Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Gout

Episode Date: August 12, 2014

Welcome to Sawbones, where Dr. Sydnee McElroy and her husband Justin McElroy take you on a whimsical tour of the dumb ways in which we've tried to fix people. This week: We change the course of human history with gout. Music: "Medicines" by The Taxpayers (http://thetaxpayers.net)

Saabones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books! One, two, one, two, three, four! We came across a pharmacy with a twin that's lost it out. We were shot through the broken glass and had ourselves a look around.

Some medicines, some medicines that escalate my cop for the mouth. Wow! Hello everybody and welcome to Saw Bones, a marital tour of misguided medicine. I am your co-host Justin McAroy and I'm Sydney McAroy I said hey Justin. How are you doing? I'm doing pretty well. How are you doing good? Are you enjoying that that Starbucks Frappuccino you're drinking? I am it looks delicious It's weird because they call it a Frappuccino, but it's really just in a bottle It's very different from the frappuccino that you would get as a frappuccino at Starbucks. I don't know why they're using that branding Well, I mean because it's cold and sweet and Chocolat-y. I think that's all people know about a frappuccino. This isn't germane to the topic. What are we talking about today?

We get a lot of emails suggesting topics and we get a lot of great suggestions and thank you for everybody who emails and suggests them. I saw bones at maximumfund.org by the way. Yes and as a side note just because we haven't covered a topic that you have suggested it doesn't mean we're not going to. We have a long list of them. It's just kind of what strikes our fancy from week to week. So if this week on email caught my attention because not just the topic,

but the email itself I thought was really intriguing. What was that? We got an email from Joanne Marin who said that she wanted to know about Gout, which Gout on the surface, I don't think sounds like a very exciting topic. I literally have no, I've heard about gout my entire life, I could not tell you, when I hear gout I imagine some sort of foot crust, it's like a foot crusted over and petrified, like a foot disease. I don't think you're alone, that was the thing that kind of drew me to the topic, is not to the topic is not doubt itself is not as we'll talk about. It's not very exciting, but I think that a lot of people feel like you do. They have no idea what it is. It has something to do with a foot. And as Joanne

mentioned, she kind of had the impression that it was something, was it an older disease? Was it something that didn't exist anymore? Not hip anymore, not fashionable. Yeah, was it part of other diseases? didn't exist anymore. Not hip anymore, not fashionable. Yeah, was it part of other diseases? She referenced that she knew it existed in things like pickwick papers, mentioned Gow, and her mother were watching an old Aero Flynn movie, and they talked about Gowd.

And so she was kind of wondering, is this still a thing? Her mom said that she remembered it as being called the Rich Persons disease. So is that something? And you know, it's funny when I think back to what like when did I ever hear the word gout or what was my kind of perception of gout prior to, you know, being a doctor because hopefully it's different now. Right. It was actually from Archie Comics. Oh, I remember because Veronica's dad who if you're not familiar with Archie comics, first of all,

what are you doing with your life? Get it together. Seriously. They've been around for a really long, like just jump in, just read one, please. But secondly, Archie's dad, or Veronica's dad, is really rich. Hyromlog is very rich. And he would get gout periodically. So my perception of gout, as well, was that it was something that Rich Guy's got.

Fancy, a fantasy. Yeah, an old Rich Guy would get gout. It was his foot. It was always wrapped up, bandaged, and I had no idea what it was. Because the gout. So let's talk about gout. Hit me, I'm ready.

I'm so ready to be educated about gout. Because it's a real deal thing that still exists. I'm, am I gonna be scared of it by the end? Am I gonna be worrying about gout possibilities? No, I wouldn't worry about gout. Of all the things that we talk about on the show that you could worry about gout Would be low on my list all right? So it was first identified a long time ago in like 2640 BC

So hundreds and hundreds of years old Yes, at least minimum at least hundreds probably thousands there if you do some math. Maybe, yeah. It's hard to tell. The Egyptians identified it and it was initially thought to be something that just affected the foot and that is because gout classically affects the big toe. And what gout is so that you know what we're talking about, it's pretty simple. So you're familiar with the idea of arthritis in a joint.

