This quartet shared not only a love for politics, but also the torture of their aching toes. It is easy to imagine them sitting around a fire in the evening, comparing aches and pains (actually it would have to be imagined because while Franklin, Jefferson, and de Vergennes were making nice in France, Hancock was back home in the Colonies).
Franklin, the only man to have signed all four documents that created the United States—the Declaration of Independence (1776); the Treaty of Alliance, Amity, and Commerce with France (1778); the Treaty of Peace between England, France, and the United States (1782); and the Constitution (1787)—was subject to attacks of gout so painful that, unable to walk, he was delivered to the Constitutional Convention in a sedan chair hoisted aloft by four hardy prisoners from the Walnut Street jail in Philadelphia. In 1787, Jefferson wrote from Paris to John Jay, the future Chief Justice of the United States, that the Comte de Vergennes was “very seriously ill. Nature seems struggling to decide his disease into a gout. A swelled foot, at present, gives us hope of this issue.” As for his own gout, Jefferson dealt with that by soaking his feet in cold water each morning; there is no record of whether he followed the advice of various Old Wives to add willow bark (American Indian), stinging nettles (Swiss), salt (Russian), cider vinegar or pine extract (New England) to the water and no record either of the remedies’ effectiveness. Meanwhile, at home in Massachusetts, Hancock cannily used the threat of his gout to political advantage when as Governor of Massachusetts, he took his time showing up to sign the Constitution, citing a convenient attack of toe throb. His tactical delay forced the Federalists to dance an offer of the vice presidency in front of him and to promise the addition of a Bill of Rights, thus prompting a most fortuitous recovery; in February 1788, Massachusetts became the sixth colony to ratify the Constitution. That same month, with de Vergennes’ enthusiastic support, New America and Old France signed Treaties of Amity and Commerce granting military aid to the Colonies and mutual most-favored-nation status.
Gout, on the other hand, had long ago been accorded most favored disease status, miserable to be sure, but as we have seen, also surprising proof of the sufferer’s virtue and medical and libidinous good fortune.
But how to soothe the unfortunate pain?
Cutting corns and cultivating customers
The search for an effective way to ease an aching human foot is probably as old as the human foot itself. We have no studies from the caves, but drawn and written records tell us that the Chinese practiced chi (qi) foot massage, an ancestor of modern reflexology, more than 5000 years ago. As early as 2400 BCE, the Egyptians carved a bas relief of a foot operation on to Ankhmahor’s Tomb, a structure sometimes called The Physician’s Tomb. Although Ankhmahor was not a doctor but a politician whose proper title was Vizier, First under the King, Overseer of the Great House, the tomb was decorated with scenes of medical procedures. Hippocrates prescribed a vinegar bath to soften corns and calluses, a remedy that along with lemon juice or, in a pinch, urinating on the corn or even into your shoes, remained popular for centuries. Type “natural remedies for corns” into the search bar on your computer, and lemon juice and vinegar are still there, along with chamomile tea and a modern bath of aspirin dissolved in water. What all these remedies have in common is that each is an acidic solution that accelerates the body’s natural flaking of the top layers of skin, softening a corn so it may be peeled or scraped away.
For hundreds of years, foot care peddled along in the backwaters of medicine, practiced by people known as “corn cutters.” Kings and Queens had their own podiatric practitioners at court; lesser mortals found theirs on the street. In Britain, anyone might hail one of those who advertised their wares and work in the songs known as “The Cries of London” promising
Here’s fine herrings, eight a groat;*
Hot codlines pies and tarts.
New mackerel I have to sell.
Come buy my Wellfeat & Oysters, ho!
Come buy my whitings fine and new.
Wives, shall I mend your husband’s horns?
I’ll grind your knives to please your wives,
and very nicely cut your corns.
* Four pence; for comparison, according to the “Time Traveller’s guide to Tudor England” (http://forums.canadiancontent.net/history/49884-time-travellers-guide-tudor-england.html), at the time a diet staple for the poor was a “halfpenny loaf of bread, which feeds two people.”
