For Franklin, it came down to lifestyle, family history

Franklin suffered from recurrent bouts of gout, a form of inflammatory arthritis associated with high levels of uric acid in the blood. In the last 15 years of his life, his gout attacks became longer and fiercer.

During one bout in France, he may have received colchicine for relief, an ancient remedy for rheumatism and swelling found in a plant called autumn crocus. Colchicine, first isolated in 1820 by a pair of French chemists, is still used today for gout.

In 1776, uric acid was discovered by Swedish German scientist Carl Wilhelm Scheele, who found it in kidney stones and urine. But it's not known whether Franklin was aware of the discovery.

About 20 percent of gout sufferers, without therapy, will develop kidney stones made from uric acid, not calcium oxalate. Family history revealed that Franklin's brother had kidney stones, pointing to familial, genetic uric acid abnormality.

Franklin's lifestyle, including a diet high in purines (found abundantly in meat and beer), can result in uric acid synthesis and gout. What's more, as a printer for many years, Franklin was exposed to lead type daily. Lead and gout have been linked; lead exposure is suspected as a cause of gout by inhibiting urinary uric acid excretion.

Although Franklin disclosed that he understood his diet and sedentary lifestyle could be the causes of his gout, he did not give up his favorite foods, especially wine. The pain he suffered likely precluded much physical activity.

Before long, he suffered more than foot problems.

At age 82, in 1787, Franklin began experiencing acute abdominal pain, thought to be caused by a urinary bladder stone, according to an American Philosophical Society record. Surgical removal was considered too risky in those pre-anesthesia, pre-sterile technique days, especially for someone of Franklin's age. The stone was never recovered, but it was most likely composed of uric acid, completing the painful duet of gout and kidney stones.

Franklin died in 1790 of pleurisy, a painful inflammation of the tissue lining the lungs and chest.

Today, uric acid crystals are easily recovered and identified under the microscope. Treatment for acute gout includes colchicine or NSAIDS (anti-inflammatories), and chronic therapy includes probenecid, a medication that prevents gout attacks by increasing urine uric acid excretion, and allopurinol, which decreases levels of uric acid synthesis.

Also important are lifestyle changes, including avoiding alcohol, limiting animal protein consumption, maintaining a healthy weight, eating a balanced diet, and drinking a lot of fluids, preferably water.

- Allan B. Schwartz