The idea that the disease might be self-inflicted was a way to exert control over what was, once an attack started, uncontrollable, and to give the pain meaning, as a path to edification and redemption, since for centuries, sacrifice of earthly pleasures was the only relief. Premodern medical treatments — apart from colchicine, a plant extract applied by the Byzantine physician Alexander of Tralles in the sixth century and still used today — were largely ineffective: leeches, diuretic purges, poultices of fermented ox dung, ointments of boiled dog, glugs of treacle and, in one 1518 prescription, a roasted goose stuffed with “chopped kittens, lard, incense wax and flour of rye. This must all be eaten, and the drippings applied to the painful joints.” In Sydenham’s 1683 treatise on the disease, for the sudden onset of violent symptoms he recommended laudanum — a tincture of opium and alcohol — to take the edge off the pain; his own blend was steeped with saffron, cinnamon and cloves. Formulas like this helped spawn a market in patent medicines, sold out of suitcases by bamboozlers promising miracle cures. The British historian Richard Barnett has even traced a line from another Sydenham gout treatment, distilled alcohol laced with the likes of horseradish and wormwood — that is, bitters — to contemporary cocktail culture.
If gout is but a historical footnote (forgive the pun), it has nevertheless occasionally caused a tiny flutter in world events, because its victims have so often been men of power. In 1552, Charles V, Holy Roman Emperor, had to delay his siege on French-held Metz while he grappled with the disease, giving the enemy ample time to fortify the city. His armies repulsed, he slunk back to the Low Countries and, a few years later, gave up the throne. The British statesman William Pitt, first Earl of Chatham, was a fervent champion and defender of the young American colonies in the late 18th century, but when gout confined him at home, less sympathetic members of Parliament took advantage of his absence to rally support for the Stamp Act of 1765, imposing the first direct tax on the colonists, and then the infamous Townshend Acts, which taxed tea, among other goods. Revolution followed.
More recently, after Paul Manafort, the American political consultant and former campaign chairman for President Trump, was convicted in 2018 for financial fraud, he was rolled into court in a wheelchair for a sentencing hearing, his right foot in bandages without a shoe, felled by what his lawyers described as “severe gout.” Some observers suspected that this was just a ploy for leniency; Manafort ended up getting less than four years instead of the recommended 19 to 24 (three and a half years were added later for separate charges, though he was released this past May to serve the remainder of his sentence at home, because of concerns about the coronavirus). But others saw the disease’s sudden public manifestation as an emblem of our indulgent epoch. Katy Schneider, writing in The Cut, pointed out Manafort’s fondness for fine clothes — like the $15,000 ostrich-leather jacket entered into evidence during the trial, one in a series of wardrobe purchases totaling nearly $1.4 million over six years — as part of a pattern of overconsumption. Of course he got gout.