Despite the lowly status of the corn cutter, problematic feet often made their way into art and literature, such as this passage from Romeo and Juliet, Act I, Scene 4. Or Act I, Scene 5, depending on the source. Bartlett’s Familiar Quotations (16th ed., 1992) has five scenes in Act I; The Yale Shakespeare (1993) has four. Either way, Juliet’s father, Lord Capulet, hosts a dinner dance where Romeo, seeing Juliet for the first times, rhapsodizes: “Did my heart love till now? forswear it, Sight! For I ne’er saw true beauty till this night,” which surely beats the modern adolescent accolade, “Awesome!” Back at the dance floor, Capulet encourages participation in the festivities by slyly suggesting that ladies who decline to dance have un-romantically aching feet:
Welcome, gentlemen! Ladies that have their toes
Ah, my mistresses! Which of you all
Unplagued with corns will walk a bout with you.
Will now deny to dance? She that makes dainty,
She, I’ll swear, hath corns. Am I come near ye now?
Treating feet eventually became more respectable, but it was a slow trek up from the bottom. The number of corn cutters in England increased after William of Orange deposed the Catholic James II and ascended to the British throne in 1689, bringing with him his own squad from the Netherlands. The group included John Hardman, a man so well regarded that not one, but two portraits of him hung in the British National Gallery. A second corn cutter, one Mrs. Seymour Hill, was so widely known in London and her clientele so fashionable that Charles Dickens is said to have chosen her as the model for the dwarf beautician, gossipy Miss Moucher in David Copperfield. When the novel appeared, Mrs. Hill reputedly buttonholed the author and upbraided him for satirizing her but was mollified by Dickens’ explanation that her character ended up a heroine.
Hartman and Hill aside, cutting corns and shaving calluses were still the low end of the healing arts. In 1800, Kelly’s London Directory, a sort of pre-telephone telephone book that listed, in alphabetical order, “persons holding situations under the crown in the Bank of England, the various Law, City, and all other public offices, local officials such as mayors, heads of households, commercial traders, judges and lawyers, members of Parliament, banks and the various forms of transportation.” There was only one foot specialist.
Then came the revolution. It started with the introduction of a fancier name: chiropodist, which etymologists consider either a smoother version of the earlier chirurgapodist, from the Latin chirurgia for surgeon, or a combination of chiro, the Greek word for hand or foot, plus the Latin pod meaning foot. The word appears to have been invented by a Londoner named David Low. Looking to enhance his reputation, he appropriated as his own a book called L’Art de Soigner les Pieds (The Art of Caring for the Feet [1781]), actually written by Louis XVI’s personal corn cutter, Nicholas-Laurent LaForest. Low changed the title to Chiropodologia, but was soon exposed as a plagiarist; LaForest’s original book remained the standard treatise on foot care. In 2012, Bauman Rare Books, a New York antiquarian bookseller, offered for sale at $16,500 a copy with Marie Antoinette’s very own gilt crest on the cover, “Second edition (first published in 1781) of this classic podiatric work, written by the chiropodist of Louis XVI and the royal family, with the gilt arms of Marie Antoinette, beautifully bound…. Small octavo, contemporary full brown morocco, elaborately gilt-stamped spine and covers bearing the armorial crest of Marie Antoinette, marbled endpapers, all edges gilt. $16,500.”
The word chiropodist was eventually replaced by the modern podiatrist during the first decades of the twentieth century,
a period that also brought the introduction of dedicated professional training; a professional degree, Doctor of Podiatric Medicine; and several professional societies (some of which still use the name “chiropodists”) along with the requisite professional journals. Today, like dentistry, podiatry remains a separate branch of the health sciences with its own schools. And like dentists, who with further training may become oral and maxillofacial surgeons, treating complicated injuries, abnormalities, and diseases of the head, neck, and face, podiatrists may choose to specialize in various fields, in this case primary care, pediatrics, geriatrics, diabetic wound care, or foot and ankle surgery.
