Historical Ailments with Dr. Josh

Susan here, turning the blog over to Dr. Josh, nephrologist-toxicologist (and my firstborn) as he takes a look at some common diseases in history -- a useful subject for writers and readers of historical fiction . . .

Dr. Josh says …

As we approach the fall and winter holiday season, it’s a good time to discuss the disease historically known as consumption, and two diseases of behavior, gout and lead poisoning. 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 is largely eliminated (though in some areas it has been making 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 (this is an approach we are unfortunately familiar with these days due to the pandemic). 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" - it was believed that the touch of a newly crowned king would cure neck swellings that were actually caused by tuberculosis. British kings traced the power back to King Edward the Confessor, though 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 lead-sweetened 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 with the holiday season soon to begin, what is the holiday message in all this?  Well... consider the rich meals of the holiday season carefully before indulging ... you could join the ranks of the historical nobility in ways you don't want to! And more importantly, please think of the millions around the globe afflicted with lead in their environment, and the billions who are exposed to TB. If you are so inclined, there are many fine organizations dedicated to helping these people that would welcome holiday donations. 

Stay safe and well all year round,

Joshua King, M.D.

Thanks, Dr. J!

The Victorian and medieval views of disease varied wildly from our own medical knowledge . . . In your own reading, have you encountered any of these diseases in historical fiction or history reading? 

Comments

[Mary M.]

My impression of gout was always the Regency presentation, the grumpy old rich man with his bandaged leg on a stool, holding a glass of forbidden port in his hand. Then I got it myself. Had a couple of mild bouts, then an excruciating one. Finally realized, a couple of weeks after the fact, that it had been triggered by my glomming a whole two pound box of snow crab legs in one long, very enjoyable evening. Biiig mistake! No more endless shellfish binges for me, alas. 😿

There's a replica Victorian village at Leeds, England, with a medical emphasis. At the beginning, you choose a character to "be" as you learn about life in the day, with lots of medical complications. At the end, you find out how "you" died, (spoiler alert) unpleasantly in most, maybe all, cases. Fascinating to me, perhaps not for everybody.

[Binnie Syril Braunstein]

Susan-I wish Dr. Josh had mentioned lead in connection with its use in cosmetics. Didn't the aristocrats use it in powders or unguents? It can't have been healthy. Or maybe I was thinking of arsenic...not terribly healthy, either. As regards consumption, I was strongly reminded of Camille, La Traviata and if course, Mimi in La Boheme. Please thank Dr. Josh for sharing his expertise with us.

[Sue McCormick]

It was wonderful to share Dr. Josh's knowledge. I DO have arthritis, but NOT gout. I found out many years ago that I had been exposed to tuberculosism, but never developed the disease. When I was under five years old, we lived next door to an "open-air" house, where adult with tuberculosis were exposed to sunlight and fresh air. Children are curious and get in everywhere; I have long suspected that may have been my exposure.

[Katja]

Interesting topic.
The most famous book at least in German which deals with TBC is probably Der Zauberberg (Magic Mountain) by Thomas Mann.
Gout for me will always be connected with the grandfather in Little Lord Fauntleroy, especially in the movie version with Alec Guinness.

[Margot]

We are so lucky to have come so far in medical knowledge.
I was a nurse and trained in the late 1960's - the changes since then make my training feel antiquated. This was a great post as I do enjoy medical aspects in Historic novels.
I also have genetic gout, my father, two brothers and I all have had it. Lucky for me I have only had two episodes and know the foods to avoid. My brothers are not as lucky. I also was exposed to TB as a child and test positive. Living in the tropics with limited treatments, several adults had active cases and many of the children were exposed to it but I do not know of any of them becoming active cases.
Thank you Dr. J King for your insights into medicine in past centuries.

[Annette N]

First, thank you, Dr J, for all the information. You obviously listened carefully in medical school. And you learned how to explain to all of us.

I have read books which include people who have gout. And of course,TB from Camille.

Thanks again.

Hope everyone is well and safe and happy.

[Kareni]

Please thank Doctor Josh for his informative post.

Yes, I've definitely encountered both gout and consumption in historical romances. @Mary M's description of gout in books matches my own. As regards consumption, someone is generally shown coughing into a blood stained handkerchief.

[Karin]

Thank you for the interesting post. I often encounter medical issues in historical novels, not only physical diseases, but mental illness, wounds and childbirth. And the way they treated all of them often makes me cringe! The lack of sanitation alone! I find it difficult to read, but I guess they believed they were doing the right thing.

[Teresa Broderick]

I too have come across gout in my reading, especially in Regency romances. My husband suffered from it some years ago but it cleared up and he never got it since.
An uncle of mine died from TB. He was only twenty three. My mother said the one thing she always remembered about him was the cough.
Really interesting post.

[Teresa Broderick]

I would LOVE to do something like that!!!

[Vicki L]

I would love to go visit that replica village as well. I'm pretty sure all my sister's would join me on that trip!

[Jeanne Behnke]

How interesting & great pictures too. Thanks to Dr. J! Of course, these things are in so many books, movies & opera. It will be interesting how this time of pandemic works itself into more stories.