Gout and ‘Podagra’ in medieval Cambridge, England

Jenna M Dittmar,Piers D Mitchell,Peter M Jones,Bram Mulder,Sarah A Inskip,Craig Cessford,John E Robb

doi:10.1016/j.ijpp.2021.04.007

Abstract

ObjectiveTo estimate the prevalence rate of gout and to explore the social factors that contributed to its development in the various sub-populations in medieval Cambridge. Materials177 adult individuals from four medieval cemeteries located in and around Cambridge, UK. MethodsLesions were assessed macroscopically and radiographically. Elements with lytic lesions were described and imaged using micro-computed tomography (μCT) to determine their morphology. ResultsGout was identified in 3 % of the population. Individuals buried in the friary had highest prevalence (14 %), with low prevalence rates in the Hospital (3 %) and town parish cemetery (2 %), with no cases in the rural parish cemetery. Gout was more prevalent during the 14th–15th centuries than the 10th–13th centuries. ConclusionThe high prevalence rate of gout in the friary is at least partly explained by the consumption of alcohol and purine-rich diets by the friars and the wealthy townsfolk. Medieval medical texts from Cambridge show that gout (known as podagra) was sometimes treated with medications made from the root of the autumn crocus. This root contains colchicine, which is a medicine that is still used to treat gout today. SignificanceThis is one of the first studies to assess the epidemiology of gout in medieval England and suggests that gout varied with social status. LimitationsOur sample size precludes statistical analysis. Suggestions for further researchAdditional studies that assess the epidemiology of gout in medieval Europe is needed in order to be able to fully contextualize these findings.

Highlights

Gout is an inflammatory arthritis resulting from monosodium urate crystals forming in soft tissues or joints
We examine individuals who were buried in a parish cemetery, a friary, a charitable institution for the poor, and a rural parish located approxi mately 6 km from the town
No skeletal evidence of gout was identified in those buried within the rural parish cemetery in Cherry Hinton

Summary

Introduction

Gout is an inflammatory arthritis resulting from monosodium urate crystals forming in soft tissues or joints. While gouty arthritis most commonly affects the meta tarsophalangeal joint of the great toe, it can affect any joint including those in the axial skeleton (Gentili, 2006; Roddy, 2011). This condition is associated with reduced quality of life, functional impairment, reduced productivity and a higher risk of death (Singh and Strand, 2008)

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Results

Discussion

Conclusion