On the early uses of the word 'gout': novel evidence and a critical assessment of the published literature.

Recognized since antiquity, gout is still a relevant pathology with rising prevalence and incidence. This study aims to assess the reference accuracy in journal articles mentioning the early use of the word 'gout'. Specifically, it investigates whether the term was indeed coined in the 13th century by the Dominican monk Randolphus of Bocking, as widely believed. Several historical sources in their original Latin were consulted to test the hypothesis of literary mentions predating Randolphus of Bocking's description. At the same time, biomedical articles spanning the last two decades were perused using specific keywords in different combinations to determine the accuracy level of references related to the earliest use of the word 'gout'. The results showed that several biomedical publications wrongly ascribed the origin of the word 'gout' to Randolphus of Bocking. Indeed, various texts predate his mention by many years. In particular, gutta, the Latin word used to indicate a host of rheumatological conditions including gout, is recorded as early as the 10th century in a biography dedicated to the martyred nun Saint Wiborada of St. Gall. Written by Swiss monks between AD 960 and 963, this text should be regarded as containing the earliest known adoption of the word. For this reason, scholars should now avoid quoting Randolph of Bocking's description as the first use of the word 'gout' in Western literature.

From poison to drug: new recipes discovered containing colchicine as a remedy for Podagra in Rome and Byzantium.

OBJECTIVES: In Antiquity, colchicine was used as a poison and as a remedy for Podagra. Research so far has revealed that the physician Alexander of Tralles was the first who used it in the 6th century AD. Alexander recommended a plant he called "Hermodaktylon", which takes off the pain in the feet immediately. "Hermodaktylon" is identified with Colchicum autumnale L., which contains colchicine in his bulbs and seeds. We will present new data that varieties of Colchicum were used for medical treatment of Podagra far earlier than hitherto known by research. METHODS: We performed a systematic full text search in Greek and Latin original sources of Antiquity for "Hermodaktylon"/"Hermodactylus" and for the synonyms "Ephemeron"/"Ephemerum", "Kolchikon"/"Colchicum", and "Bolbos (agrios)"/"bulbus (agrestis)". We analysed our findings with philological and historico-critical methods. RESULTS: There are 48 text passages in original sources. Lucian of Samosata (2nd century AD) was the first who mentioned a plant he called "bolbos" as a remedy for Podagra. The Byzantine physician Jacobus Psychrestes (5th century AD) developed two recipes. Aëtius of Amida (6th century AD) transmitted two recipes. One case with an overdose of colchicine was discovered which resulted in the death of a patient in Byzantine times. CONCLUSIONS: New specific recipes containing Colchicum were discovered. Jacobus Psychrestes and Aëtius used Colchicum systematically for the therapy of Podagra earlier than the 6th century AD. However, the therapeutic use of Colchicum was already known in the 2nd century AD.

Gout in the Gilded Age: The Case of Richard Morris Hunt.

Richard Morris Hunt, a distinguished American architect of the late 19th century (the Gilded Age), had onset of gout at age 41 years. His attacks became more frequent and severe, eventually leading to chronic pain and disability. His medical care by highly regarded physicians resulted in very limited benefit, but through his dedication and work ethic, he remained productive until his death at age 67 years.

Colchicine: an ancient drug with novel applications.

Colchicine is a treatment for gout that has been used for more than a millennium. It is the treatment of choice for familial Mediterranean fever and its associated complication, amyloidosis. The 2009 U.S. Food and Drug Administration approval of colchicine as a new drug had research consequences. Recent investigations with large cohorts of patients with gout who have been taking colchicine for years have demonstrated novel applications within oncology, immunology, cardiology and dermatology. Some emerging dermatological uses include the treatment of epidermolysis bullosa acquisita, leucocytoclastic vasculitis, aphthous stomatitis and others. In this work we relate the history and the new horizon of this ancient medicine.

Gout in Duke Federico of Montefeltro (1422-1482): a new pearl of the Italian Renaissance.

The article examines the truthfulness of historical accounts claiming that Renaissance Duke Federico of Montefeltro (1422-1482) suffered from gout. By direct paleopathological assessment of the skeletal remains and by the philological investigation of historical and documental sources, primarily a 1461 handwritten letter by the Duke himself to his personal physician, a description of the symptoms and Renaissance therapy is offered and a final diagnosis of gout is formulated. The Duke's handwritten letter offers a rare testimony of ancient clinical self-diagnostics and Renaissance living-experience of gout. Moreover, the article also shows how an alliance between historical, documental and paleopathological methods can greatly increase the precision of retrospective diagnoses, thus helping to shed clearer light onto the antiquity and evolution of diseases.