You get pain in a joint. Right. Sometimes it gets swollen. Well, in gout, it's not arthritis, but you can kind of think of a similar thing. You've got a joint. The joint gets swollen. In the case of gout, it gets red. It gets very painful, very tender.

Touching it at all could cause you a great deal of pain. And it's because you have a build up of these certain kind of crystals in your blood from uric acids. You get a build up of these uric acid crystals. They deposit into the joint and make the joint swell up really big and hurt. So that's pretty much what gout is. It doesn't have to happen in the big toe, but that's the most common joint that it happens. And so a lot of the early writing

about gout is about the foot and about the big toe. Okay. So that's all that gout is. Why does that happen? Well, it has to do with your diet and how much, you know, what the foods that you eat and how much Your acid is produced from them and then how good your body is at getting rid of it. Okay, so that's pretty much it So it's not something to freak out about When it does happen in the big toe we call it pedagra Pedagra, which is I think that means foot pain Okay, it's not the best one we've ever done, but it's not bad. We've done worse, certainly.

For that reason, Hippocrates called it the Unwalkable Disease. Okay. She could probably piece together. Because you can't walk with it. Yeah, because your foot hurts. Hippocrates, this would be a smart guy, like in an author and a playwright. I'm surprised. That was the best he could come up with. Hypocritees, he wrote some stuff, right? He wrote plays. Did he write plays? Sure, he had probably.

And he wrote an oath. There were only like five Greek people. It was like, Hypocritees and so crates. And the Occamalese. I'm Play-Doh. I'm Play-Doh. They're a Stoddle. They're a Stoddle.

That's it. Those are all the Greeks. That's it. Those are all the Greeks. There were only five Greeks running around. It was like the Power Rangers. They were the first the Greeks. There are only five Greeks running around. There's like the power rangers. They were the first power rangers. They were only five of them. So one of them had to do everything.

There's a historian right now who's just tearing. One of them had to have the babies like an Arnold Schwarzenegger in junior because they had to keep this aside. There were no females. There were no females. There was only Plato and Aristotle and Socrates. Right. This is not a History podcast. Let me just say. Yeah, this is not stuff you missed in history

Metaclott trivia entertainment So the Greeks also had a goddess assigned to galt. Oh, man. Why not? Yeah, yeah, you gotta put it on everything Pedagray. So there you go. Wait, did they name her for this? Yeah, she was the goddess of gout. That's a foot pain. Hi. Such a downed me. Well, we'll build into existence. Like, they hold my power. Humans, what, what do I have dominion over? Shake before pedagogy. Wait a minute, that means foot pain, doesn't it? Just foot pain.

Okay. Look at my whole thing, I can grant you or release you from foot pain. Now I expect you to line up with idols and offerings and things, no? Pretty much a minor god, eh? A goddess. I mean, my undershade is that galka really hurt.

Yeah, but like, yeah, that's fine. She was born, this is interesting because her parents specifically relate to their perception of the disease at the time. They thought it had something to do with a lifestyle of excess, you know, drinking too much alcohol, eating too much, which was kind of true. Really? Yeah, it has to do with, this is something we'll get into, but it has to do with certain foods that are rich in purines, which is something that breaks down and you get more uric acid. But the important thing to know is that foods that are rich in purines are usually things like meats, some seafoods, beer has a lot of purines. So when we talk about like the kind of foods at the time who would have had, you know,

access to them, it would have been rich people, people who live lives of access or in In the Greek perspective, kind of like Bacchanalian type people, so that from their perspective, pedagogy was the product of the God Dionysus, seducing Aphrodite, with all of his wine and feasts and whatnot. But yeah, you hope for the best for your kids. You know, you hope that they're going to really achieve great things. I can't, I imagine it would be a little bit of a downer when you have a child and she

becomes the goddess of foot pain. I have much higher aspirations for our daughter. Yeah, she can be better than that. The, the word gout came along because of our concept of the humors we've referenced before, the four humor system, where you have to keep them in balance in your body in order to stay healthy. The word gout comes from the Latin word gutta, which means drop. And they thought it was, the belief was that one of the four humors would drop to your foot and accumulate there. Sure.

