Dr. Josh on Historical Ailments

Susan Sarah here, turning the blog over to Dr. Josh, who will look at common diseases in history -- a useful subject for writers and readers of historical fiction... be warned in advance that Dr. J's blogs are not for the squeamish!

Dr. Josh sez...  In the holiday spirit, I'll discuss the disease historically known as consumption, and two diseases of behavior, gout and lead poisoning. The mention of "holiday" might strike you as odd, but perhaps it will make sense by the end of this column. The last two, particularly, had a propensity to be brought on by the revels and heavy meals of nobility in days gone by; the first just infected everyone.

CONSUMPTION, a name prompted by the progressive weight loss seen in the disease, has been around since early antiquity. One theory holds that it was due to milk drinking and cattle herding -- the bacterium causing consumption is thought to be a mutated version of a less infective bacterium that afflicts cattle. Two billion people worldwide are infected, and although only roughly 5% of these people have symptoms, the disease has been responsible for more death due to infection than any other. It has been demonized and romanticized throughout history.

Today consumption is called tuberculosis, and it is largely eliminated (though it's beginning to make a comeback). We treat it with long courses of antibiotics, and a therapy first championed 150 years ago, isolation from public places while disease is active. A person with consumption in an earlier century might be taken to the king--it was one of the diseases known as "king's evil," and it was believed that the touch of a newly crowned king would cure neck swellings caused by tuberculosis. British kings traced the power back to King Edward the Confessor, and in England--perhaps being more socially progressive--the king's touch was also attributed to queens as well. The disease profoundly affected society, given its frequency in every century but the last, and its relentless course without treatment. Other possible causes of consumption could have been certain cancers, but TB is the main culprit.

The Victorians romanticized it, turning a scourge into a kind of poisoned blessing. Spes phthisica, or "hope of the consumptive," a term batted around then, refers to a supposed feeling of euphoria brought on by end-stage consumption, accompanied by spurts of creative energy and even physical attractiveness. But that was the diametric opposite of what people with advanced tuberculosis suffered. Largely due to public health improvements (and antibiotic therapy), tuberculosis has greatly diminished in the U.S. and most developed countries. Historically, however, it holds no peer.

GOUT. While people may have been scared silly by consumption, they were less alarmed by the "disease of kings." Gout is characterized by deposition of uric acid, a breakdown of digestion of DNA, into joints and occasionally other areas of the body, leading to an intensely painful arthritis. Now we have a number of quite effective treatments for gout, but that was not the case for thousands of years. Gout is unique in that, while many have a genetic predisposition to developing it, it is most common when the diet is high in rich, fatty foods (like organ meats washed down with heavy beer) -- the sort of feast a discerning noble might have.

King Charles V, Holy Roman Emperor and King of Spain in the 16th century, became a celebrity in the medical world when Spanish doctors analyzed his pinky bone and confirmed the historical accounts of his raging, uncontrollable arthritis pain: gout. Its name is Latin for "drop," referring to an imbalance in one of the four humours defined by Galen (and by medical practitioners for 1500 years after him). The Arabs and Greeks used the herb autumn crocus for centuries to treat gout; later it was found to contain the anti-inflammatory colchicine, a key medication used today to treat gout. As dietary patterns shifted, gout became less prevalent, and once its cause was better understood, it became treatable. Ironically, it has now become a disease of the underprivileged.

LEAD POISONING is intricately connected with gout. Lead has been used for centuries in munitions, solder, pewter, and paint -- but a lesser known use was as a sweetener. The Romans and medieval Europeans used lead acetate to sweeten wine (as a side note, children often eat lead paint because it tastes sweet) --and to make matters worse, they drank this wine from lead-containing pewter cups. Lead poisoning has a variety of effects, among them chronic brain injury and dementia. Some authors in the medical community suggest lead poisoning as a factor in the decline of the Roman Empire. A peculiarly severe form of gout is called "saturnine gout," stemming from the association of the Roman god Saturn with lead. Lead toxicity causes the kidneys to excrete less uric acid, resulting in more retention and deposition of uric acid -- and therefore, gout.

  So what is the holiday message in all this?  Well... consider the rich meals of the holiday season carefully before you indulge. Over time, you could join the ranks of the nobility in a way you don't want to!  More importantly, please remember the millions around the globe afflicted with lead in their environment, and the billions who are exposed to TB. If you are so inclined, the many fine organizations dedicated to helping these people would welcome holiday donations. 

Safe and happy holidays,

Joshua King, M.D.

Comments

[Kalen Hughes]

Great info!!! I'm bookmarking this post.

