The story of the gouty heart.

Many distinguished fellows of the College of Physicians including Harvey suffered from gout in the past, as recorded in Munk's Roll (I878-I968). As an example may be cited Dr. William Stukeley (I687 -I765) who started practice in Boston, my native town. He had long been a sufferer from gout and overpowered by repeated attacks he turned his thoughts to the Church, was ordained in I729, and became rector of All-Saints Stanford (Doomsday spelling of Stamford). Here Dr. Rogers, himself a sufferer from gout, had invented an oleum arthriticum which Dr. Stukeley was induced to try with great success, so that in 1733 he published a letter to Sir Hans Sloan on 'the cure of gout by oils apply'd externally' (Fig. i); the oil was heated in a spoon and rubbed in while hot. This letter passed through several editions and the third of 1740 is in the library of the Royal College of Physicians. In I747 Stukeley moved to London where he died of a palsy in an apoplectic attack, aged 78. He was evidently highly regarded in Lincolnshire not only as a physician but also as an authority on Druidical history. Ten pages are devoted to him in Pishey Thompson's history of Boston (i856) which he described as a town lying in a region of dirty roads and dull company. Though heart disease could not be recognized clinically in Stukeley's time, cerebral vascular episodes were not uncommon and some were probably associated with hypertension. James Wardrop, surgeon to King George IV, who wrote a treatise on heart disease (i85i), believed that gout was translated to the heart when the arthritic inflammation subsided. Called to the king during his last illness when he was being treated by Sir Henry Halford for inflammation of the lungs, Wardrop diagnosed gouty heart disease. Necropsy disclosed aortic stenosis and atheroma, a large heart, and bilateral hydrothorax. A full account of the king's illness is given by Pettigrew (I838). Sir Henry Halford had been much criticized in the press for his misleading bulletins and it was not until two days after Wardrop's visit that he first informed the government of the king's heart disease.