An examination of the skeletal remains dating back to the Roman era supports the concept that saturnine gout was pandemic among the aristocrats of the Roman Empire.
(For unknown reasons, medieval alchemists named this base metal after the Titan Saturn—perhaps because lead seemed to devour all others, much as the old god ate his own children. Hence the term, saturnine gout.) It caused a painful and debilitating form of arthritis. The Stoic philosopher Gaius Musonius Rufus perceptively noted the health hazards of gout and plumbism:
“That masters are less strong, less healthy, less able to endure labor than servants; countrymen more strong than those who are bred in the city, those that feed meanly than those who feed daintily; and that, generally, the latter live longer than the former. Nor are there any other persons more troubled with gouts, dropsies, colics, and the like, than those who, condemning simple diet, live upon prepared dainties.”3
History Repeats Itself
Roman society may not have been the only community to suffer the ravages of saturnine gout.2 In the late 1600s, the British Parliament sought to limit commercial competition by the Dutch fleet by banning the importation of French wines, a cargo not carried by the British, in favor of Spanish and Portuguese wines. Port was particularly popular and it happened to be rich in lead. The consumption of port in England tended to parallel the incidence of gout, and both peaked in the 18th and 19th centuries. In contrast, the incidence of gout was quite rare in other northern European countries where alcoholic beverages other than port were favored by all social classes. Gout came to symbolize the leisured class, whose members brought grief upon themselves through their excesses. Gout was perceived as being socially desirable because of its prevalence among the politically and socially powerful. A quip in the Times of London in 1900 echoed this view: “The common cold is well named—but the gout seems instantly to raise the patient’s social status.”4 The American satirist Ambrose Bierce, who resided in England during the 1870s, mocked that, “gout was a physician’s name for the rheumatism of a rich patient.” The literature of this era was rife with satirical caricatures of gouty aristocrats and merchants.
Perhaps the greatest collection of these images was amassed by our late colleague, Gerald P. Rodnan, MD (1927–1983). Dr. Rodnan spent most of his career with the department of medicine at the University of Pittsburgh School of Medicine. In 1956, he was appointed chief of the newly formed division of rheumatology and clinical immunology. He rapidly became noted as a teacher and clinical investigator and rose to the rank of professor of medicine in 1967. Dr. Rodnan published extensively and served as editor of several publications, including a major textbook of rheumatology that I fondly recall using to study for the rheumatology board examination. He was president of the American Rheumatism Association (now the ACR) from 1975 to 1976. Following his death, his estate graciously gave the Rheumatology Research Foundation permission to reproduce a limited number of prints from his collection of antique gout artwork.5 Each year, the Foundation releases a new print in honor of the ACR/ARHP Annual Meeting, where it is displayed along with previous years’ selections.