And so then it would cause swelling and pain and whatnot. It's just gravity, it just makes sense. Right. And so that was, that's where we get the word gout. And as I kind of have already alluded to, it was also known as the disease of kings, because again, it was associated with rich foods, with alcohol, things that kings would have had access to,

not just kings, but rich people, powerful people. This is also why for a long time it was thought to only really occur in men, because men had access to all this stuff over women. There were rich women kind of a, ooh, what a she up to. Slow down, Beverly. Hey, I don't know, that was really kind. Yeah, really. It was also kind of considered like a divine retribution at the time. retribution at the time. So like the gods were trying to keep you from walking to more beer,

more steak, and they were trying to keep you from walking to it, because they knew that you know, it was going to bring it to you. So they would try to keep you from walking to it by giving you foot pain. Well, I mean, I guess you could look at it that way. I think it was more as we're moving especially into like Judeo-Christian times more of like, well, if you're gonna live that life of, you know, riches and excess, you gotta pay the price. This is what you get in return.

Yep. You know, so you eat all those meats, you know, those beef meats. Beef meats? Beef meats, you know, those beef meats. That's a culinary. culinary, technical term. Drink your grog. Your grog and your beef meats.

They did think that for some reason, there was also this idea that you may not want to treat it because not that we knew how to treat it, although I'm gonna tell you all the ways we tried, we didn't really know how, but you may not want to because they thought it prevented you from getting worse diseases. How? What? Why? There was some perception that if you had gout, you probably weren't going to get, you know, whatever fever was killing people. And I don't know if this is, I really didn't find any basis for this, my theory, this is just me

guessing, would be that maybe if we're still talking about this royalty class, like this higher class of people, that they would have had more access to kind of a more sanitary lifestyle. Okay. So maybe they wouldn't naturally have gotten some of the diseases that were related to crowded living conditions and poverty and of course sanitation, that kind of stuff. Rich people got gout, rich people didn't get as many of these hygiene related diseases therefore gout prevents other diseases. Right. Which obviously was flawed logic. This is purely a guess on my end because I don't know why else you would think gout prevents.

But you know what? Old Tommy people did enough guessing. I think we're owed a few, right? I think so. You know plenty of making stuff I think so. Plenty of making stuff up. Exactly. I mean, they guessed about this. So. Yeah, why not? Yeah. Now, if you did want to treat it.

I do. And most people do, even today. Some recommended treatments, one, was just avoid that lifestyle. I mean, people said that. You know, if you didn't drink so much, if you didn't eat all these rich people foods, then you probably wouldn't get gout, which actually was probably the best advice of all these things we're going to mention. If you were, if you didn't want to do that, the main things they would give you, especially,

the Greeks were things that would make you either throw up or have diarrhea. Well, if you could manage to get dysentery, they thought that that was particularly effective. Perfect. Somebody get this man some dysentery. And that would cure your gout. That's not really true. Actually, dehydration probably made things worse. So I don't know where they got this.

Sounded good. I mean, again, and as we move forward, it makes a lot of sense when you move into the time of the humors, because everything was about making you puke or have diarrhea or something. Get the evil out. Get rid of some sort of fluid. Of course, Galen would later come in and say, hey, you bloodletting. Why don't you try some bloodletting?

He also said taking a spring sea voyage could cure your gout. No, I mean, it's good for the soul maybe. Get out there, assault air. Sounds delightful. Open waters. Yeah. It's good for anybody. I wouldn't mind being prescribed a spring sea voyage.

