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

State University of New York2015

© Copyright by Cassandra Simone Basile 2015

All Rights Reserved

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

Sean Dunwoody, Secondary ReaderDepartment 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.

Table of Contents

Introduction Page 1

Content Page 2

Appendix Page 38

Bibliography Page 39

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.

Appendix

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