Safe, effective—and expensive
Before there were doctors and drugs, there were herbalists and the green pharmacy, the plants that yielded effective medicines whose benefits we still enjoy. The dental analgesic eugenol comes from clove oil, the painkiller salicylic acid (our modern aspirin) from the bark of the willow tree, and the painkillers codeine and morphine from the pretty red poppy. Celery seeds and dandelions produce diuretic oils. The anti-hypertensive, anti-arrhythmic digitoxin (Digitalis) comes from foxglove; the sleep-aid Valerin (valeric acid) from teas made with valerian roots and stems; the anti-malarial quinine from the bark of the South American cinchona tree
Another medicinal plant, meadow saffron (Colchicum autumnale), also known as the autumn crocus, has been part of the natural pharmacopoeia for as long as there have been written medical records. The plant, native to Eastern Europe and Asia, is named for Colchis, the ancient province east of the Black Sea where legend says the Greek hero Jason conspired with the sorceress Medea to steal from her father the legendary Golden Fleece that would win Jason back his rightful kingdom. The Ebers papyrus describes meadow saffron as soothing to the joints. The first person known to prescribe it specifically to relieve the pain of gout was Alexander of Tralles, a sixth century Greek physician practicing, as most of them seem to have done, in Rome. Alexander was well known and respected as the author of Letter on Intestinal Worms, the first treatise on parasitology, and the Twelve Books on Medicine, available in Latin, Greek, and Arabic editions. Tralles’ treatment did ease his patients’ pain, but meadow saffron was a risky remedy. The plant is poisonous, a purgative whose adverse effects may include nausea, abdominal pain, bloody vomit and diarrhea, high blood pressure, and respiratory failure followed by death; Greek slaves are said to have used it to commit suicide. Thomas Sydenham, who had created laudanum, the opium and sherry mixture whose addictive soothing qualities ensnared such luminaries as Mary Todd Lincoln, Samuel Coleridge, and Franklin, considered the colchicum plant too dangerous for human use. But like modern advocates for medical marijuana, gout victims begged to disagree, and, Sydenham’s warnings were ignored. The herb, well regarded on the Continent and listed in the London Pharmacopeia starting in 1616, eight years before Sydenham was born, remained the remedy of choice.
Traveling to London on Colonial business in 1757 and 1764, Franklin spent much time in the coffee houses of London with the members of “The Club Of Honest Whigs” where, as Samuel Johnson’s biographer James Boswell recalled, “Some of us smoke a pipe, conversation goes on pretty formally, sometimes sensibly and sometimes furiously: At nine there is a sideboard with Welsh rabbits and apple-puffs, porter and beer.” Many of “us,” it should be noted, suffered from gout and were treated with remedies brewed from the colchicum plant. Franklin was neither a fool nor a fan of suffering; after one trip abroad, he returned to America with a supply of colchicum plants for himself and his fellow gout sufferers.
Colchicum wasn’t the only plant Franklin carried back across the Atlantic. The Chinese tallow tree is a horticultural wonder. It thrives in sun or shade, flood or drought, all the while producing waxy berries that can be used to make candles or burned as fuel. “Tis a most useful plant,” Franklin wrote to Noble Wimberly Jones (c. 1723–1805), a British ex-pat whose support of the French and American revolutions led him to immigrate to America where he settled in Georgia, and became a leader of the Whigs in Georgia, eventually serving in the Continental Congress. Unfortunately, the seeds Franklin gave to Jones were, as predicted, extraordinarily hardy. Today, the tallow tree, also known as the popcorn tree, has spread throughout the South and into the Gulf states, crowding out native plants such as the American holly. Kerry Crisley of the Nature Conservancy, writing on the Cool Green Science, a.k.a. “the conservation blog of the Nature Conservancy,” called importing the seeds the “one dumb thing that Benjamin Franklin did.”
Franklin’s other import, however, was doing well while doing good. With a few tweaks here and there.
