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This webpage reproduces a section of De Medicina (On Medicine) by A. Cornelius Celsus published in Vol. III of the Loeb Classical Library edition, 1935 The text is in the public domain. This page has been carefully proofread and I believe it to be free of errors. If you find a mistake though, please let me know!

(Vol. III) Celsus
On Medicine

 p463  Appendix

ON PODAGRA AND CHEIRAGRA

Dictionaries wrongly give gout as the only meaning for these two words, which, in many classical writers,​1 and sometimes in Celsus, are simply used to mean pain in the foot or hand.

It is, however, a fact that all animals, as well as man, are subject in old age to a degeneration of the cartilaginous surfaces of their joints. This is true even in prehistoric times; such changes occurred among the Dinosaurs of the chalk period, among various primitive animals and in early man. This degeneration is now met with, not only in the old, but in middle age; it is a form of precocious senility; often the tendency is clearly inherited and the condition becomes an essential primary factor in various joint diseases. It was to this condition, when occurring in the feet, that the terms podagra and cheiragra came specially to be applied. Gout was first scientifically diagnosed after the finding of urate of soda in the tophi and an excess of uric acid in the blood. But the description of Aretaeus​2 seems to show that it was known to the physicians  p464 of the 1st century A.D. He mentions that the disease (podagra) sometimes begins by attacking the great toe and that the tophi break down into a chalky fluid.3

Pliny​4 and Galen,​5 writing in the 2nd century A.D., declared that a new form of podagra had appeared, definitely inheritable from parents and grandparents, which they have attributed to luxury in food and drink; this had become prevalent in the Roman world, but was hardly known in the Greek world of Hippocrates.

The development of the disease, which Pliny and Galen referred entirely to the increase of luxury, may have had, in part at least, another cause. In the 16th century an outbreak of illness occurred inº Poitou​6 with similar symptoms, which was finally diagnosed as chronic lead poisoning due to the use of lead pipes or vats in the preparation of the wine. Another outbreak, due to the same cause, occurred in the 18th century in connection with the manufacture of cider in Devonshire.​7 On the other hand, the marked decrease in cases of gout during the last half-century may be related to the simultaneous reduction of cases in chronic lead poisoning.

It is, therefore, not improbable that the form of podagra described by Pliny and Galen may have been closely related to chronic lead poisoning due to the  p465 great increase in the use of lead pipes owing to the extensive building of aqueducts under the Empire.8

To sum up, it seems clear that if the words podagra and cheiragra when used by Celsus are simply translated "gout," we are attributing to him a specialized use of the term which he probably did not intend; his podagra and cheiragra were used of any pain in the feet and hand,º though such pain was often a joint pain and sometimes, no doubt, occurred in a case of true gout.9

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The Editor's Notes:

1 See Aristotle, History of Animals, VI.21, 575 B, and VIII.22, 23, 24, 604 A. By podagra he meant a disease of the feet in animals, cattle, horses, etc. Cf. also Virgil, Georgics, III.299.

2 Chronic Diseases, II.12 (ischiatica). His date is unknown; it has been conjectured that he flourished about 70 A.D.

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3 The earliest skeleton definitely recognized as affected by true gout was found in a Nubian cemetery belonging to the 5th century A.D.

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4 Natural History, XXVI, X.64.

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5 XVII.A, 431-XVIII.A, 43 (K).

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6 Ctesius, Opera 1639.

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7 Huxham, Obs. Med. Phys., 1784, III.54.

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8 For an account of lead poisoning see Celsus V.27, 12 B; for the use of lead pipes see Vitruvius VIII.3.5,º and Frontinus, Aqueducts I.25.

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9 The word gutta from which gout is derived was used by later Latin medical writers as equivalent to Destillatio (ῥεῦμα), the "dripping" from the head described by Celsus. The first to use it in the sense of gout was probably Alexander of Tralles in the 6th century A.D. The term gout is wrongly used by Dryden in his translation of the Georgics to translate the podagra of Virgil (III.299) which refers to foot-rot in sheep.

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