Yeah. So this is a prescription sea voyage. Especially if the alternative is bloodletting or dysentery. Right. You could also try Mandrae Groot. That was a prescription for Gout. Soak it in vinegar, and this is good for Gout in Somnia. And if all those fails, it'll work as a love potion.

Oh, well, why not, you got lying around anyway. And there were lots of other plants that you could try, you know, Ivy, Barley, Cabbage, Hemp, Moss, Plantains, lots of stuff. Of course, Plenty, our favorite buddy, Plenty the Elder. He had several suggestions. First of all, you could try Bear Grease

with wax and some bullseuit, which is a hard fat that surrounds the kidneys. So you could try that. Or you could try that. Or you could try a mixture of he goat, suet with she goat, dung. Don't get those two confused, it's explosive. Exactly.

If you get some she goat, suet with he goat, dung. Forget it, I don't know why. That's basically C4. And you mix it with saffron. I don't know, that for color. For color, for yellow. Yellow coloring. Or if you don't like saffron. I don't know that for for color for yellow color yellow coloring or if you don't like saffron if that's not your thing you could try some mustard if you like that better there was also he also suggested bulls blood he also suggested calf's dung or if you just want to go crazy, you could boil a live fox.

Oh no. Yeah. That is the most unpleasant one I think. I think that's terrible and I the one gets you wet with it. You you eat it? Yes. Yeah. You just eat it afterwards. It's holy unpleasant. Yeah, boil, but it's gotta be live. Oh Wonderful wonderful good job folks everybody patting the back plenty He said here best best jams yet plenty if you like foxes and you think they're adorable and you don't want a boil one I would probably fall into that category. I mean, I'm never I'm not like partial to foxes I don't like have a secret love for foxes, but I don't want to boil a live fox. Don't blame you. Instead, you could boil a live wolf. Can I need a bigger pot?

My question is, if you're already struck with gout, how are you gonna hunt down a wolf? That's true. And then capture it alive. Like it's not like you can... You catch gout first thing you're gonna need are some real good friends who are really fast And you can capture a live wolf boil it in oil for you alive and then you can eat it. Yeah, that's dedication. Yeah, I don't recommend this

Um, of course if you get attacked by the wolf, I guess you don't care about the gout so much Maybe it takes your mind off it. Maybe this whole process is so thrilling by the end of it you forget you add gout The wolf takes your foot off and then forget about it. People like to try poltuses for gout which made sense because you know you could see it, the joint would get all red and hot and swollen and so you could see something. So when you have like a place to focus your energies, a poultice, you know some sort of where the sickness is. Exactly. ...playing out some sort of mixture or pace that you can actually apply.

So, in ancient times, these were mainly mixtures of things like grains and grease and honey, bone marrow. There are some early American cures with gymson leaves and wheat bran. And then there was a German suggestion for Poulthus, which was just warm cow dung. Yeah, sure. I don't know how that counts as a Poulthus. That's just like...

It's just hot cow dung. It's, no. Maybe it's all in the packaging and marketing. Do you think that was somebody who just happened to accidentally walk barefoot through... Hey, I feel... That's a lot better. While they had cow.

My smelly foot's clearing up. That's nice. Still smells pretty bad, but I guess it's a painy. Good job. There was one actual real treatment that I stumbled upon. In the six century AD, Byzantine physician, Alexander of Charles, tried something called Colchocene.

Now, Colchocene is a plant-based compound. It comes from the autumn crocus and it had been used before him for lots of stuff. It was known to make you throw up. It was known to give you diarrhea. So obviously people loved it. You know because we love stuff that made us tummy sick. We thought that that was doing something. That's some really working. Right, because it was doing something.

If you're projecting out of one of your ends, something's going on in there. We have succeeded. He was the first one to actually say, I think that it is good for Gout, specifically. Like not just in that, like, I don't know, try some Colgisine. He actually said, you know, I think that this particular plant and gout are good match.

