Post on 07-May-2023
PALEOPATHOLOGIES OF RENAISSANCE ELITES: THE MEDICI FAMILY
BY
CASSANDRA SIMONE BASILE
BFA, Binghamton University, 2015
HONORS THESIS
Submitted in partial fulfillment of the requirements for the degree of Medieval Studies in
Harpur College of Binghamton University
Accepted in partial fulfillment of the requirements forthe degree of Medieval Studies in
Harpur College ofBinghamton University
State University of New York
May 17, 2015
Dana Stewart, Faculty AdvisorDepartment of Medieval Studies, Binghamton University
Abstract
Known traditionally as the patrician's disease, gout was
long purported to be the most common disease in Renaissance
Florence’s Medici family. The disease, scholars have long
assumed, was a consequence of their decadent lifestyle. By
utilizing new evidence from the Medici tomb excavations, I
will argue that there is a need to apply the definitive
method of HPLC. Such excavations and methodology imply that
the Medici lines were afflicted by many differing diseases.
In light of this new evidence, I will be looking at
scholarly and contemporary accounts to show that gout was
part of various identifiers and labels of Early Modern
elites.
Few Italian surnames elicit such a popular response
like that of Medici. The family tended to typify the
normative lavish standard of noble living, and set an
example for the rest of Italian nobility in the
Renaissance. Despite enjoying upper class pleasures, such as
patronizing works of art or feasting on lavish foods, the
Medici family began its public life as a family of more
humble origins. The family's overall identity becomes even
more complex in light of recent archeometric studies;
surrounding the family ailment of gout. Historically gout
was asserted for the family from its earliest days, and
proceeded to span the two major lines of the Medici until
their subsequent ends. Traditionally, gout had a strict
association with the vices of nobility, such as sexual
licentiousness and excessive diet. Despite this, in light of
my research, gout appears as an ambiguous identity marker in
Early Modern society; varying upon the patient gout could be
linked to differing facets of one's personality or
lifestyle. According to Porter and Rousseu gout was seen by
doctors as a constantly shifting ailment (1998, p. 26).
Thus, I intend to examine the above connotations within the
context of: the elite perception of gout, elite remedies,
historic rhetoric (on the Medici themselves and gout as a
disease), and modern methodological diagnoses. I will
discuss how the literature and the science behind the
disease presents gout as an ambiguous and malleable label,
and add clarity to the identity of the Medici family.
Through this examination, I will elaborate on the
traditional widespread nature of gout, and what this means
in light of the new scientific excavations upsetting
traditional assumptions on the gout-ridden nature of the
Medicean lines. While the initial work on the paleopathology
of the Medici has been done, I argue that we are now able to
be far more precise about the nature of the Medicean
maladies. Now, I shall briefly specify the Medici lineage,
to clarify the major two lines of the Florentine and Tuscan
Dukes. This exposition will enable a comparison of ailments
spanning both lines, the senior and cadet branches, which in
turn illuminates a broader Renaissance connotation to the
elites1.
The more famous individuals of the Medici family, such
as Lorenzo the Magnificent, reside in the senior branch. As
was common in most elite families, this branch begins with
eldest son of the first main patriarch: Cosimo the Elder,
son of Giovanni di' Bicci. The cadet line originates from
di' Bicci's younger son Lorenzo (Weisz et. al. 2010 p.126).
The descendents of Cosimo the Elder eventually became the
Dukes of Florence, and the descendants of Lorenzo became the
Dukes of Tuscany. As is well known, the Medici family
accumulated their wealth and power through the banking
business. It was Giovanni di' Bicci de Medici who would
initiate the family's success in banking--Smeaton refers to
him as "...a banker pure and simple," implying that Giovanni
was not a very political man as his son Cosimo, later was
(1901, p. 23). Despite maintaining a focus on business, the
early generations of the Medici did vie for political power.
1 See Appendix (p.31) for complete Medici Family tree
According to Van Helden their "...political influence
increased until the gonffaliere Salvestro de' Medici led the
common people in revolt..." (1995 p.1). A connection between
the family lines also played a major role in the early
political dealings of the Medici. The Medici family line was
extensive, even at this early stage, that "...work has
stressed...that households were separate economies entities
within a wider family which might embrace the extremes of
wealth and poverty..." (Kent 1978, p. 41). Kent goes on to
examine the Medici Bank employing many of the poorer
extended family members (1978, p.42). This illustrates the
vital role that family ties played in the Early Modern city,
as well as illustrating the favor of the common people as
the Medici assisted the poorest of their own family. Both
Cosimo the Elder and Lorenzo the Magnificent were well liked
by the people of Florence; this was in part due to the
mutual respect these individuals extended to the citizens.
Cosimo's charm lay in his affability as "[h]e made himself
the equal of the poorest... [and] was proud to be considered
'only a burgher.'... [and] he still lived among his fellow-
townsmen in the mercato." (Smeaton 1901, p. 60). Lorenzo
continued a similar familiarity with the commons as he
ascended into the pinnacle of Medici rule. Having it both
ways he: "...addressed the Florentines as his fellow
citizens at the time when their last shreds of civic freedom
were disappearing." (Smeaton 1901, p.13). This shows that,
despite their origins of politically favoring the popolo,
the Medici were cunning in winning over the commons;
manipulating civil policies yet fully retaining the backing
of the people. It is amidst this beginning of Medici
accumulation of wealth and political ties, where many
biographers, contemporary and modern alike, mark the initial
evidence of gout. Most evidently this comment is made in
relation to Piero, nicknamed "the gouty" for obvious
reasons, who lived during the mid-fifteenth century (Cleugh
1975, p. 392). Cleugh states that he was not his father's
first choice as heir, and it was only due to the death of
his brother Giovanni that he assumed the position of heir
(Cleugh 1975, p. 93). The fact that gout was thought to be
inherited and passed on to his progeny, corresponds to the
immediate accumulation of wealth, as gout was heavily linked
to nobility and kings.
Gout, termed today, is a joint disease ambiguously
linked to hyperuricaemia, or overproduction of uric acid,
which in turn leads to bone degeneration as the uric acid
crystallizes between joints (Buckley 2001, 106). The cause
of hyperuricaemia is unknown though many people may have a
genetic disposition for it and never acquire gout (Buckley
2011, pg.110). Buckley clarifies that "... [a] high
frequency of gout is not universal, some populations...have
high rates of hyperuricaemia...but clinical gout is low or
negligible." (2001, p.107). This study is vital in
illustrating the potential causes of the symptoms of modern
termed gout, which is what the Medici paleopathological
studies test for. Two type of gout are defined today,
tophaceous and clinical, where tophaceous results in
crystallized uric acid build up--or a tophi (Swinson 2010,
p. 135-6). Swinson suggests that tophaceous gout was more
widespread in the past than today, due to the lack of modern
treatments; patients could expect to suffer "...[from a]
tophaceous disease after ten years..." (2010, p.141).
