of medicine, impacting aristocracies from ancient Rome to 17th and 18th century France and England.
Gout originally was linked with high IQ and sexual promiscuity, and the consumption by such fortunate folks of excessive amounts of alcohol and rich foods. Social commentators loved to mock that decadent upper echelon of society, expressing little sympathy for their aching joints.
A 2009 article in the “International Journal of Rheumatic Disease” tells us that Hippocrates was the first individual to systematically describe the clinical features of gout. He felt that the best treatment for gout was “an attack of dysentery.” The use of the meadow saffron, Colchicum autumnale, thus became used in the treatment of gout—the forerunner of the currently prescribed drug, colchicine.
In an issue of the “New England Journal of Medicine” from 1983, the authors attempt to explain why gout was rampant among the Romans: Wine consumption among the Romans averaged between one and five liters per person per day. And while wine itself can cause and prolong gouty attacks, the presence of lead in Roman cooking utensils added another layer of risk.
Lead inhibits the disposal of uric acid, the material that forms the inflammation-causing crystals in gouty joins, into the urine, and thus uric acid builds up in the body. It appears that Roman wines were heavily contaminated with lead because of recipes that prescribed the use of a lead-lined copper kettle to avoid tainting the wine with the undesirable taste of copper rust. It is estimated that the resultant lead levels were several thousand times greater than the current daily lead intake, such that a taste of one teaspoon would cause what we would call chronic lead poisoning.
Symptoms of lead poisoning in adults include declines in mental functioning, pain of the extremities, arthritis, muscular weakness, memory loss, headaches, abdominal pain and mood disorders. The philosopher Gaius Musonius Rufus documented the misery of gout and lead poisoning with perceptive perspicuity: “That masters are less strong, less healthy, less able to endure labor than servants; countrymen more strong than those who are bred in the city, those that feed meanly than those who feed daintily; and that, generally, the latter live longer than the former. Nor are there any other persons more troubled with gouts, dropsies, colics, and the like, than those who, condemning simple diet, live upon prepared dainties.”
Wine and the accompanying gout and lead poisoning may well have contributed to a weakened ruling class…and the fall of the Roman empire. I wonder how history will explain the deterioration of our ruling class.