Gout in the "Anonymus Parisinus".

BACKGROUND: Gout, a disease already described in the "Anonymus Parisinus Darembergii sive Fuchsii", one of the two surviving Greek medical manuscripts of the first century CE, is reviewed in an effort to trace the timeline of the knowledge of the disease between the Corpus Hippocraticum and the Renaissance. METHODS: The treatise exists in four manuscripts of varying lengths: two are located in Paris, one in Vienna, and one in London. The study was conducted using the 1997 Leiden critical edition by Ivan Garofalo, which unifies all four manuscripts ("Anonymi Medici. De Morbis acutis et chronicis"), and was translated into English by Brian Fuchs. The treatise consists of 51 sections (a capite ad calcem, head to heel), in which the description of sixteen acute diseases precede that of thirty-five chronic diseases. The chapter on diseases affecting the joints precedes the last chapter, that describes elephantiasis. The text on gout consists of 945 words covering causes (46 words), signs (138 words) and therapy. RESULTS: The causes of gout are attributed to bilious humors and phlegm, as described by the "Ancients". The signs include inflammation and severe pain, typically beginning in the great toe (later known as podagra), but can extend to affect the entire leg, hands (referred to as cheiragra), or other joints, indicating a broader condition of arthritis. Pain is more tolerable when swelling coexists. Therapy is based on immediate bloodletting, dietary restrictions, and abstention from meat, wine and venery. CONCLUSIONS: Gout in the "Anonymus Parisinus" allows a full understanding of gout in the centuries between the Corpus Hippocraticum and Galen.