However only two examples of tophi have been found in
paleopathological examinations; both bodies were mummified
(Limbrey et. al. 2011, p.2497) (Swinson 2010, p. 136).
Although the specific causes of hyperuricaemia and gout
remain unclear, and as previously stated a predisposition to
hyperuricaemia does not always lead to gout, it is certain
that gout can be both inherited genetically or acquired
through lifestyle choices. On genetic inheritance, Buckley
states that "A genetic marker for gout susceptibility...has
been identified which...suggests a 'founder effect'..."
(2011, p.107). Buckley also shows that modern day gout can
be traced to the increase of average age, dietary changes,
and increases in auxiliary diseases (2011, p. 106). Buckley
also points to antiquity by mentioning "Saturnine gout"
which was regularly tied to wine, though he suggests that
this was on account of the use of lead in wine vessels
rather than the wine itself (2011, p.108). This information
is relevant when discussing the Medici gout because, it is
well known (and recently demonstrated) that the Medici had
various family ailments- some due to lifestyle choices or
genetically inherited. Specifically, as will be discussed at
length later, wine consumption was thought to be a common
cause for gout; as the Medici court was similar to other
Early Modern courts, wine was heavily consumed. Thus,
Buckley's work reinforces the theory that the Medici gout
was due to their lifestyle, or made worse by other diseases.
Despite modern changes in the definition of gout,
classical antiquity has recorded many cases of gout. The
term gout stems from the Latin 'gutta,' or 'drop' which, at
the time, implied any disease caused by the accumulation of
humors in the body (Porter and Rousseu 1998, p. 14). For
example, Porter and Rousseu state that the English word
plays upon the cause of the disease (in classical terms),
thus necessitating "...[the patient] to specify gouty
sciatica, migraine or hemorrhoids, and even gouty epilepsy
and paralysis..." as "...gout might be implicated whenever
humors accumulated." (1998, p. 14). Despite this need for
specification in translation, Classical authors, such as
Seneca or Hippocrates, allude (quite obviously) to the
rheumatoidal gout in their writings. There are mythological
ties to elites, such as King Priam of Troy, Belleophron,
Achilles, and Oedipus of Thebes (Porter and Rousseu 1998, p.
18). This illustrates the degree to which there was a
strong association with the nobility and gout.
Simultaneously, classical sources gave rise to the
traditional associations of gout with licentiousness as
manifested in Oedipus. This connotation is furthered by the
Roman statesman Seneca, who stated that gout was "...the
rosy daughter of Bacchus...and Venus..."(Porter and Rousseu
1998, pg. 18). In light of this description, I propose that
the invocation of gout, indeed in many cases, serves to
implicitly draw critical attention to what the speaker
believes to be some licentious quality of the lifestyle of
the individual described. There is an insinuation that both
vices (wine and lovemaking) are the core causes of this
ailment, as Bacchus is the Roman god for wine, and Venus the
Roman goddess of pleasure. Sources such as Hippocrates'
Aphorisms concentrate on the connotation between gout and
sexual depravity. There are three particular references not
only to the gender of patients with gout, but also to
unaffected individuals due to lack of sex. For example,
Hippocrates states that "Eunuchs do not take the gout, nor
become bald." yet "a young man does not take the gout until
he indulges in coition.." and finally "A woman does not take
gout unless her menses be stopped." (Hippocrates Aphorisms
28-30). All of this suggests a virile and masculine
connotation to the sexual licentiousness that was linked to
gout. Emphasis on the male patients of gout continued well
into the Early Modern period, especially through the divine
connotations of gout affecting the feet known as ' podagra'
(Porter and Rousseu 1998, p. 31-33). Podagra, as Buckley
indicates, is "...diagnosed based on pain and swelling of
the...phalangeal joint of the first toe..." (2011, p.110).
As late as the fifteenth century, a poem by Georg Flessiner
(an elusive author from the modern day Bohemia) stating that
men must "...realize that she [podagra] is noble...who will
not be so forgetful as to have relations with a coarse
peasant man." (Porter and Rousseu 1998, p. 33).This presents
a second emphasis on the identity of one afflicted with
gout, that of status. I suggest that this notion became even
more prevalent during the Early Modern Period, as
Neoclassical and Humanist movements revived and accentuated
this notion specifically.
Petrarch's treatise entitled De Remediis utriusque fortunae--
Remedies for fortune fair and foul--eludes to the self
inflected nature of gout, while managing to illustrate some
hidden benefits of the ailment. As gout and rheumatism were
not distinguished from one another until the 17th century,
gout continued to be overly diagnosed as it was in antiquity
(Buckley 2011, p. 110). Thus Petrarch's treatise represents
multiple manifestations of gout, and alludes to the
connotations behind each. The style of the work proceeds
as a question and answer format between (in the case of the
ailment gout) sorrow and reason (Petrarch 1304-1307, p. 198-
200). The statement of sorrow "I am weakened by gout."
elicits a caustic, yet positive, remarks from Reason
(Petrarch):
Your illness probably does not allow youto engage in single combat with and enemy. But it does not keep you from combating vice, which is not any easier than war, and certainly occurs more often. Nor do we know that the pain in your body, which you are trying to overcome, was not sent to exercise and strengthen your mind. (Petrarch 1304-1307, p.199).
Among Petrarch's personal correspondence as well, he depict
the virtue within the ailment, as he connotes gout to
"...the bridle for the untamed horse..." in the case of his
friend of the Colonna (Porter and Rousseu 1998, p.30). I
suggest this presentation of gout by Petrarch, an individual
who was patronized by elites, indicates an emphasis of gout
as an opportune disease which confirms higher social
standing. This is obvious in another section of Petrarch's
treatise, when he reiterates a tale of the Roman Emperor
Septimius Severus who suffered gout and unearthed a
seditious plot against him, and Petrarch credits him with
saying "Now at last you know the head does the ruling and
not...the feet." (1304-07, p. 200). Licentiousness was not
always so lightly discussed, as the Swiss iconoclast
Paracelsus warned against gout more so than Petrarch.
According to Porter and Rousseu, Paracelsus thought that
"...there was a risk that gout would change into a gouty
syphilis." (1998, p. 24). Despite this, later humanists
continued to commend gout as a an instructive force that led
to the cessation of vice, rather than a punishment for
nobility. One such humanist, Willibald Pirckheimer, went as
far as blaming his scholarly pursuits and lifestyle as the
cause of his gout. He states that "The doctors state that my
excessive studying is the cause of my ailment." (Porter and
Rousseu 1998, p. 32). I suggest that this view of gout
indicates a different aspect of the individual; rather than
emphasizing vice, it illustrates the difference between
wicked and moral men. Additionally, in Christianity there
was a notion of pious suffering, which in turn illustrates
that gout allows for increased piety (Porter and Rousseu
1998, p.32). Indeed, Cosimo I wrote to his son Ferdinando I
requesting that Ferdinando procures the Pope's blessing upon
a bottle of wine he is sending, in order to assuage his gout
(Medici 1570). Therefore, as a bishop may not need such
moral instruction that gout or podagra presents, gout in
clergymen presents a conflict to gout as 'pious suffering'
and gout as an opportunity to practice piety.
