History of Medicine

                     BENJAMIN FRANKLIN’S GOUT

      Benjamin Franklin’s name is recognized everywhere. No American history course omits mention of his accomplishments. Less often referred to, though, is his struggle with gout and urinary stones, maladies that plagued him in later years. 

Benjamin Franklin in a fur hat he often wore 
in France (Wikipedia)

         Franklin first mentioned “a touch of the gout” in a letter to his sister when he was 56 years old. Gout appears off and on in later letters as an annoying but not serious impediment. Franklin, of course, was conversant with many medical and scientific matters, often corresponding with doctors. He knew the writings of Thomas Sydenham, considered the father of English medicine, who had published a treatise on gout in 1683. Sydenham noted that gout “generally attacks those aged persons who have spent most part of their lives in ease, voluptuousness, high living, and too free an use of wine and other spirituous liquors” and “…have

Thomas Sydenham, by Mary Beale
(Wikipedia)

large heads, are generally of a plethoric, moist, and lax habit of body…” When, less often, it attacks younger persons, they received it from gouty parents or occasioned it by “over-early use of venery.” Sydenham also recognized an association with urinary stones, and he discouraged bleeding, emetics, purges, and sweating agents in favor of certain herbal remedies. Leeuwenhoek had seen the needle-like crystals from gouty tophi but identification of uric acid as the important substance came after Franklin’s time.

         Franklin had been sent to France early in the American Revolution to enlist the aid of the French government in the revolt against England. He arrived in December 1776, at the age of seventy. He was well known there, as Voltaire had extolled him as the discoverer of electricity, a genius, a successor to Newton, and a scientist. He took up residence on an eighteen-acre estate in Passy, a wealthy commune near Paris, owned by an aristocrat sympathetic to the American cause. 

Franklin presented at court. Louis XVI and Marie Antoinette are seated on the right. The woman
in white next to Franklin is Diane Polignac, lady-in-waiting to the queen's sister. (Library of Congress)
(click on image to enlarge)

Franklin commuted to Paris for consultations with the French government, during which he faced numerous meals rich in fatty meats, pastries, and wines, many of the latter fortified. He became especially fond of Madeira and consumed generous quantities of it. His gout intensified and he believed that his new lifestyle was responsible. Lead was often present in wine at the time, entering during its production and seeping in from lead-containing wine vessels. Lead can promote gout by decreasing uric acid clearance and is believed to have contributed to Franklin’s case. 

Madame Brillon, by Fragonard (Wikipedia)

Near Franklin in Passy lived Madame Brillon, the wife of a much older and frequently absent man. Madam Brillon was quite attractive, and she and franklin flirted with each other. During one of Benjamin’s gouty attacks, she composed a poem, chiding him for bringing it on himself by eating too much, drinking too much, avoiding exercise, and “you pass your time with dames” (translated).  He subsequently composed a dialogue  between himself and "Madame Gout," who also berates him for dietary excesses and lack of exercise.

Colchicine, known to the ancients as a remedy for gout, seems to have fallen out of favor in Franklin’s time. He probably did not use it, but it was available in Paris as part of a secret formula called “Eau Médicinale.” Colchicine is derived from the plant Colchicum autumnale, or autumn crocus, found most abundantly in Colchis, an ancient tribal area, described by Herodotus, that covered a region corresponding to the western part of modern Georgia. The identity of colchicine as the secret ingredient in Eau Médicinale was revealed in 1814 and its use in gout subsequently reaffirmed.

Aside from gouty attacks in his feet, Franklin had passed “gravel” in his urine off and on, but it was not until he was 76 that he became aware of a bladder stone that would not pass. The stone troubled him principally when traveling in a coach or walking and he limited his activities to avoid excruciating pain. This hampered his negotiations over the Treaty of Paris of 1783 ending the American Revolutionary War. He medicated himself with large amounts of honey, molasses, and jellies, hoping that they would increase the specific gravity of the urine and allow the stone to be buoyed up and perhaps keep gravel from coalescing. His idea stems from a school of thought known as iatrophysical or iatromechanical medicine, seeking to explain physiological processes through the laws of physics. He could not know the modern conception of urine and stone formation.

Doctors advised another medication for the stone, Blackrie’s Lixivium, a solution of salt of tartar (potassium carbonate), quicklime (calcium oxide) from oyster shells, and water, which is basically a lye solution. Prescribers of this remedy, a remnant of the iatrochemical school of thought, hoped that the lye would dissolve stones. Surgery was discussed among his doctors but dismissed as unreasonable. The operation would have been a lithotomy, removing

John Jones, surgeon (National Library 
of Medicine)

the stone through an incision between the scrotum and the perineum, without anesthesia. Founding father and later chief justice John Marshall underwent this procedure in his sixties, successfully. His surgeon was John Jones, a prominent surgeon in the American Revolution, the first to perform a lithotomy in America, and one who could accomplish the surgery in a little over one minute, to minimize pain.

Franklin returned to America in 1785 in ever more pain from the stone. He finally resorted to opiates, which eased the agonies somewhat. He signed the new U.S. Constitution in 1787 but eventually, with John Jones attending him, succumbed to a lung abscess in 1790 at the age of 84. Alert to the end, he lived a remarkably long life for his era, and certainly a productive one.

 

SOURCES:

 

Corner, GW and Goodwin, WE, “Benjamin Franklin’s Bladder Stone.” 1953; J Hist Med Allied Sci8: 359-77.

 

Finger, S and Hagemann, IS, “Benjamin Franklin’s Risk Factors for Gout and Stones: From Genes and Diet to Possible Lead Poisoning.” 2008; Proc Amer Philosoph Soc 152 (2): 189-206.

 

Franklin, JL, “The Three Contraries of Benjamin Franklin: “the gout, the stone, and not yet master of all my passions.” 2021; Hektoen 13 (3).

 

Franklin, B. The Bagatelles from Passy. 1780; Facsimile by Eakins Press, New York, 1967 (Originally printed by B. Franklin on his personal press at Passy).

 

Griesemer, A D, et al, “John Jones, M.D.: Pioneer, Patriot, and Founder of American Surgery.” 2010; World J Surg. 34 (4): 605-9.