He was absolutely right about that. Colgisine is a treatment for gout that we use today. Wow. So this was true, but here's the problem with Colgisine. It has potential toxicity if you don't know the right dosing, which at the time, we were just like grinding up plants and, you know and I don't even know how people were taking them in powders and liquids and compounds, whatever.

So who knows how much culture seen people were ingesting. And it did have those GI side effects. So you would get sick when you took it. So it probably, if you gave it to people in the wrong dose, you were just as likely to kill them as you were to fix their gout. As a result, Alexander was like, you know, well with malpractice rates, what they are nowadays. I don't know if I want to tell people about Colchocin. So what he advised was first before you try Colchocin try exorcism because it may be a gout demon and then Colchocin should only be a

last resort. Right. So somebody got mad at me. He was like, hey, listen, did you try the exorcism? I clearly said that. I said you were supposed to try that first. This is classic, what we would call CYA medicine. Which is. Cover your, we have to say butt for this pod. Okay, cover your butt. CYB medicine. CYB medicine. Cover your butt.

You said that a lot of like rich and royal people throughout the years have gotten this disease. Has it had like an impact on the the world at large? Has it shaped our times? That's a good question, Justin. And that's actually I think the most interesting part about Gout, which is why instead of telling you about it right away, I'm going to stop and make you visit our billing department. All right, let's go. Alright, gout. Alright, you've paid your dues, so I'm gonna,

I'm gonna let you hear about the most interesting part about gout. Yay! So as I mentioned, it was called the disease of kings because so many rich people and people in positions of power got it. As a result, many leaders of the Roman Empire were struck by gout. So Claudius, Caligula, Nero, Tiberius, all of these people had gout at one point or the other. Now, this may have led to, you know, we don't know for a sure what kind of effects that had on them running the empire. What, and actually this should probably be an episode someday. Their chronic lead poisoning probably caused a lot more problems. Because in the crown, right?

Let in the crown. No, it had to do with the vessels. They were drinking wine out of it. Okay. But anyway, but we know for a fact, it's not as dramatic as mine, but that's fine. Yours is probably real. No. Well, as I was reading about Gout, I'd learned that all of the Roman emperors

were probably all crazy with lead poisoning. Perfect. So that's kind of cool. Thanks, history. But we know for a fact that Charles V, who later ruled huge chunks of Europe, Africa, Asia, South America during the Middle Ages, he actually postponed a key battle over some French territory because of his gout.

And it was a situation where he postponed it and then winter set in and it was one of those situations where it wasn't going to be a good condition to fight. You didn't bring your pants, your long pants, your long fighting pants. You just got your short pants. You only bought your shorts, your battle shorts, and you don't have in your pants, your long pants, your long fighting pants. You just got your short pants. You only bought your shorts, your battle shorts, and you don't have your battle pants. And your battle tank top. You only have your battle swimmies.

You're battle flip-flops. You're not ready for it. So by the time you recovered it was too late, they didn't fight the battle, we didn't get this territory, and he actually ended up abdicating his throne because he was so embarrassed and humiliated with a whole affair. That's a tough one. That's tough to move away from.

And not just because your foot hurts so bad. Yeah, I, you know, at the same time, like he wasn't gonna fight in the, you know, war. But you had your head on straight. Well, I mean, it was just his foot. I had your head on straight. Well, I mean, it was just as fun. I think it was hurting. Oh, well, anyway, be very distracting. I think a more current, I guess more current than Charles the fifth, anyway, William Pitt was a member of the British parliament.

And he was actually, um, during the time of the American revolution, uh, bright, uh, immediately prior to it. He was one of the representatives who was trying to stop the British Parliament from doing all the things that were, you know, making the colonists so angry and causing them to want to revolt. So he was absent from a session of Parliament during passage of the Stamp act, which imposed more taxes on the colonists and made them very angry and made them, you know, want to. That was part of why they wanted to revolt. He came back after his battle with Gout was over, found out about the stamp act and actually got it repealed.