Porter and Rousseu declare that many sought to explain
why gout ails "...Bishops, Cardinals, Dukes, Earles, Lords,
Knights, Judges, Gentlemen, and Merchants." (1998, p.29-30).
Including so many of the clergy should not be surprising, as
many clerics were of wealthy families. The common
understanding by no means associated piety with every clergy
member. However, when an individual was considered to be
exceptionally moral, a contradiction occurred between the
individual's identity as pious and the understanding of gout
as an insurrectionary force. As I have previously shown, one
personality trait which gout emphasized was that of moral
licentiousness, and many humanists viewed gout manifested
not as a punishment but as a mental exercise. Thus, in such
cases where individuals with gout were in no need of such
pious instruction, many viewed gout was seen as an unjust
monster which a physician would combat (Schuler 2015, p.68).
This evidence comes in the form of a medical poetry, which
have a long-term history throughout the Renaissance--the
imagery shows a physician "...assum-[ing] a mock heroic
stance...address-[ing] gout as a 'beast' and a 'monster' and
select-[ing] his 'darts' and other weapons with which to
defeat it." (Schuler 2015, p.68). Schuler presents a
scientific poem on the remedies of gout by the sixteenth
century physician Chrisophe Arbaleste, or Christophorus
Ballista (2015, p.67-107). According to Schuler, Ballista
was a physician monk who withdrew from the Church towards
the beginning of the Reformation, and wrote two poems about
gout (2015, p. 67-8). His work was intentionally written for
the Bishop of Sion, Switzerland, Philip of Platea, whose
gout he personally treated. Ballista had the authority to
decide whether the Bishop was a genuinely pious man, from
his work and position, knowledgably in healing works and
having previously served in a monastery (Schuler 2015, p.
67). Within Schuler's work, Ballista is clearly presented in
thinking that the Bishop was a pious man, as Schuler credits
to Ballista's shorter poem, he tells the Bishop's gout
"...to punish not only gluttons...but also lechers,
murderers, and even..evil princes and pastors." (2015,
p.68). I argue that this is a suitable outlook for Ballista
as his medical work, similar to Petrarch's poetry, was
patronized by an elite. In addition, I think that Ballista
medical and religious life, as previously stated, provide
him with the credibility to acknowledge when gout should be
associated with vice. and may have taken on their viewpoint
of gout. Furthermore, I contend that his present viewpoint
illustrates a third connotation between gout and its
victims; first with lax morals, second with nobility, and
now third shows a sympathetic view of the patient who
suffers gout for no identified cause. Casting gout onto
vicious people, such as murderers and lechers, would also
support this new emphasis (or lack of one) in the patient's
identity. Within the above individuals, the insurrectionary
piety of gout would be justified and needed. In a similar
manner I argue that each of the above shameful cases, gout
stressed the negative aspects of those suffering from it. I
now apply this frequently shifting emphasis and agenda of
the diagnosis of gout to the identity of the Medici family.
Gout appears frequently in the Medici court documents.
The documents are almost always letters, and range in
context and individuals. The key factor between them all is
the reiteration of gout among the nobility. Multiple times
there are external requests of the Medici, specifically
Cosimo I of the cadet line. These letters are examples of
gout among the nobility of Europe, including the Medici, and
illustrate how the ailment could interrupt daily and
political occurrences. One letter from Giangiacomo de'
Medici asks Cosimo I for "...a litter to meet him in
Bologna..." as his journey is made slow due to an attack of
podagra (Medici, 1553). Similarly, Federico Dovara informs
Cosimo I an attack of gout keeps him from meeting the duke
and "...from putting on not only his boots but his
stockings." (Dovara, 1565). Bartolomeo Concini write twice
to Cosimo I, first in 1554 to request a stretcher for
Giangacomo de' Medici who is camped outside of Siena and
impaired due to his gout (Concini,, 1554). A second time
Concini writes of the behalf of Giangacomo is a year later,
as "...his gout...is worsening..." and requests for a halt
in plans for the Marquis' health (Concini, 1555). From the
above correspondences, it is evident that gout was indeed a
norm of nobility during the reign of the cadet line of
Medici dukes. In between these two correspondences, the
Marquis Giagiacomo himself informs Cosimo I of his gout.
Although the abstracts to not go into great detail
surrounding the encampment at Siena or its purpose, the
multiple correspondences show how gravely gout could affect
the politic of the nobles. I suggest that this asserts yet
another connotation of suffering from gout, specifically
within the elite circles, that gout was a hindrance and even
annoyance when attacks were severe. This presents a foil to
the connotations between shame and gout (as it emphasized
negative qualities a person may attempt to conceal). As
presented in the letter abstracts, the Medici and their
peers are openly discussing their gout. There is no shameful
tone present within these letters, rather advice is sought
and given between the elites some of which frowns on the
traditional treatments. Here, I suggest that this also
emphasizes the role of gout as a confirmation to the status
of its victims.
Despite yielding new evidence of the family's health of
the cadet line of the Medici, the paleopathological studies
of Colagrande and Fornaciari continue to compare the Medici
to other nobles of the time period (2013)(2008). I will
argue that this treatment is reasonable in the cadet line of
the Medici, whereas it should be avoided in the senior line
individuals (whose gout I will argue for a different
identity marker). These studies especially undermine this
image, as Colagrande presents a comprehensive dental
analysis of the family, and Fornaciari initiates a dietary
analysis of the Medici and Aragonese princes. While
Colagrande uses tooth analysis as a comprehensive health
analysis due to excessive diet and other factors, Fornaciari
shows just how elite the Medici diet was. Beginning with
Fornaciari's study, his use of stable isotope analysis
allows the carbon and nitrogen isotopes to indicate the
customary diets of these elites (2008, p.11). Fornaciari
states that a high level of the isotope nitrogen 15
demonstrates a diet that was very rich in meat, whereas
higher values of carbon 13 isotope indicate a diet of fish
or marine protein (2008, p. 11-12). The study goes on to
illustrate that out of the two families the Aragonese have
more of a marine protein diet, and the Medici are more of a
carnivorous--red meat based diet. This is unsurprising as it
is known that most of the lower classes at the time "...
[were] best off eating vast amounts of vegetables." (Greico
1999, p. 311). Fornaciari's study illustrates, in the
archaeological record, two Italian elite families conforming
to the social stratification of foodstuffs. As Greico
describes, food was aligned on a hierarchical scale; this
spectrum was divided between the four elements of fire air
water and earth (1999, p. 308). Along this spectrum, fire
retained mythological animals as the most prestigious meat
and earth contained plants as the lowliest foodstuffs; as a
result the terrestrial meat of the Medicean diet lies above
the marine protein of the Aragonese princes (Greico 1999, p.
