WEDNESDAY, Aug. 2, 2006 (HealthDay News) -- Holy Roman Emperor Charles V, one of history's most powerful rulers who died 448 years ago, was afflicted with a crippling case of gout that may have eventually forced his abdication, Spanish researchers report.
The researchers based their conclusion on an examination of a fragment of one finger that had been faithfully preserved since his death in 1558.
There already was strong evidence that Charles V -- of whom it was said he ruled an empire "in which the sun did not set" -- had gout. The emperor suffered intense pain throughout his life, was carried about in a special chair and entered a monastery two years before his death, handing over his territories to his son, Phillip II, and the Holy Empire to his brother, Ferdinand I, the study authors said.
But tests done on the finger "showed without doubt that it was a case of gout," said Dr. Pedro L. Fernandez, chief of the section of molecular pathology at the University of Barcelona Hospital Clinic. He is one author of a paper on the finding published in the Aug. 3 issue of the New England Journal of Medicine.
Those tests included electron microscopy, which showed heavy layers of the urate crystals responsible for the pain and crippling effect of gout, Fernandez said. X-rays of the finger confirmed that finding.
"Then we also used a technique that is in routine use in hospitals for analysis of blood samples, a third way to confirm the presence of urate crystals," Fernandez said. "A scanning microscope also shows in three dimensions that it was without doubt a case of gout."
X-rays showed erosion of the end of the bone in the finger, Fernandez said. "This would have to be very, very painful," he said. "The joint was destroyed. We made slices of the sample and didn't find bone until we reached quite a depth."
Gout is a type of arthritis that's caused by too much uric acid in the joints. Uric acid is a substance that forms when the body breaks down a substance called purines. In people with gout, the uric acid accumulates, forming sharp crystals that can collect around the joints, causing pain and swelling in the affected joints, according to the American Academy of Family Physicians.
Charles V, who was also King Charles I of Spain, ruled for 40 years during the transition from the Middle Ages to modern times. He governed territories in Europe, Africa and Asia, as well as conquered regions of Mexico and Peru.
While Charles V was known to have other medical problems, including hemorrhoids and possibly diabetes, the gout "was the worst of his conditions," Fernandez said. "It made him go into the monastery" in western Spain.
That conclusion might be a bit of a leap, said Dr. Philip Mackowiak, director of the medical care clinic at the Veterans Administration Health Care System in Baltimore, and a devotee of the study of famous patients throughout history. "They [the Spanish researchers] might have gone too far," he said, "but we all do it."
"From my vantage point, they pretty convincingly proved he had gout," Mackowiak said. But the Barcelona researchers had one major advantage, he added: "They actually have pathological material."
Mackowiak has presided over a yearly series of meetings about the medical history of famous people, ranging from Mozart to Herod the Great to Christopher Columbus to the Roman emperor Claudius.
First-hand evidence is hard to come by, he said: "Mozart was buried in a common grave and covered with lime. Claudius, like all the Roman emperors, was cremated."
One recent success was a meeting on Booker T. Washington. There was "a cryptic statement in his hospital record saying his death was caused by racial characteristics," Mackowiak said. "That raised the specter of syphilis."
With the help of Washington's granddaughter, Mackowiak got the full hospital record. It showed a negative test for syphilis, he said.
More information
Learn more about gout from the American Academy of Family Physicians.
