A severe pain in the great toe

According to the Gout & Uric Acid Education Society, Gout is ‘a disease which results from an imbalance between the production of uric acid (a break-down product of protein digestion), and the ability to excrete this substance, which is mainly a function of the kidneys. Why this imbalance and the resulting excess of uric acid in the blood, and often also in tissues, causes symptoms only intermittently is still being investigated.’

Evidence of gout has been found as far back as 4000 BC, in the skeletal remains of mummified Egyptians. Written evidence of the disease begins with the Hippocratic writings from about 400 BC. One such passage states: ‘Persons affected with the gout who are aged, have tophi in their joints, who have led a hard life, and whose bowels are constipated are beyond the power of medicine to cure.’ The notable reference to ‘a hard life’ is of some interest, since from at least the 1st century AD right through to the 20th century, Gout was thought to be a punishment for excesses of food, drink and debauchery.

A 1683 description of an acute attack of Gout by Dr. Thomas Sydenham is still referenced today:

The victim goes to bed and sleeps in good health. About two o’clock in the morning, he is awakened by a severe pain in the great toe; more rarely in the heel, ankle or instep. This pain is like that of a dislocation, and yet the parts feel as if cold water were poured over them. Then follows chills and shiver and a little fever. The pain which at first moderate becomes more intense. After a time this comes to full height, accommodating itself to the bones and ligaments of the tarsus and metatarsus. Now it is a violent stretching and tearing of the ligaments-now it is a gnawing pain and now a pressure and tightening. 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.

According to the GUAES, Dr Sydenham

was one of the few medical writers who admitted to the lack of a reliable treatment. Indeed, while patients were blamed for contracting Gout, the inadequacy of medicine in general was symbolised by its inability to cure this particular disease. Despite the use of many mainly herbal medications, used internally or as poultices, the basic therapy of that time continued to be diet modification.

In 1596 ‘A. T’ a ‘practitioner in physicke’ published A rich store-house or treasury for the diseased Wherein, are many approued medicines for diuers and sundry diseases, which haue been long hidden, and not come to light before this time. Now set foorth for the great benefit and comfort of the poorer sort of people that are not of abilitie to go to the physitions. It contains the following remedies for relieving Gout:

TAKE stale Pisse, and seeth it, and scome it, and put thereto a good quantity of the juice of red Nettles, red Fenell, Mints, and Wormewood, and let the iuice of them be of as euen porcions as you can gesse them.  Mustard and Cummin, of each of them a little, and the juice of hearbe Benet as much as of all the rest, Seeth all these together, and make a Playster thereof, and so apply it often to the place grieued, and it will help. This hath been prooued.

Another good Medicine for the Gowt, or any other ache.  Take Rosen and Pitch, of each of them a quarter of a pound, and a quantity of Frankensence, as much as a beane, and as much of Turpentine, then take a quantity of Deare-suet, or Sheepes [illegible] and boyle them all together in a pot, and when it is well boyled, then take it foorth, and wash it as you do Birdlime in cleane water, and then take some of it, and spread it vpon a peece of Leather, and lay it to the sore, and so let it remaine there untill it fall off it selfe.  Use this two or three times, and you shall finde greate ease thereby.

Take Shoemakers pieces of leather, and fry out the grease, and lay some of it upon a browne paper, and warme it a little at the fire, then apply it to the place grieued, and it will take away the paine thereof in one night.

In 1630, The Newlanders cure Aswell of those violent sicknesses which distemper most minds in these latter dayes: as also by a cheape and newfound dyet, to preserue the body sound and free from all diseases, vntill the last date of life, through extreamity of age. Wherein are inserted generall and speciall remedies against the scuruy. Coughes. Feauers. Goute. Collicke. Sea-sicknesses, and other grieuous infirmities. Published for the weale of Great Brittaine, by Sir William Vaughan, Knight, recommends the following treatment for Gout:

First let him betake himselfe, if he can, to our Dyet.
Secondly, let him beware of all strong Drinkes and Wine.
Thirdly, let him purge himselfe with the Potion of [illegible] which I have before described against the Scurvy: Or else let him use PilluSingle illegible letterae Cochiae (?) which drawes awayes the causes from the Head. And these Purgations hee shall use once a moneth. And if there bee cause, let him bleede sometimes.
Fourthly, let him exercise.
Fiftly, let him annoynt for a locall Lenitive the place affected with Oyle of Frogs, or of Mirrh, eyther alone, or with a little Saffron, and if the paine bee violent with some Opium.
But indeede to mollifie and asswage the griefe, for the richer sort, I advise them never to bee without this precious Cataplasme: Take of dried Rose leaves one Ounce, of Masticke halfe an Ounce, of Saffron one dragme, of Campher sixteene graines, and of Barly meale two ounces.  Powre thereon as much white wine, as will make them boyle, which must bee gently, and by leasure, and often stirred.

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  • December 9, 2009 - 10:17 pm | Permalink

    I’m pleased that Sydenham has proven to be so accurate and it’s amazing his descrptions of the agonies of Gout have stood the test of time so well. I’m also relieved that Liam is no longer forced to smother himself in the Oyle of Frogs in order to gain relief.

    As to Gout appearing on the stage, I am fairly certain I read a play recently in which one of the characters complained of Gout. I’ll have a rummage and see if I can locate it.

    Thanks as ever for the comments and the interest.

  • December 9, 2009 - 6:53 pm | Permalink

    Sydenham made remarkably acute and sensitive observations, and deserves to be quoted more widely.

    I wonder where the ideas for the various treatments came from. They show great inventiveness in, and little agreement between, physicians.

    Did gout appear in the theatre?

  • December 9, 2009 - 6:22 pm | Permalink

    Thanks for the highlight on my infirmity! December is now Gout Awareness Month.

    The description of the pain is very accurate. It is excruciating. I shudder to think of the plastyrs, with or without pisse, because even lightly touching the inflamed area would make the most hardened and stoic individual howl in agony.

    Fortunately, our modern physicks and alquymists have invented a lovely pill called allopurinal which I take every day and which regulates the amount of uric acid in my blood.

  • December 9, 2009 - 5:57 pm | Permalink

    yes, the pisse plaster is the most appealing. That’s quite a vivid description of gout from Dr Sydenham, makes your toes curl.

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