308). As previously discussed, diet and food choice is
indeed a factor in many rheumatoidal diseases. However
predisposition and genetics should be taken into
consideration as probable causes for these afflictions. I
continue to show this with the evidence of dental health of
the cadet line in the study conducted by Colagrande et. al.
The study by Colagrande et. al. can be interpreted as
both a direct effect of their excessively lavish diet as
well as a measurement of each individual's overall health
status. The latter point Colagrande et. al. brings up in the
study, by stating "...health of the teeth moreover is
considered a key element to detect the state of [the]
general health of an individual and his/her habits of life."
(2013,p. 194). The results of the study illustrate that,
although the Medici were using the popular oral hygiene wash
of the day, termed Aqua di' denti by Colagrande, their
efforts were in vain (2013, p. 193). The main components of
this mouthwash was rosemary, believe to be an anti-septic,
and vinegar (Colagrande et. at. 2913, p.193). In turn this
remedy, according to Colagrande et. al., was shared among
the elites, as the Francesco I is noted to have sent this to
King Felipe II of Spain (2013, p.,193). I illustrate that
this evidence is in line traditional view of the Medici,
especially with the mention of Francesco I (a duke from the
later generations of the cadet line), that they typified the
norm of nobility in their day. This is also seen solely from
the amount of cavities that were recorded in the Colagrande
et. al. sample size of Medici teeth. Colagrande et. al.
makes another comparison between the Aragonese princes and
the Medici, illustrating that the Medici have a higher value
on the DLI (Dental Lesion index) which refers to the amount
of dental pathology suffered by the family (2013, p. 197).
Accordingly, both the Medici and Aragonese princes have high
values on the DLI due to their noble diet. With this in
mind, the higher DLI value of the Medici, especially as this
sample size of teeth is from the individuals of the later
generations of the cadet line, indicated the extreme
excessiveness of those individuals. In turn, I state that
this evidence indicates that these individuals were
acculturated into the noble class; highly disparate from
the earlier Medici, who quickly became wealthy and
constantly needed to reassure themselves of their nobility.
This is also evident in practices such as intermarriage
between noble families, and the differences between noble
and common treatment.
Many time when faced with a patient, physicians
"...tailored their prescriptions to the patient's ability to
pay--cheap, easily obtainable ingredients for the ordinary
patient; exotic drugs, gold, or precious stones for the
rich." (Siraisi 1990, p. 147). This is true for the remedies
of gout when concerning the Medici. This conspicuous
prescriptions are attested in the biographic work by Smeaton
on the life of Lorenzo the Magnificent. Smeaton states that
Piero passed on his immense gout to his son, Lorenzo--
however Lorenzo did not suffer until late 1491 (1901,
p.167). The biography describes Lorenzo "... although not a
vicious [man] [he] was a pleasure-loving man..." (Smeaton
1901, p. 167). Smeaton goes on to illustrate the types of
remedies open to Lorenzo, visiting the sulfur baths was a
popular choice even among women whom suffered gout, such as
none other than Lorenzo's own mother Lucrezia (Pottinger
1978, p.46-47). However the most extravagant remedy of
Lorenzo's is documented by Smeaton to be "...a potion
compounded of crushed pearls and jewels." (1901, p. 168). I
believe this adds to the traditional view of gout as a
shameful disease, emphasizing an individual's negative or
vicious qualities. In addition, although this illustrates
Lorenzo's health, I maintain that his 'gout' should be
categorized as that of a wealthy merchant rather than a
noble individual. As indicated by the archaeological study
below, Lorenzo's ailment was primarily genetic. This issue
illustrates the long practice tradition of presenting the
entirety of the Medici line as nobility; a common form of
scholarship visible in early 20th century biographers of the
family (Smeaton1901, p. 167) Emphasis on specific negative
traits in a patient is clarified by looking into the medical
context of the Early Modern period.
The remedies for gout in Early Modern Europe, were
based especially on humoral theory. Siraisi points out that
the Hippocratic humoral theory set the standard of four
bodily humors-- "...blood, phlegm, bile...and black bile..."
(1990, p. 104-5). This type of theory prescribed a balance
between the four humors and connected to each were specific
"...good and bad, or unnatural varieties..." (Siraisi 1990,
p.g105). I contend the specification within the theory leads
to not only an individualized and stratified treatment but
diagnosis as well; the various connotations of gout suggest
that clarification would be needed on the nature of any
given individual's case--ie: a diagnosis of gout suggesting
sexual excess, lavish diet, or an unjust cause. Due to the
nature of this theory some extreme methods were used, such
as bleeding and contracting dysentery to help expel these
negative humors. Porter and Rousseu state that the natural
use of dysentery, to relieve a joint afflicted with gout,
was mainly a belief of the Hippocratics (1998, p. 16-7).
However, the use of leeches in bloodletting is congruent
with the Early Modern time period. Ballista makes mention of
this prescribed bleeding in his poem, among numerous other
treatments for gout; stating: "...with Horseleaches
[leeches] beset your feet about...all the vilest
humors...they drink with greedy minde..." (Schuler 2014,
p.86). Despite these extreme treatments, it was much more
common for a change in diet or herbal balm to be prescribed
for gout. Indeed, in Ballista's scientific poem, treatments
are split between plant, animal and mineral. The contents
following in animal category, apart from the used of leeches
above, dictate which animals should or should not be eaten,
and the usage of their by-products in balms (Schuler 2014,
p. 85-9). This illustrates the issue of noble diet causing
a disorder in the humors, as well as supports my previous
claim of an individualized treatment of gout. In the Early
modern period it was "Morally and Medically
speaking...dangerous to eat food that was thought to produce
excessive overheating in the body..." as it increased not
only the sing of gluttony but the sin of lust (Greico 1999,
p.305). Such food was typically "...the flesh of foul..." or
chicken which was highly regarded among the elites (Greico
1999, p.305). Thus such extremes measures may be needed, due
to disregard of diet and a buildup of the humors.
Balms were also highly prescribed, and ranged in
ingredients, as previously seen with Lorenzo's potion made
of grinded up pearls. Not only would some ingredients be
only available to the rich, but I propose that it was
unlikely that elites were willing to lather their joints
with a balm made of pig's fat, ashes, and goat's dung
(Schuler 2015, p. 87). Many popular ingredients, according
to Porter and Rousseu, included: diuretics of various types
of roots, ox dung wrapped in cabbage, and dog skin pants
(1998, p.26). I suggest again that such balms would be found
among the lower classes who may have contracted gout through
some lifestyle activities, and would be less common among
the nobles. Medici court documents illustrate the use of
these popular treatments. This occurs in three letters, all
addressed and sent to Cosimo I. The first of these is from
Lucantanio Cuppano, the abstract of the document states he
"...asks Cosimo for a certain medicinal oil known to be an
effective gout cure." (Cuppano 1552). The second of these
letters is from Donado Bardi, a long time associate of the
Medici family--reaching back into the senior branch as their
original banking partners (Kent 1978, 56-58). With this
previous connection of the two families, I assert that it is
easy to see his account of Charles V's gout, in his letter
to Cosimo as informative of new treatments to gout; stating
"...his treatment [was]...serum with 'legno della china'...