In 1820, two French chemists, Pierre Joseph Pelletier (1788–1842) and Joseph Bienaimé Caventou (1795–1877), isolated the active anti-gout ingredient in meadow saffron seeds, flowers, and corms (the corm is the round underground stem in which the plant stores its food). Thirteen years later, the German chemist P.L. Geiger purified and named colchicine. After that, the goal was to identify a safe and effective dose, a job that required the sacrifice of several unlucky kittens under perfectly horrible conditions. Tracing the history of colchicine, the 1868 edition of The Dispensatory of the United States, reports that one-tenth of a grain of the substance extracted from meadow saffron seeds triggered exactly the adverse effects in an eight-week old kitten that Sydenham thought too dangerous for humans. “Violent purging and vomiting were produced, with apparently severe pain and convulsions and the animal died at the end of twelve hours,” while “[a] kitten somewhat younger was destroyed in ten minutes by only the twentieth of a grain.” As for humans, the Dispensatory reports that “in doses sufficiently large to affect the system, [colchicine] gives rise to more or less disorders of the stomach or bowels, and sometimes occasionally acts as a diuretic and expectorant; and a case is on record of violent salivation … while it somewhat diminishes the action of the heart. In an overdose, it may produce dangerous and even fatal effects.” In short, exactly the consequences that made colchicine the poison of choice for Greek slaves and convinced Thomas Sydenham that it was too dangerous to be used as medicine. Nonetheless, relatively high doses were the rule in the United States as well as Europe, the standard prescription being to “take until diarrhea occurs.” Not until 2009, 103 years after Congress passed the first Pure Food and Drugs Act in 1906, did the government begin to address the problems caused by what was considered a “normal” dose of the gout remedy from the meadow saffron plant.
The original Pure Food and Drugs Act arrived in 1906, one year after Upton Sinclair’s novel The Jungle was published in serial form in the weekly political newspaper Appeal to Reason. The novel was an immediate sensation. “I aimed at the public’s heart,” Sinclair (1878-1968) said, “and by accident I hit it in the stomach.” One prominent stomach belonged to President Theodore Roosevelt who, having read Sinclair’s revolting depiction of the Chicago slaughter houses where workers, animals, and food itself were abused, pressed strongly for passage of the food law.
The 1906 law was administered by the Bureau of Chemistry of the U.S. Department of Agriculture. In 1927, Congress created the Food, Drug, and Insecticide administration, within the U.S. Department of Agriculture. Three years later, this division became the U.S. Food and Drug administration. In 1933, when it began an overdue drive to update the 1906 law, the agency faced an uphill battle with manufacturers on all sides, but tragedy led to remedy, first in cosmetics and second in drugs.
As the FDA began its work, at least 12 women were blinded and one died after using Lash Lure, an eyelash dye sold as “permanent mascara.” The culprit in the product was p-phenylenediamine, a coal tar dye that caused blisters, infections, and ulcers on the eyes, lids, and face of customers (all modern hair dyes carry a warning to avoid the eyes). The scandal not only reinforced the need for new laws; it was a bonanza for Maybelline which introduced cake eyelash and brow darkener in 1917. The coloring, packaged as a cake and applied with a moistened brush, was re-christened “mascara” and advertised i
n 1934 as “genuine, harmless Maybelline. Nonsmarting, tear-proof Maybelline is NOT a DYE, but a pure and highly refined mascara for instantly darkening and beautifying the eyelashes.”
Four years later, in the fall of 1937, the motivating factor was a drug disaster—more than one-hundred Americans in fifteen states died after drinking Elixir Sulfanilamide, a raspberry-flavored antibiotic syrup manufactured by the S. E. Massengill Pharmaceutical Company. The antibiotic had been dissolved in diethylene glycol (DEG), a sweet-tasting syrupy liquid found in antifreeze. The product was tested for flavor, but not for toxicity; although the subject was under consideration, at the time, the law required testing for purity, but not for safety. Unfortunately, diethylene glycol is a poison, and the Elixir appeared to contain more than the potentially lethal amount per dose. Testing food and drugs for safety was implicit if not explicit in the FDA’s name and on the agenda even before the Elixir event. Now, the Lash Lure injuries prompted the inclusion of cosmetics. In 1938, Congress finally passed the Food, Drug, and Cosmetic (FD&C) Act with new safety provisions for all three categories of consumer products. Then, in 1962, in the wake of the thalidomide disaster, a new set of amendments named for Senator Estes Kefauver (1903–1963) and Representative Oren Harris (1903–1997) required manufacturers to prove their drug not only safe, but also effective before it could be approved for marketing.
All drugs have side effects (usual and expected consequences); some have adverse effects (rare and unexpected consequences). When patients ask about possible problems with a new medicine, doctors are likely to respond that if aspirin were introduced today, given its side effects and adverse effects, it might never win FDA approval.
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