Case Closed: Charles V Had Gout

The box containing Charles V's digit and the uric acid crystals that were the smoking gun.

University of Barcelona

One of the most powerful rulers of the Middle Ages was conquered by a bad case of gout, according to an unusual postmortem conducted on the fingertip of Emperor Charles V of Spain.

During his reign as Holy Roman emperor from 1519 to 1556, Charles V controlled territories spanning the globe, from Asia and Africa to the newly conquered Aztec and Inca empires in the Americas. Charles was known to suffer from painful gout--a term then used to describe a number of symptoms, including kidney aches and painful joints, associated with a gluttonous and lazy lifestyle. His suffering, which began at the age of 28, limited his ability to write and travel and eventually, many historians say, caused him to give up the throne at the age of 56. He died of malaria two years later. Before being buried in a tomb within El Escorial monastery in San Lorenzo, one of his pinky fingertips was cut off as a religious relic. The mummified morsel has been held for centuries at the monastery in a red velvet-lined box.

Hoping to pin down exactly what troubled the emperor, a team led by Pedro Fernández, a pathologist at the University of Barcelona, persuaded Spanish church officials to sacrifice a bit of the relic for the sake of science. The researchers embedded a portion of the finger containing part of the joint in paraffin wax, thinly sliced it, and examined it with x-ray and electron microscopes. They found that the flesh around the finger bone was infiltrated by needle-shaped crystals of uric acid, which typically accumulate in joints to cause the symptoms of gout. The condition seems to have become so severe toward the end of Charles' life that his finger joints were probably destroyed by crystal-packed growths known as gouty tophi, some of which were found preserved within the fingertip, the team reports 3 August in the New England Journal of Medicine.

"The evidence is totally convincing," says Philip Mackowiak, a pathologist at the University of Maryland School of Medicine in Baltimore. The next question, he says, is what caused the gout. The emperor was very fond of meat and drink by all accounts, "but the disease can also be caused by lead in the blood, which was used at the time to line water pipes and even added to wine as a preservative," he says. To answer this would require a study of the rest of Charles' remains; there are no plans at present for an exhumation.

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