For some reason I've always had an irrational fear of contracting TB. The idea of it really freaks me out. And when I read accounts of people with drug resistant TB flying it just raises my hackles (and freaks me out even more).

[maryjoputney]

Welcome back, Dr. Josh! It's great to have you here again, explaining and demystifying historic disease. As Kalen says, it's wonderful information, and I like the way you provide the social context as well as the medical.

Please come back whenever you have a bit of spare time--and have a great holiday season.

Mary Jo, safe from gout because she doesn't much like organ meats and heavy beer :)

[Susan Wilbanks]

It's probably a good thing you don't work where I do, Kalen! We have TB patients here in the hospital, and all staff have to be tested every year. I figure my odds of contracting it are still vanishingly low, since I'm an office manager rather than a medical worker, but I'm sure they're higher than they were when I started her.

[NinaP]

Hello Dr. Josh!

Thanks so much for coming back. Great info on gout. Another good reason to avoid liver and beer.

Hope you and yours have a wonderful Holiday.

Nina

P.S. For next time, could you do a bit on mental disease and/or opium?

[Patricia Rice]

Great info, thank you! Maybe we could conclude the Roman emperors not only ate too much, but eating it off pewter they managed to kill or maim themselves in many creative ways. When did they figure out lead was harmful? I know the nobles were still using lead in their cosmetics in the 1700's.

[Sherrie Holmes]

Awesome post, Dr. King! You pack a lot of information into your posts. I hope you return often.

Pat, good question about lead. I'm thinking it must have been rather recently when lead was discovered to be so harmful. Like in the 20th C. I know they didn't ban lead-based paint until the late 1970s.

[AgTigress]

Actually, pewter plate (= table utensils) was not at all widely used in the Roman Empire. Both eating and cooking utensils were normally made of unglazed ceramic materials, and the metal utensils used by the wealthy were of bronze/brass or silver. It was really only in the north-west provinces of Britannia and Gaul that pewter plate was ever used as a cheaper substitute for silver, and that only in the late-Roman period. It is therefore highly unlikely that any Roman Emperor ever ate off, or drank from, pewter vessels. In the early Empire, wine-cups were usually made of silver: in the later Empire, from glass.
*However*, lead pipes were widely used in the provision of water (as they have been in far more recent times), and lead was, in general, a metal in widespread use in building construction and crafts.
:-)

[Louis]

As a child of six or seven, I remember my Mom having TB. She stayed in bed rest for about two years. Recovered and lived until her late 80s.

[Loretta Chase]

* "hope of the consumptive," a term batted around then, refers to a supposed feeling of euphoria brought on by end-stage consumption, accompanied by spurts of creative energy and even physical attractiveness.*
Thanks for explaining, Dr. Josh! I've come across this time and time again, and--having been fortunate enough to live in an era when I never encountered TB in real life, I supposed it had some basis in reality. There's that last spurt of energy from the dying Violetta in La Traviata, for instance--and all those scenes in books where the consumptive becomes ethereally beautiful, shortly before dying.

What an enlightening post! Thank you.

[LorettaChase]

"It is therefore highly unlikely that any Roman Emperor ever ate off, or drank from, pewter vessels. In the early Empire, wine-cups were usually made of silver: in the later Empire, from glass."

See? Who knew that? Thanks, AgTigress.

[Jane George]

*Ironically, it(gout) has now become a disease of the underprivileged.*

Interesting.

I feel from personal experience that there's a lot about the relationship between joint inflammation and food that we don't understand yet.

Thanks for the info. Have bookmarked it as well.

[Abby]

This was great. Where is Dr. Josh's last post? I'd love to read it.

They used lead solder on tinned food well into the 19th century, so it took them a long time to understand the danger...

[Helen]

My mother told me that her grandmother (or great grandmother?) part of a rather wealthy Victorian family in London had their milk brought in daily from their private cow that was stabled outside of town. This way they could be sure of the health of the cow and decrease the risk of TB that might come from the mixed milk of a dairy.

[AgTigress]

Yes, bovine tuberculosis was a major source of TB in the past. The systematic testing of dairy cattle that was introduced in the 1930s pretty well eradicated that source. In general, I think that the disease was pretty well subdued here by around 1950, and its resurgence now is a real concern.

[Elizabeth Rainbird]

hi Susan,
Glad to see your son has done so well with medicine. I love your books under Sarah Gabriel, look forward to the next one

Elizabeth

[Jo Beverley]

Sorry to be late to the party. I had a rare couple of busy days that took me out of the house and left me very tired.

Thanks, Dr. Josh, for the great info again. I knew two people who died of TB in the '50 -- a cousin and the daughter of neighbors -- so it isn't that long ago that it was feared.

Jo