How did they treat gout in the 1800s?

Medical writers and practitioners in ancient civilisations identified gout as a specific disease. Prehistoric evidence shows that people in ancient China treated rheumatic disease, including gout, with acupuncture and moxibustion, in which small cones of the dried herb artemisia were burnt on the affected joint.

The Greek doctor Hippocrates (460–375 BC) thought gout was caused by one of four humours, phlegm, settling in the joints. He called gout “the unwalkable disease” and “the arthritis of the rich”, and blamed it on an excess of wine, food and sex, showing that the 18th century stereotype had ancient origins.

Galen (129–216 AD) was the first doctor to describe the tophi (lumps of crystallised uric acid under the skin) that some gout sufferers experience. In the Byzantine empire surrounding today’s city of Istanbul, physicians introduced Colchicum autumnale, commonly known as meadow or autumn crocus, as a specific treatment for gout. Centuries later, Victorian proprietary medicines for gout continued to rely on colchicum, and some sufferers still take colchicine today.

The English word “gout” comes from the Latin word gutta, meaning a drop. Its first recorded use was in the 1200s by the Dominican monk Randolphus of Bocking. The word’s origin followed the Hippocratic theory that phlegm dropped into a joint, causing pain and swelling.

Consequently, the ancient remedies of bleeding and purging to restore humoral balance remained popular.

Like the Byzantines, medical men in England also suggested plant-based preparations. Nicholas Culpeper in his ‘Complete herbal’ (1653) advocated horseradish and ground elder (or gout-herb): “the very bearing of it about one eases the pains of the gout and defends him that bears it from the disease.”

Meanwhile in Europe, a treatment suggested by Lorenz Fries, writing in 1518, was to: “Roast a fat old goose and stuff with chopped kittens, lard, incense, wax and flour of rye. This must all be eaten, and the dripping applied to the painful joints.”

In the 1700s, leading doctors advised spa treatments, including William Cadogan in “A dissertation on the gout, and all chronic diseases” (1771), which went through nine editions in two years.

Technological developments allowed Antonie van Leeuwenhoek, inventor of one of the earliest microscopes, to first describe crystals from a gouty tophus in 1679. And in 1797, the English chemist William Wollaston demonstrated urate in a tophus from his own ear.

Sir Alfred Garrod (1819–1907) identified uric acid as the “specific morbid humour” that caused gout. In his milestone book ‘The nature and treatment of gout and rheumatic gout’ (1859), he wrote: “the deposited urate of soda may be looked upon as the cause, and not the effect, of the gouty inflammation.”

Some of the earliest “cure-alls” included gout in their sights, although dealing with the acute pain was all that most medicines could attempt. Daffy’s Elixir “the Health-Bringing Drink” was invented by Reverend Thomas Daffy in around 1650. Although a secret remedy, its laxative properties were due to ingredients including senna and liquorice, alongside coriander seeds, raisins and brandy.

Other than for gout, it was sold to treat conditions ranging from dropsy to convulsions. Thomas Dover invented his Dover’s Powders to treat the pain caused by gout using ipecacuanha and opium. In ‘The ancient physician’s legacy to his country’ (1732) he claimed that “in two or three hours, at farthest, the patient will be perfectly free from pain”.