[or] china root."(Bardi, 1549). The china root, and roots in
general were often used in treating gout. Porter and Rousseu
state that the Holy Roman Emperor, Charles V, "...preferred
China root..." for the treatment of his gout (1998, p.28).
And lastly Francesco Vinta relays to Cosimo another
treatment of '...vernaccia grapes with a certain mixture..."
that Ferante Gonzaga de Gustalla uses for his gout (Vinta,
1547). Other sources are Anonymous, or have been lost to
time, yet illustrate mud baths in Istanbul as a treatment
for gout. (Anon.,1546). With these letters it is easy to see
that seeking new and different treatments was a constant
labor for the Medici. This not only connects the cadet line
strongly to other nobility, but it again reinforces the
notion that the nobles used gout to confirm their status.
Diet and drink were the main prescriptions for the
rich, as well as small increments of exercise. Such
treatments were also utilized as a means of preventing
vices, evident in Petrarch's De Remediis, "It is believed that
many have been relieved of the gout by poverty...a frugality
which may be called voluntary, pretened or imaginative
poverty..." (1304-7, p. 199). These prescriptions can range
from the very precise to the rather vague, as presented in
Ballista's scientific poem on gout. Ballista prescribes
watered down wine, but not the eradication of wine from the
diet, similarly he tells the patient to eat and drink but
"...leave with some desire to drink, and some desire to
eat." (Schuler 2014, p.92). The foods that are to be avoided
include: peas. nuts, chestnuts, cheese, and specific types
of fish (those with scales) (Schuler 2014, p.90-1). Drinking
wine was common among the Medici, and some of their
contemporaries, as the court documents reveal. Three letters
in particular illustrate wine for purposes of treating gout;
the first is from Francesco I to Chiappino Vitelli, warning
him not to be too frugal with his diet to cure his gout
(Medici 1568). This illustrates the norm of gout among the
elites, and also the critical eye many had to purported
treatments. The second letter is from Chippino Vitelli to
Cosimo I detailing his recovery from a gout attack due to
oysters and Spanish wine (Vitelli 1567). The irony of this
treatment illustrates that the nobles lacked in connoting
any shame to their gout. In fact, I view this letter as a
social statement that the nobility will not debase
themselves in seeking treatment that causes them to eat
frugally like a pauper. The final letter is from Cosimo I
to his son Ferdinando I asking for the pope to bless a
bottle of wine to aid his gout (Medici 1570). Again, I argue
that, in light of the content of these letters, the Medici
used gout as a positive emphasis on their status. Porter and
Rousseu address the consumption of old cheese to be
previously taboo, and thus unsurprisingly restricted, as it
"...bred melancholy..." which in turn bred black bile and
offset the humors (1998, p.27). Further, Ballista presents:
balms, oils, broths, and dietary change as remedies to gout.
Siraisi also states that the prescription of certain
medicines or rubs may depend on the relationship between not
only patient and doctor, but doctor and pharmacist. She
states that "...in Florence...physician and pharmacist had a
contractual arrangement whereby the practitioner made
himself available...[to] patients on the pharmacist's
premises (and prescribed the pharmacist's medications)."
(1990, p.146-7). I suggest that this, again, accounts for
the massive amount of varied treatments for the disease.
With all this in mind, I turn now to the modern studies
which debunk the Medici gout; showing that these efforts and
treatments, as stated above were in vain.
I have specified five particular individuals of both
Medici branches, upon whom recent studies have focused.
Three originate from the cadet line, and they include:
Cosimo I, Ferdinand I, and Cardinal Carlo (Colagrande et.
al. 2013) (Fornaciari and Giuffra 2013) (Fornaciari et. al.
2009) (Villari et. al. 2009). The two remaining individuals
are from the senior line, and they include Piero the Gouty
and Lorenzo the Magnificent (Weisz et. al. 2010). At this
point, I will discuss each individual's ailments, both the
traditional views (as was discussed briefly above), and the
new re-assessments of archeometric study. The recent studies
represent more individuals from the cadet branch, whom were
historically diagnosed with 'fatal' cases of gout more so
than those individuals of the senior branch (Lippi et. al.
2009, 246, 248). These findings illustrate the faultiness of
the previous belief, that the Medici gout was prevalent in
the family's origins and in the later Tuscan dukes. I begin
with the senior branch, in chronological order, as the case
of Piero the Gouty has uncovered some intriguing realities.
Unfortunately none of the Medici court records, for the
time being, that are accessible mention any of Piero's
ailments. From his epithet alone it is evident that he was
believed to have suffered from a degenerative form of gout.
In fact, as Smeaton relates, Piero's life was indeed "...one
prolonged struggle with gout..." (1901, p.123). This disease
handicapped Piero to the point where his wife, Lucrezia,
acted in "...political and literary affairs to a greater
degree than was customary for women at the time" (Smeaton
1901, p. 124). One recent study focuses on the diagnosis of
new syndrome for the senior branch. Under radiology,
microscopic and macroscopic study researches have concluded
that they found "...no signs of gout as the disease is
understood today..." (Weisz et.al. 2010, p. 128). I suggest
that, in light of Weisz et. al. study and the Medici family
history by Smeaton, Piero's rheumatoid ailment should be
considered as genetic--thus reliving Piero of the negative
lifestyle connotation of gout. Furthermore, I state that
this shows a false application of gout, and thus illustrates
the previously mentioned excessive diagnosis of gout in the
Early Modern period. This study included the analysis of
the bones of Piero's son, Lorenzo, as well.
The many deeds of Lorenzo di' Piero de' Medici launched
Florence into a pseudo-Golden age. Like his father and
grandfather, Lorenzo was a supporter, of what Smeaton calls
"new learning", or Italian Humanism (1901, p.10). In
addition to being place under the educational care of one
Federico of Montefeltro, Lorenzo trained physically as well.
His is quoted as saying "Whatever is worth doing, is worth
doing well." and proficiency in swimming, running, leaping,
and horsemanship have all been attributed to him (Smeaton
1901, p.133-4). Despite, or perhaps because of, his assumed
physical ability, Lorenzo's death occurred at the height of
his reign and gout historically cited as the cause (Smeaton
1901, p.167). According to Smeaton, Lorenzo was afflicted
with gout yet "...in1491 he began to feel the
gout...becoming so troublesome that he was unable for the
duties devolving on him." (1901, p.167). This again suggests
a genetic origin of gout in the individuals of the Medici's
senior line. However, as the recent study by Weisz et. al.
notes, it appears to be, again, a faulty diagnosis. These
recent findings corroborate a previous statement made by
Costa and Weber, noting in Piero and Lorenzo's bones "...the
absence of those radiological signs which are most
characteristic of gout." (Weisz et. al. 2010, 128). I
consider the archaeologist acknowledgement of the hereditary
nature of the senior line ailment extremely notable. This
acknowledgement bolsters my argument against the application
of not only gout but the negative qualities gout emphasized,
specifically among those individuals whom contracted the
disease via lifestyle choices.
