Saturnine gout: A review of 42 patients

Abstract

HE CONCEPT of lead poisoning acquired through negligence or malfeasance is as old as alchemy, from which the term saturnine, as in saturnine gout, is derived. In this review, we relate our long-term observation of patients with saturnine gout, a consequence of drinking leadcontaminated moonshine. The accidental contamination of alcoholic beverages with lead has been recognized for centuries. Lead has been added intentionally to wines to improve their flavor or prevent spoiling, attested by Imperial ordinances interdicting this practice as early as 1437, and as late as 1837, wines of France were examined by tasters trained to detect lead. Gout as a complication of chronic lead intoxication was described as “saturnine gout” by Musgrave in 1703, and considered at length by Garrod who noted that onefourth of all his gouty patients were painters or other artisans with occupational lead poisoning.‘,* Garrod’s attention was thus drawn to the role of lead poisoning in the pathogenesis of gout by the obvious occupational exposure of these patients, and by other recognizable features of plumbism, anemia being one. He did not consider alcohol as the source of saturnine gout in any of his patients, even though he was intrigued by the observation that gout was far more common among the bibulous English than among their equally bibulous Russian, Scottish, Polish, Swedish, and Danish counterparts, and he attributed this to a unique property of the port and other fortified wines favored by the English.