When Rheumatic Disease May Have Affected the Course of Western Civilization

Gout was prevalent in ancient Rome and was described— and satirized—among the wealthy by notable Romans, such as Virgil and Galen.^7,17-19 Many Roman Emperors between 15 and 225 CE were known to be heavy consumers of wine and food, and were described as having symptoms potentially consistent with chronic lead intoxication, including severe neuropsychiatric disturbance, neuromuscular dysfunction, gout and abdominal pain.

The principal source of lead poisoning likely stemmed from a grape-based sweetener common in Roman wine. It was produced by boiling grapes in lead-lined vessels, resulting in lead levels in wine ranging from 240–1,000 mg/L. Given that the Romans consumed approximately 1–5 L per person, lead toxicity may have been widespread.²⁰ Worse yet, city pipes, cookware and utensils were also lined with lead. Thus, it is estimated that aristocrats consumed ≥250 mcg/L of lead daily. Consider this: The U.S. Occupational Safety and Health Administration (OSHA) has set 50 mcg/L as the limit of what’s safe to consume.²⁰

What if … Roman emperors had not been encephalopathic as a consequence of their lead intoxication and saturnine gout? How different might world history have been?

Saturnine Gout, Lead Intoxication, King Herod the Great & Herod Antipas

At least six prominent Herods exist in history, literature, opera and the Bible; they are often conflated, making the interpretation of, and speculation about, their possible medical illnesses challenging.^7,8,22

Figure 1A. (Click to enlarge.)

King Herod I (the Great) lived from 73 BCE to 4 BCE in Judea. He was known for his cruelty; his accomplishments included economic and diplomatic successes before the onset of mysterious symptoms and his death due to unknown causes.

The historian Flavius Josephus recorded the life and death of King Herod I, describing symptoms of paranoia, depression, psychosis, high fall risk and extreme forgetfulness. Josephus wrote of Herod that, days before death, his “entrails were … ex-ulcerated.” He described the violence of Herod’s pain in his colon, “aqueous and transparent liquor” about his feet and matter at the bottom of his belly. “His privy member was putrefied and produced worms … when he sat upright. He had a difficulty of breathing, … convulsions … choleric … like a mad man.”²³ Symptoms of edema in his lower extremity, dyspnea, abdominal distension and pain, scrotal edema and muscular spasms were described. Lead poisoning and saturnine gout were among an extensive possible differential diagnosis.