The studies related to Piero and Lorenzo specifically
illustrate a new syndrome associated with the senior line.
Termed "The Medici syndrome" by the scholars working with
Weisz, the symptoms include three distinct commonalities of
the males of the senior branch (2010, p.128-9). One of these
components is in fact a joint disorder, or the gout
diagnosed at court. However, as will be discussed in full
later, studies suggest the lack of destructive features on
the joints rules out both gout and rheumatoid arthritis
(Weisz et. al. 2010, p. 129). The other components of this
syndrome feature a skin condition, which the Weisz et. al.
study terms as "rognie" or a type of psoriasis, and an
asymptomatic spinal ailment, known as DISH, diagnosed post-
mortem (Weisz et.al. 2010, p.127-9). In light of this new
syndrome proposed by Weisz et. al., I suggest that it is
relevant to note that the senior line suffered a plethora of
injuries and diseases throughout its six generations. Mortal
diseases recorded in the senior line include: tuberculosis,
malaria, and syphilis, whereas gout is only listed as a
partial cause of death in Piero the gouty and Lorenzo (Lippi
et. al. 2009, p. 246). This shows that death was caused more
often by an infectious disease, in the senior line, than
physical or metabolic ailments (such as gout). Here I point
out, again, that early 20th century biographers, such as
Smeaton, present a skewed emphasis on the Medici origins.
These authors touch on their middle class beginnings of the
family, but after the Medici solidify their power in
Florence these authors initiate gout as a family ailment--
thus alluding to the nobility and excessive nature of the
family (Smeaton 1901, p. 166-8). However, other
biographers, namely Pottinger, clearly illustrates the
catch-22 position the early Medici fulfilled in Florentine
society, he states that "...the Medici were of good middle
class stock...and [yet] for most of the fifteenth century
they were very rich...But...the Medici never aspired to
noble status." (1978, p.18). Pottinger's narrative supports
my argument that gout had various social implications of
those suffering from it. In addition, the archeometric
studies illustrate that not only did the senior line of the
Medici suffer from a cocktail of diseases, but that gout was
not as rampant in the senior line as previously thought.
Moreover, the fact that only Piero and Lorenzo are cited as
suffering from gout in the senior branch adheres to the
moderate beginnings of these individuals. Conversely,
individuals of the cadet line, have more evidence of: gout,
uricemia (over production of uric acid), obesity, syphilis,
and arthritis are noted as factors of death (Lippi et. al.
2009, p.248). I will illustrate below that, over time, the
Medici dukes accumulated gout and other diseases through
noble practices such as intermarriage. Essentially, the
later cadet branch was acculturated into nobility, and thus
their gout could be attributed to their excessive lifestyle
choices as well as inherited through the newly acquired
genetic diseases of other nobles.
To specify this notion of earning or acculturation
gout, the archeometric studies of the cadet line suggests a
similar deterioration in health from father to son (as
previously noted in the senior branch). Despite this, I
suggest that an excessive lifestyle was inherited from
father to son causing the gout of the cadet line, rather
than a genetic disposition. In addition to this, Cosimo I
was known to be a sportsman and defined as robust (in
reference to his bones) reminiscent of Lorenzo (Villari et.
al. 2009, p. 2102). Yet, despite seeming to be physically
fit, Cosimo grew fat in his old age, and suffered illnesses
such as: smallpox, malaria, bladder/kidney stones,
bronchitis and of course gout (Villari et. al. 2010 2102).
However, with numerous recent studies, the hallmarks of
Cosimo's bones point to a difference rheumatoid affliction.
DISH, or diffuse idiopathic skeletal hyperostosis, has a
similar connotation with elite and luxuriant living, as many
link "...the incidence of DISH and high social status, with
particular regard to lifestyle and nutritional patterns."
(Fornaciari and Giuffra 2013, p.2). Indeed, DISH is a
plausible alternative, as recent study links it to type II
diabetes and obesity (Fornaciari and Giuffra 2013 p. 2)
(Fornaciari et. al. 2009, p. 377) (Villari et. al. 2009,
p.2113). I emphasize that, although studies have disproven
gout in Cosimo I, the asymptomatic ailment proposed still
retains similar connotations of gout. DISH, as will be
discussed more thoroughly below, has been linked to similar
lifestyle traits that cause gout--indeed this ailment also
makes one more susceptible to gout (Cammisa et. al. 1998,
p.S7) (Hannallah 2007, p.174).
The main alternative suggested, among the cadet line
specifically, in place of gout is DISH. Diffuse Idiopathic
skeletal hyperostosis (DISH), is able to be confirmed and
diagnosed in the living via CT and MRI scans (Cammisa et.
al. 1998). Cammisa also states that while there is a
majority of male cases, 65%, the distribution of DISH is
relatively equal between males and females (1998, p.S7).
This differs from the norm in gout, which continuing today
is a highly male dominant disease, with female vulnerability
increasing only in those sixty and over (Swinson et. al.
2010, p. 138). The hallmarks and disability from DISH
include fusion of the spinal column, with three vertebrae
(at the least) "...becom-[ing] irregularly calcified..."
(Cammisa et. al. 1998, p.S8). Many researchers describe a
spinal column with DISH to appear "flowing" or like "candle
wax." (Hannallah et. al. 2007, p. 174-5) (Fornaciari and
Giuffra 2013, p. 2). Studies also indicate that those
suffering from any trauma with DISH need more immediate
care, and DISH may be more likely in individuals suffering
from "...type II diabetes, gout, and obesity..." (Hannallah
et. al. 2007, p. 174-5). This supports my previous argument
that, in the case of DISH, there are similar causes to
gout--thus this disease alone still bolsters the traditional
connotations to gout. Despite this, the asymptomatic nature
of DISH leads me to conclude that DISH on its own cannot
replace gout as a disease entirely; as previously discussed,
gout was known to be an exceptionally painful disease. The
methods above were extremely useful in debunking the
widespread nature of the Medici gout and in re-diagnosing
some of the Medici Dukes with DISH.
Ferdinando I is the most interesting case, out of all
the individuals tested. Categorized as an anomaly,
Ferdinando is the single case, in both Medici branches, to
retain and demonstrate evidence of gout. Ironically enough,
biographers detail Ferdinando I to be "...[of] practical
good sense, in strong contrast with his predecessor's
[Francesco I] idleness and self indulgence." (Cleugh 1975,
p. 331). I assert that it is beneficial to uncover this
individual instance of gout- as it illustrates that
hallmarks of gout are indeed visible in the archaeological
record. As Buckeley states:"...this erosive process...make
gout potentially visible in the archaeological human
skeletons..."(2011, p. 107). Indeed, Fornaciari shows that
Ferdinando I retains a "scooped out" defect, a common sign
of gout in the joint of the "great toe." (Fornaciari et. al.
