[Gout From the Corpus Hippocraticum to the Renaissance: The Role of Galen]

Gout is a common, complex, systemic and well-studied form of chronic inflammatory arthritis due to deposition of sodium monourate crystals in peripheral joints and periarticular tissues driven by hyperuricemia. Gout is the oldest recorded inflammatory arthritis to affect humankind, with roots stretching back to 2640 BCE. To establish the timeline of gout from the Corpus Hippocraticum to the Renaissance, this study focuses on Galen (129-c.215 CE). A princeps English edition of Galen's works is still lacking; therefore, this paper provides a translation of the paragraph on gout from the Latin edition [12] by Carolus Gottlob Kühn (Leipzig, 1821-1833). Galen departs from Hippocrates and displays a vast knowledge of pathogenesis, symptomatology, clinical course, differential diagnosis, therapeutic skills and prognostication. In Galen's view, gout is due to fluid overflow that infiltrates nerves and causes pain. Overflowing fluid may be blood, phlegm, or a mixture of bile, blood, and phlegm. The prevailing humor is crude, mucous, and thick, and by residing in the joint, causes tophi. The nature of infiltrating humor can be diagnosed through color of the joint, symptoms, effects of heat and cold, effects of drugs, and information related to age, diet, quantity and quality of exercise, attitude towards baths of the patient. Treatment, according to Galen, required immediate bloodletting by venesection at the elbow, which could be repeated. Purges, enemas, and/or emetics are additionally needed to evacuate the humor(s). Poultices played a role draining the humor(s) as well as for their emollient-softening properties.