Portrait of King Henry III by Follower of Hans Holbein the Younger (philipmould.com) [Public domain], via Wikimedia
Portrait of King Henry III by Follower of Hans Holbein the Younger | philipmould | Wikimedia Commons

Who doesn’t follow stories about the travails of the rich, famous and powerful? Think Bill Cosby, Brian Williams, Martin Shrekli, and Penn State’s Jerry Sandusky to name but a few. It seems all of them succumbed to the vice of hubris; they thought they were above the laws of mere mortals. And then, they were brought down with a vengeance. Of course, this is nothing new; a whole theatrical industry flourished in ancient Greece revolving around the tragedy wrought by hubris. But at least, today’s demi-god celebrities look to me hale and fit; none with those plebeian maladies of obesity, diabetes and heart disease. It hasn’t been always thus. There used to be a time when the rich and powerful paid for their transgressions not with jail time, but with disease.

 

The agony of gout

Gout used to be called “the disease of kings” or “blue-blooded disease”. Some very famous people suffered from this affliction, such as Alexander the Great, Christopher Columbus, Isaac Newton, and Henry VIII. Even Shakespeare’s Falstaff, the hard living, hard-drinking buffoon exclaimed, “a pox on my gout, a gout on my pox (Henry IV, Part 2).

Going even further back, an Egyptian medical hieroglyph from 2500 years ago describes the symptoms of gout. Now, Egyptian doctors of the time did not bother themselves with diseases of the masses; they ministered to the Royal court and the priesthood. So gout must have been quite common among these privileged classes.

Clinically, gout is caused by precipitation of uric acid crystals in joints, especially the one at the base of the big toe (a condition known as podagra). Uric acid is a metabolic product of purines, a class of nucleic acid bases, which are present in large quantities in yeast, red meats, seafood, alcohol such as beer, stout and port wine.

James Gillray's "The Gout" (from Wellcome Images via Wikimedia (cc by 4.0)
James Gillray’s “The Gout” | Wellcome Images | Wikimedia (cc by 4.0)

Many people have a genetic disposition to hyperuricemia (high uric acid concentration in the blood). But that’s not enough to precipitate a gout attack. Acute gout is brought on when uric acid precipitates in the joints in the form of sharp needle-like crystals, which cause inflammation and severe pain.

Amongst other things, gout is associated with consuming a diet rich in meat and seafood (high-purine foods) and drinking too much alcohol. And this is why the ruling classes were prone to gout: they were the only ones who could afford the fois gras of their days. As a fringe benefit of the democratization of modern society, we all share now in the delights of fois gras and le gout.

[Historical footnote: it was Anthonie van Leewenhoek, inventor the microscope in 1716 who first saw those nasty crystals in a joint aspirate, and thus dispelled the notion that gout was the work of the devil, or caused by “bad humors”. Strike one for science.]
I can already hear the cries of anguish: Why us? Why don’t other animals that eat red meat (albeit don’t drink alcohol) suffer from gout? The answer is that upon becoming “thinking people” (which is what Homo sapiens means, more or less), we lost the enzyme that converted uric acid to a water-soluble product that is readily excreted in the urine. We, and Dalmatian dogs, believe it or not. I don’t know if the poor dogs suffer from the Royal Disease, but I wouldn’t be surprised if it affected their famous temperament, which is charitably described as a royal pain. (Dalmatian lovers, keep the emails civil, please).

 

Lead poisoning

This one is based on Irvin Modlin, a professor of surgery at Yale University, and a historian of medicine par excellence. In his book, Medical Tales of the Tagus: From Port to Pombal, he relates a delightful vignette. The Duoro valley of Portugal has been a wine-growing region of the Iberian peninsula since antiquity. One specialty of the region was (and still is) port wine.

We already know that port wine is rich in purines (see gout, above). But to add insult to injury, ancient port was rich in lead. How come? Because the wine-growers of the Duoro knew how to make wine, but didn’t know how to fire their storage amphoras to high enough temperatures as to avoid leaching of lead from the ceramic.

The Roman legions who conquered Iberia brought back with them some port, which immediately became popular among the Romans and kindled huge demand. That caused prices to skyrocket, with the obvious result—only the rich could afford it. Bone biopsies of Roman aristocratic skeletons revealed levels of lead that are in the toxic range. Since lead causes neurological and cognitive impairment, could it have contributed to the slow decline and final fall of the Roman Empire?

 

Heart disease

In a previous post, I discussed an MRI study of Egyptian mummies that showed widespread atherosclerosis and coronary artery narrowing. Here is a quote:

“They performed CT scans on 52 of their mummies and found that 44 of the mummies still possessed identifiable cardiovascular tissue. And of these, 45% exhibited definite or probable hardening of the arteries. Average age of death was 40…Obviously, the mummified bodies did not belong to the proletariat; only royalty, their household (nursemaids, children of royalty), high officials and priests, merited embalming. Their diet consisted of salted fish (cause for hypertension?), bread, and cheese like the rest of the hoi polloi, but they also dined on rich foods such as cow, sheep, and goat meat, as well as something similar to today’s Baklava.”

The poor slaves who built those fabulous pyramids died even younger; average lifespan in Egypt was 30-35 years. But they didn’t have the privilege of dying of heart disease or suffering from gout. They typically succumbed to infections and parasitic diseases.

Today’s ills of the rich and famous are shared by us plebeians. But the fall from grace due to social indiscretions and sheer hubris is still, by and large, their province. If for no other reason than when we do it, nobody gives a hoot. But when they do it, we experience a bit of Schadenfreude.

Chinese proverb: “be careful of what you can afford. You may be sorry you could.”

Translated and improved by D.M


Originally posted May 2011. Updated on January 31, 2016.

Dov Michaeli, MD, PhD
Dov Michaeli, MD, PhD loves to write about the brain and human behavior as well as translate complicated basic science concepts into entertainment for the rest of us. He was a professor at the University of California San Francisco before leaving to enter the world of biotech. He served as the Chief Medical Officer of biotech companies, including Aphton Corporation. He also founded and served as the CEO of Madah Medica, an early stage biotech company developing products to improve post-surgical pain control. He is now retired and enjoys working out, following the stock market, travelling the world, and, of course, writing for TDWI.

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