2009, p. 376). Ferdinando I's gout illustrates my previous
points on the Medici gout--that of the senior line indicate
a genetic disposition and perhaps their wealth, while the
cadet line indicates noble lifestyle effects. Although
Ferdinando I is not described as a vicious man as his
brother Francesco I, he "... even as a cardinal had never
taken clerical vows, [and] married...Christine of Lorraine,
the favourite granddaughter of Catherine de' Medici."
(Cleugh 1975, p. 331). In light of this evidence, I
illustrate that Ferdinando I, while moderate in law and
ruling, practiced a 'vice of Venus' as he was a married
cardinal.
Lastly, the new findings have displayed the numerous
ailments and bone atrophy which Cardinal Carlo de Medici
suffered. Fornaciari and Giuffra state that Carlo was
diagnosed at the age of 24 with gout of the feet, hands and
knees (2013, p.3). This eventually led to his total
inability to move in his later years, highly reminiscent of
Piero the gouty (Fornaciari and Giuffra 2013, p. 3). And
similarly, there has been no evidence of gout found in
Carlo's hands and knees, but rather convincing evidence for
RA and very severe osteoporosis. Some hallmarks of these
diseases include: "swan-neck" deformities in the hands and
fusion of carpals in the writs, as well as fusion of the
knee and elbow joints (Fornaciari and Giuffra 2013, p.3).
The cardinal also suffered from more extreme dental ailments
than other Medici, as his entire jaw line was asymmetrical
(Villari et. al. 2009, p. 2111). As I will discuss later,
although these ailments are reminiscent of Piero il Gottoso,
their true nature stresses generations practicing
intermarriage among fellow nobles.
The gout of the cadet line accumulates towards the
later generations of eight through eleven; as seen on table
2 of Lippi et. al. (2009, p.248). This shows that, as I have
previously indicated, these Medici have completely left
behind their middle beginnings. As previously mentioned, in
many cases gout is accompanied by obesity and kidney or
heart failure as causes of death. This is the case for later
dukes, such as Francesco Maria and Gian Gaston (Lippi et.
al. 2009, p. 248). In the death of Cosimo I there is some
historical evidence of gout as a cause, but only as an
auxiliary factor of uricemia (Lippi et. al. 2009, p. 248).
Cosimo's sons Ferdinando I and Francesco I are both said to
have become rather corpulent after their late 30's, and
Francesco I had a bout of malaria in his youth (Villari et.
al. 2009, p. 2105, 2107). The importance of Francesco I's
morally laxity is that, again, it was a personal trait
traditionally indicative of gout. I suggest that in
addition to the vices practiced by Ferdinando I, the
ailments his wife Christiana of Lorraine suffered from need
to be considered in the ailments of the following
generations. As Ferdinando's son Carlo, who became Cardinal
at age 20, suffered in his youth from a bout of tuberculosis
and had many malformations, specifically in his spine and
jaw. These physical deformities were so severe especially in
his back, that he became hunchbacked and was required to
wear a corset the rest of his life (Villari et. al. 2009, p.
2111). Again, I point to the foil of the senior line
ailments, as Piero was similarly handicapped by his gout
only being able to move his tongue later in life (Porter and
Rousseu 1998, p.28). The ailments abound in Medici women,
highlighted in those individuals below whom married into the
family, of the cadet line presented physical deformities
similar to that of Carlo's (Villari et. al. 2009).
Beginning with Giovanna of Austria, it is known that
"Contemporary reports describe her as hunchbacked but [a]
very religious woman." (Villari et. al. 2009, p. 2106). In
addition to her back ailment, new reports show that she had
facial progenism, otherwise known as Hapsburg jaw; an
ailment that rarely manifested in women and was genetically
inherited (Colagrande et. al. 2013, p. 194). Another example
of female deformities lies in, as previously mentioned,
Ferdinando's wife and Carlo's mother, Cristiana of Lorraine.
Her serious back ailment was indicative of severe
scoliosis,; similar to that of her son, Carlo, and to
Francesco's wife Giovanna (Villari et. al. 2009, p.2106,
2109-2110). I suggest that these ailments indicate that
Cristiana may have passed on her deformity to her son,
similar to how the Hapsburg jaw was inherited by Giovanna.
It is notable that Cristiana was the granddaughter of
Caterina de Medici; whom in turn was a granddaughter of
Lorenzo the Magnificent, thus a coveted tie to the senior
branch (Villari et. al. 2009, p. 2109). I assert that shows
that not all of the physical Medici ailments may have
originated from the paternal Medici line. Moreover, the
above example of intermarriage, within the Medici line
itself, may have also led to some unforeseen ailments and
deformities. In order to fully clarify the context and
methodology of these studies, I now turn to a brief
explanation of the utilized methods.
Regarding the archeometric methodology, it is important
for the archeologists to choose an effective reliable
method. Additionally, archaeologists need to consider the
environment and context in which they are working. I define
archeometry as the field of archaeology which applies
scientific tests and proofs to archaeological samples. In
the case of excavations at San Lorenzo, I would like to
emphasize that the Medici bones are not simply artifacts,
and there is a limited sample size for researches to work
with as well as some ethical restraints to consider within
the study. Thus most of the methodology utilized while non-
destructive has heavily relied on human accuracy. The
technology which aided in human macro-analysis of the bones
was typical harmless scans such as radio-graphs and
macroscopic study. The prior methods are utilized in the
majority of the paleopathological publications, namely:
Fornaciari and Giuffra, both Fornaciari et. al. and Giuffra
et. al., Weisz et. al., and finally Villari et. al. (2013)
(2008) (2009) (2010) (2009). As I previously discussed, this
type of methodology is unsurprising as the articles have a
goal of re-diagnosis, yet wish to test for differing
ailments such as DISH, gout, and a comprehensive study of
deformities. The work of Colagrande et. al. is similarly in
line with the aforementioned methodology, as these scholars
utilized CT scans and orthopantomography; more commonly
known as dental x-rays (Colagrande et. al. 2013). The only
study to use destructive while admittedly precise methods is
Fornaciari's solo study of Renaissance diet in Naples and
Florence. In this study an isotopic analysis is used to
determine past food patterns within the Bone collagen of the
Medici dukes and Neapolitan princes (Fornaciari 2008). It is
relevant to take note of the conformity in testing the
Medici bones, as Radiographs are convenient and macroscopic
study non-destructive (Applbaum and Y.H. 2005, p. 244).
Yet, this does hinder the project as these methods are more
vulnerable to human error in recognizing bone malformations,
especially in the case of tophaceous gout. As Swinson et.
al. tells us only two examples of known tophi appear in the
archaeological record, and both bodies were highly
persevered via mummification (2010, p.136). The diet and
nutrition study signifies that Fornaciari, while previously
using conservative methods of analysis, sparingly
prioritized study that relies on destructive or expensive
methods. Be that as it may, I believe Fornaciari could have
prioritized the use of a destructive method for a research
question that is more ambiguous, as diet of the elites has
been thoroughly recorded in such works as Greico's. I also
suggest that newer destructive methods are becoming more
appealing. McMaster shows that many destructive methods,
including that of HPLC, require a small sample and therefore
the amount of destruction done to the artifact or bones is
limited (2007, p.3).