On the history of gout: paleopathological evidence from the Medici family of Florence.

OBJECTIVES: Throughout history, gout has been referred to as the "disease of the kings", and has been clearly associated with the lifestyle of the aristocratic social classes. According to the written sources, several members of the famous Medici family of Florence suffered from an arthritic disease that contemporary physicians called "gout". A paleopathological study carried out on the skeletal remains of some members of the family, exhumed from their tombs in the Church of San Lorenzo in Florence, offered a unique opportunity to directly investigate the evidence of the arthritic diseases affecting this elite group. METHODS: The skeletal remains of several members of the family were examined macroscopically and submitted to x-ray investigation. RESULTS: The results of the study allowed us to ascertain that the so-called "gout of the Medici" should be considered the clinical manifestation of three different joint conditions: diffuse idiopathic skeletal hyperostosis, rheumatoid arthritis and uratic gout. In particular, uric acid gout was diagnosed in the Grand Duke Ferdinand I (1549-1609). Recently, a new case of this disease was diagnosed in Anton Francesco Maria (1618-1659), a probable illegitimate member of the family. CONCLUSIONS: With this new case, uratic gout was observed in 2 out of 9 adult males, leading to suppose that the disease should have been a common health problem within the family. The aetiology of the disease has to be searched in environmental factors, since both historical and paleonutritional studies demonstrated that the diet of this aristocratic court was rich in meat and wine.

Did Michelangelo Have Gout?

Michelangelo, the great Renaissance artist, is often included on lists of celebrated gout patients. His letters describe a single acute attack of foot pain at the age of 80, but a case for early onset has been presented, based on a fresco by a contemporary artist, Raphael. A figure resembling Michelangelo at the age of 36 appears to have nodules resembling tophi over his knees.In this report, we review Michelangelo's medical history, discuss the proposal that he had tophaceous gout, and address the significance of "knobby" knees in his works and those of other artists.

[Gout and its manifestations, description and treatment in ancient times]. / Dna a její výskyt, popisy a lécení ve staroveku.

Gout is a very old disease, which exists for thousands of years. The first descriptions interpreted as the symptoms of gout can be found already in the Egyptian medical papyri dating to the 3rd mill. BC. In the Ancient world, many physicians dealt with the causes, diagnostics and the treatments of gout, such as Hippocrates of Cos, Diocles of Carystus or Claudios Galenos. A personified gout (as the goddess Podagra) is also to be found in the Ancient mythology and culture. Several human remnants of the people suffering from gout are preserved from the Antiquity as well.

[Historical Study of the Etymological Form and Translational Process of Gout (Tongfeng,)].

This study aims to address questions regarding the translation of 'gout' into 'tongfeng ()' in East Asia. To this end, the formation process of the origins, 'gout' from Western medicine and 'tongfeng' from Oriental medicine, and the translational process were investigated through the relevant records and literature dating from the 16th century on. Symptoms associated with gout were originally mentioned in ancient Egypt and various terminologies were used to refer to gout, such as podagra, cheiragra and gonogra. The word 'gout', which is derived from Latin, was used for the first time in the 13th century. The reason for this linguistic alteration is thought to be the need for a comprehensive term to cover the various terms for gout in symptomatic body parts, since it can occur concurrently in many joints. However, it took hundreds of years before gout was independently established as a medical term. In oriental medicine, terms describing diseases with features similar to gout include bibing (), lijiefeng (), baihufeng () and tongfeng (). Among them, the concept of 'tongfeng' has been established since the Jin and Yuan dynasties. The cause, prevention and various treatments for tongfeng were proposed throughout the Ming and Qing dynasties. The early translation of gout and tongfeng in East Asia, respectively, is estimated to have occurred in the 18th century. The first literature translating gout in China was 'An English and Chinese Vocabulary in the Court Dialect (yinghua yunfu lijie, )'. From the publication of this book until the late 19th century, gout was translated into an unfamiliar Chinese character 'Jiu feng jiao ()', likely because the translation was done mostly by foreign missionaries at the time, and they created a new word on the basis of Western medicine instead of researching and translating similar diseases in oriental medicine. In Japan, the first book translating gout was 'A Pocket Dictionary of the English and Japanese Language (Eiwa taiyaku shuchin jisho, )', Japan's the first English-Japanese translation dictionary. In this book, gout was translated into tongfeng, a word adopted from oriental medicine. These differences from China are thought to be caused by Rangaku doctors (), who, influenced by oriental medicine in the Jin and Yuan dynasties, played an important role in translating medical terminology at that time.

