To some people, the lilac-petalled autumn crocus is just a pretty flower, a welcome touch of colour in a drab October landscape. The delicate blooms, known to British countryfolk as meadow saffron or dainty maidens, spring up after the leaves have died away. To farmers, they are anything but welcome. Every part of the plant is packed with poisons-enough to kill a sheep or a cow. But there is one group of people for whom the toxic nature of Colchicum autumnale is what makes it so attractive. For thousands of years, victims of gout have relied on the lily-it鈥檚 not really a crocus at all-to relieve the agony in their joints. But if it hadn鈥檛 been for a prince鈥檚 royal pains, colchicum might have been consigned to history.
GEORGE, the Prince Regent, was middle-aged, overweight and overindulgent in all departments. Lampooned at the time for his gluttony and debauchery, George paid for his pleasures with pain. He was not alone: the early 19th century was an age of hearty eating and heavy drinking among the English gentry. And, not surprisingly, it was also the golden age of gout. Among the multitude of distinguished sufferers, few went through worse agonies than the Prince Regent himself.
Long did that prince of pleasure suffer the ministrations of the royal physicians, Sir Henry Halford and Sir William Knighton. Both followed the orthodox line that gout was congenital, constitutional and best left alone. George鈥檚 pain grew intolerable, until eventually he was swallowing 1200 drops of laudanum a day, without relief. One day in 1817, when he could stand it no longer, the prince rounded on his doctors. 鈥淕entlemen, I have borne your half measures long enough to please you,鈥� he declared. 鈥淣ow I shall please myself, and take colchicum.鈥�
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The royal physicians were appalled. Colchicum was deemed a 鈥渉eroic鈥�, a desperate remedy for a disorder in which violent treatments were judged counterproductive. Worse still, it had the reputation of being quackish, associated in the public mind with a nostrum called the Eau m茅dicinale, which was marketed from the 1770s by a French army officer called Nicolas Husson.
Husson claimed that his 鈥渟ecret water鈥� would cure not just gout but sciatica, rheumatism, madness, apoplexy, lethargy, catalepsy, paralysis and epilepsy. Faced with such sweeping claims it is small wonder that the regular medical profession dismissed colchicum as a cure for anything at all.
It had not always been so. Colchicum autumnale was known to ancient physicians as a mighty remedy for gout. The 1st-century Greek physician Dioscorides discussed the merits of the colchicum corm at some length in his pharmacological blockbuster De Materia Medica. Dioscorides, though, recommended colchicum primarily as an antidote against mushroom poisoning.
By contrast, the 6th-century author Alexander of Tralles wrote that hermodactyl, an extract from the colchicum corm, had purgative properties that were useful for dealing with arthritic conditions. Alexander graphically described the rapid relief from joint pain and swelling experienced by many of his patients. His near contemporary, the Greek medical writer Aetius, also advocated its use but was well aware of its side effects: 鈥淗ermodactyl is bad for the stomach, producing nausea and anorexia, and ought therefore only to be used in the case of those who are pressed for time by urgent affairs of business, for it does remove the disease quickly, after two days at most, so that they are enabled to resume. For this reason some do call it anima articulorum-the soul of the joints.鈥�
Islamic physicians studied colchicum, and the learned professors of the first European medical school at Salerno in southern Italy taught students its properties: 鈥淚t helpeth the arthritic gout,鈥� states the Regimen Sanitatis Salernitanum (the Salernitan Guide to Health). Medieval pharmacopoeias mention hermodactyl as a constituent of an arthritic pill. And in 1282 it was contained in a prescription for the Byzantine emperor Michael Paleologus VIII, written by his private physician. The doctor wasn鈥檛 prepared to trust the cure entirely to colchicum, however, hedging his bets with a get-out clause: 鈥淭his will cure you,鈥� he wrote, 鈥減rovided we have the assistance of Heaven, the intercession of the Blessed Virgin Mother, and the help of God.鈥�
But colchicum was becoming questionable: doctors-and their patients-were discovering that large doses were highly toxic and had severe gastrointestinal side effects. The medieval medical abbess Hildegard of Bingen forbade its use as 鈥渁 deadly poison鈥�, and Renaissance physicians widely dismissed it as a fearsome purgative. William Turner, the leading Tudor botanist, wrote in his Herbal of 1548 that colchicum, which 鈥渉ath leaves and seedes in Sommer, and flowres lyke saffron aboute Mihelmesse鈥� should not be used.
Slightly later, the herbalist and apothecary John Gerard believed that though 鈥渋t could be very hurtfull to the stomach鈥� it could help ease joint pains 鈥渨hen mixed with white of eggs, barley meal and crumbs of bread and applied plaister-wise鈥�-or if the corm were worn around the neck or hidden in the pocket. Broadly speaking, however, its reputation sank and by 1650 it had been dropped from the Pharmacopoeia Londinensis.
The consequence was that one of medicine鈥檚 few 鈥渟pecifics鈥�-a drug that worked wonders for a particular disease-virtually disappeared from use for a couple of hundred years, until the enterprise of a quack and the patronage of a prince restored its name.
鈥淚f you can鈥檛 beat them, join them鈥� has always been the maxim of regular medicine. Once the Prince Regent and other luminaries-including Joseph Banks-the president of the Royal Society and another martyr to gout, had come out for colchicum, regular practitioners inevitably followed suit. In 1820, Edward Haden published a monograph on colchicum in acute and chronic inflammatory diseases. His father had begun to treat gout with colchicum, he reported, and had 鈥渢hen extended the use of the remedy from gout to rheumatism, and from the latter to the treatment of cases of inflammation in general鈥�.
After so long in the wilderness, colchicum was rapidly rehabilitated. In 1820, French chemists discovered its active ingredient, the alkaloid colchicine. Produced in crystalline form in 1884, this replaced the time-honoured tinctures, extracts and other ancient preparations of colchicum, as the alkaloid was stable, reliable and easy to take in exact dosage. Colchicine remained unrivalled for its effective and rapid control of pain in acute gout until the advent of allopurinol in 1963.
In whichever form, the drug proved a hit with sufferers-none more than that great and gout-ridden Anglican parson Sydney Smith. His daughter, Lady Holland, related how Smith had once noticed some of his autumn crocuses in flower: 鈥淭here,鈥� he said, 鈥渨ho would guess the virtue of that little plant? But I find the power of colchicum so great that if I feel a little gout coming on, I go into the garden and hold out my toe to that plant, and it gets well immediately.鈥