Utilizing new methodology, such as HPLC-High
Performance Liquid Chromatography--will confirm the recent
breakthrough in Medici re-diagnosis, and quell any doubts
surrounding the results. With regards to HPLC the
efficiency, versatility, and ease are key components to the
significance of this method. The basic mechanics of HPLC are
separating a solvent and identifying its key components
(McMaster 2007, p. 4-5). Results are achieved by a detector
that measures "...peaks that rise and fall..." (McMaster
2007, p. 5). These measured results are the differing
partition rates within the solution (that of the solvent and
packing material--or the sample provided by an excavation)
(McMaster 2007, p. 5). As previously mentioned, HPLC
analysis applies to a range of samples. McMaster states that
"separations have been achieved based on differences in
polarity, size, shape, charge, specific affinity for a site,
stereo, and optical isomerism." (2007, p.9). Thus, gout can
be easily identified by excessive uric acid present within a
sample. What is more is that a HPLC is quick, taking a
maximum window of 2 hours and a minimum of 15 to 30 second
runs (McMaster 2007, p. 3). Essentially, I am asserting
that the application of the method, to the excavations at
San Lorenzo, would allow for scholars to compare the
historic results to modern uric acid build up in gouty
individuals. In fact, one recent study has utilized a
reversed HPLC method in the modern diagnosis of gout; Xiang
et. al. successfully looked into the biological markers of
uric acid in urine (2013). I believe that this is notable,
as it represents the modern diagnosis of gout that recent
studies desire to achieve or disprove within the Medici
line. Moreover, HPLC has recently been tested in a
paleopathological setting, and successfully diagnosed
historic bones of over 500 years old (Swinson et. al. 2010,
p. 141). Below I suggest that successful outcome of this
recent publication calls for the use of HPLC in future
publications of Fornaciari's Medici project.
The initial argument in the study by Swinson et. al.
was not to identify gout, but rather to identify "The exact
nature of the white powder..." present in many of the
individuals from a Quaker burial ground and a friary
cemetery (2010, p. 142, 136). The article mentions how HPLC
was able to confirm the macro analysis diagnosis of
individuals selected for testing, and records a control
group of "...a child...a young female and a middle adult
female." (Swinson et. al. 2010, p. 138). This illustrates
the gender bias of gout, which was briefly discussed
earlier, which itself is connoted to excessive sexual
activity. Samples were prepared by "...crush[ing] in[to] a
fine powder using a pestle and mortar..." and the HPLC
system used was "Dionex Summit HPLC system...with Chromeleon
software." (Swinson et. al. 2010, p. 139). This system has
recorded accuracy with repeated test results, in North
America, Europe, and Asia (Thermo Scientific 2015).
Therefore, I argue that such results illustrate the
reliability of the method. Despite this, the novelty in the
use of HPLC is, again, highlighted at the mention of the use
of other methodologies prior to the HPLC test. Swinson et.
al. apply the traditional use of Radiographs, as well as a
murexide test which is destructive in nature and
necessitates drying out the sample and then "adding a few
drops of ammonia to the residue;" this test was also
confirmed by a control sample (Swinson et. al. 2010, p.
138). I argue that these auxiliary methods used in the study
of Swinson et. al. are not only indicative of the novelty of
HPLC, but also of the ambiguity of the presence of gout in a
post-mortem individual. Swinson et. al. states that "only
individuals with gout severe enough...can be identified..."
and that "Those...with intermittent gout, resolving after
each attack, will escape identification as a gouty subject."
(Swinson et. al. 141). Thus, this study illustrates that,
while destructive methods may be necessarily prioritized for
subjects that have no alternative, such as dietary analysis,
it is useful in the diagnosis of gout which has proven to be
more elusive than other arthritic diseases, such as that of
RA or DISH. As relevant as this study proves to be, the
methodology of HPLC is not free of drawbacks.
Stated above as one of the hallmarks of HPLC is the
ease of use provided by the system. Yet, McMaster states
that there ease of use dependent upon the operator's
familiarity with the specific machinery (McMaster 2007, p.
4). Another, rather obvious, disadvantage is the pricing of
HPLC systems and lifespan of the components. McMaster states
that "The basic system is rather expensive...columns are
expensive with a short operating life, solvents are
expensive and disposal of used solvent is becoming a real
headache."(McMaster 2007, p. 4). I can confirm this, as I
looked into the price of the specific system utilized in the
study by Swinson et. al.; the website for the Dionex HPLC
systems states that costs for HPLC pumps alone average
$5,000-$6,000, still lacking the entirety of the system
(Thermo Scientific 2015). I reiterate the initial drawback
of the system is the fact that it is destructive to an
archaeological sample. This is even more pertinent in the
paleopathological studies, as an individual's human bone is
of a limited amount, and to be treated ethically when
studied.
Paleopathological studies can be utilized, to further
clarify past identities and mindsets. By looking into the
'disease of kings' or gout, I was able to unearth the
various connotations of the disease in the Early Modern
mindset. By making use of the archaeological and historical
records, I was able to present a holistic and inquisitive
look into gout as a disease and identity marker. More
expressly, I illustrated these multiple connotations and
labels attributed to those suffering from gout by suggesting
separate notions for the historical gout of the senior and
cadet lines of Medici family. As the archaeological record
suggests against the historic diagnosis of gout in the
Medici, new questions arise about the nature of the disease.
Gout had a heavy tie to nobility and elites, yet it
typically emphasized the negative qualities, specifically
the luxury and excess of those classes. However, this also
varied on the viewpoint of those criticizing and commenting
on gout. As I have discussed, the nobles themselves do not
show any shame in having gout, and indeed may have used it
as a marker of their status. I assert that the multiple
connotations that arise from an Early Modern diagnosis of
gout are unsurprising. This is mainly due to the fact that
gout was an obscure diagnosis, which today would include a
range of joint and rheumatoid diseases. Studies on the
identities of elites in the Early Modern period may look
into how many individuals craved or falsified diseases which
were common among nobles. This is somewhat ironic compared
to the present topic of the Medici gout, as the original
individuals of the senior line wished not to be connoted to
nobility. This reinforces my prompt to separate the nature
of the 'gout' of the senior line from the 'gout' of the
cadet line; as gout could be positively tied to nobility--
suggesting a penchant for governing--the genetic 'gout' of
the senior line may have suggested this to the people of
Florence under their rule. Such various connotations of gout
can be compared to modern day reactions to ailment such as
cancer--as it too is a blanket term today which can refer to
various types of suffering (ie: breast cancer compared to
melanoma). And lastly, I hope to see further excavations and
publication on the topic of Medici gout, as archaeological
methods are constantly advancing. Therefore, future studies
will only aid in fully confirming or rejecting the historic
diagnosis of Medici gout.
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