Rheumatic disease in wartime: gouty generals in battles lost or won.

Leadership by a commander is an important determinant of military outcomes. This report describes 2 19th-century wars in which the commanding general was afflicted with severe, disabling gout. In the First Afghan War (1839-1942), the result was disastrous, but in the Spanish-American War (1898), subordinates ignored the general's orders and saved the day.

Sack and sugar, and the aetiology of gout in England between 1650 and 1900.

A marked increase in gout was observed in England during the 17th to 20th centuries. Many have ascribed this rapid increase in gout to the introduction of wines that were laced with lead. In this article, we suggest another likely contributor, which is the marked increase in sugar intake that occurred in England during this period. Sugar contains fructose, which raises uric acid and increases the risk for gout. Sugar intake increased markedly during this period due to its introduction in liquors, tea, coffee and desserts. We suggest that the introduction of sugar explains why gout was originally a disease of the wealthy and educated, but gradually became common throughout society.

A Renaissance Pope with arthritis following frostbite.

Pius II, a 15th century Pope, developed chronic foot pain following frostbite at age 30. Later in life he was progressively disabled by arthritis elsewhere and by colic, which may have been due to kidney stones. The differential diagnosis of his rheumatic disease and its effect on his career are discussed.

Some historical remarks on microcrystalline arthritis (gout and chondrocalcinosis).

The history of microcrystalline arthritis only began in 1961 when Daniel McCarty and Joseph Lee Hollander demonstrated the presence of sodium monourate crystals in the synovial fluid of gouty patients. However, gout is a historical disease, thanks to the descriptions of Hippocrates, Caelius Aurelianus, Soranus of Ephesus and Araeteus of Cappadocia. The relationship between hyperuricemia and gout was first documented in the nineteenth century by Alfred Baring Garrod, who demonstrated deposits of uric acid crystals on a linen thread held dipped in acidified blood (the so-called "thread method"). Gout has always been considered a prerogative of the moneyed classes (arthritis divitum), and history is full of famous gouty personalities, including kings, emperors, popes, commanders, politicians, artists, writers, philosophers and scientists. Another form of microcrystalline arthritis, chondrocalcinosis, was identified as being a rheumatic disorder different from gout in the 1960s. As a specific clinical entity, it was first identified in 1958 by Dusan Zitnˇan and Stefan Sit'aj in a few Slovak families.

[The health of cardinal Gaston de Rohan. The sickness, the diplomat in the noble class of the 17th century?]. / De la santé du cardinal Gaston de Rohan. La maladie, vecteur diplomatique dans les cours princières au XVIIIème siècle?

The few elements concerning health and medicine discovered during the exhaustive study of the numerous documents evoking the Rohan family are presented here. They concern essentially Gaston de Rohan (1674-1749). Born in Paris the 27th of June 1674, son of François de Rohan, Prince of Soubise, lieutenant-general of the French royal army, and of Anne Julienne de Rohan-Chabot, Gaston de Rohan was elected canon of the great-chapter in Strasbourg in 1690, then coadjutor of the Prince-bishop of Strasbourg in 1701. He became Prince-bishop of Strasbourg in 1704 and cardinal in 1712. He died in Paris the 19th of July 1749. The "gout" of the cardinal is omnipresent in the life of this man of the Church. Moreover, gout imposes upon the life of this statesman, preventing him from going to a given place which doesn't fill him with enthusiasm. His gout also allows to impose etiquette, since it obliges to go at the cardinal place, who receives. The illness becomes non diplomatic, but diplomacy.

[Therapy or torture: a treatment of gout misunderstood by Gregory of Tours]. / Therapie oder Tortur--Eine missverstandene Behandlung der Gicht bei Gregor von Tours.

Historiarum libri decem, a work written by St. Gregory, the bishop of Tours, is an important contemporary source for the study of the Merovingian times. In Book V 42 Gregory reports the story of Maurilio, the bishop of Cahors in the Southern Gaul, who was strongly suffering from gout. Maurilio treated the illness himself applying a hot iron to his foot and shank. This therapy is already mentioned in the Corpus Hippocraticum. It seems, however, that cauterization was not known to St. Gregory of Tours as a medical treatment of this particular illness. He simply saw in it a sanctifying practice in the sense of penitential mortification. Indeed, for Gregory this interpretation is an important part of his literary aim, as Maurilio is for him a brilliant example of a minister of the Church. Although Maurilio is well-known for his piety, knowledge, and uprightness in diocesan dealings, he voluntarily, as Gregory thinks, submits to ascetic self-castigation.