Okay, good. Which was good, except then he got another flare up of gout, missed another session of parliament and during that session is when they passed the really high duty on T. Oh gosh. Which of course led to the Boston T party. Right. Which I think we all know what happened after that. Right.

So. The war and freedom. So who knows, although I think most historians, I'm after that. Right. So. The war and freedom. So who knows, although I think most historians, I'm not one, but would probably agree that there were more factors than just William Pitt's gout. But that wasn't there. It wasn't the mix. As an interesting side note, both Ben Franklin and Thomas

Jefferson saw it suffer from gout. It was thought that was part of why they were such good friends. Lots of gout conversations. Yeah, they're goutty feet. They could talk about it. Talk about it. This is why Ben Franklin was carried in and out of the Continental Congress on a sedan by like convicts. That's awesome. I think he just wanted to make a cool like WWE style entrance. You think that was a bit like thunder struck was playing every time it came in. He strikes me as the kind of guy who might want to do that.

Yeah, yeah, it's very showy. Yeah. But that was wise because of his gout. And again, I mean, I don't think that that directly affected the course of human history, but... Or did it? No, you never know. Now, John Hancock, who is most famous for his signature, his big writing, his

giant signature, he actually used Gout to play hooky. Oh, really? Yeah. So after, you know, we all know he was the first to sign the Declaration of Independence. Right. And he signed it very large. But when it came to ratifying the Constitution later, he was actually a little hesitant about it. And they needed Massachusetts to ratify the Constitution. And he was putting off delivering those delegates, kind of being wishy-washy about it,

and then got a very convenient flare of gout right at that time. Interesting. And so the Federalist started wooing him with possible promises of maybe you'll get a Vice President's spot in this new government we're working on here. Then let me guess, the gout, no more gout. And then suddenly his gal vanished. Miraculous. Yeah. So so there you go.

A very convenient use of gal because all the other rich guys had gal been Franklin had it. So why not? You maybe just wanted gal maybe left out. Now, now in the gal club, everybody wanted well, and that that actually was a perception that gal was a rich man's disease. And if you just had regular old, what they've called rheumatism or arthritis, that that was a rich man's disease and if you just had regular role what they've called rheumatism or arthritis that that was a poor man's disease. And so it really was like all throughout history. It was a class thing.

It was well, I don't have rheumatism. It's silly. It's silly. Excuse me. It's gout. It's gout. It's very fancy. I don't have the flu. I have body gout. I have nasal gout. It's gout. It's very fancy. I don't have the flu. I have body gout. I

Have nasal gout. You would never want to admit that if you figured out it wasn't gout And it was just like the plain or arthritis that everybody else gets you don't want people to know that that's very that's very embarrassing Scosh very gosh As I mentioned gout has absolutely a real disease that people still get today. I don't think there's still that same kind of connection as a rich person's disease now. I don't think people have that protection. And it does. It affects people, like I said, who, you know, purine rich diets have trouble breaking it

down, have trouble dealing with your acid, kidney problems, so on and so forth. There are lots of different reasons, but you get a big hot red swollen joint, probably your big toe. So if that ever happens, go talk to a doctor because it might be gout. Perfect. It affects men and women, of course,

because we all can drink beer now. And we figured this out because Lea and Hook, who famously worked with the microscope, you know, did all that. You remember that? You learned that in the microscope guy. I retained all this information. Remember the microscope guy?

I'm nodding with comprehension. He saw the crystals that gout forms. The little uric acid crystals under a microscope connected it to gout and there were a couple physicians later who proved that uric acid caused it and then connected it to the diet. Now we have lots of medications and lots of ways to treat it including culture seen as I mentioned is still used today. Fantastic. Well, Sidney thank you for telling me a little bit about gout. I don't feel quite as stupid anymore. Thank you to people tweeting about the show, like Tristan Adam Ryanarty,

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