Leonardo's Foot

by Carol Ann Rinzler

  The Romans knew that handling lead could be hazardous to one’s health, so all lead mining in Rome was done by slaves. But once the metal was mined and extracted, it was liberally sprinkled through everyday Roman life, from top to bottom. Lead leeched into the drinking, cooking, cleaning water that flowed smoothly through the City’s perfectly engineered and perfectly poisonous lead pipes. Lead made its way into food via flakes sloughing off plates and drinking vessels, or as “sugar of lead,” sweet-tasting lead acetate crystals added to cakes and candies and fruits and the otherwise sour wine served in gleaming gold cups. All this lead, as well as the infinitesimal particles floating in the air, made its way into the bodies of those who ate or drank the foods and liquids, or handled the lead dishes, bowls, and jars on or in which they were served or stored.

  Inevitably, this wide exposure led to an epidemic of lead poisoning. Two important symptoms are dementia—Caligula and Nero are presumed to have been victims—and sterility. As one anonymous Roman poet quoted by the U.S. Environmental Protection Agency, no less, concluded, both effects were devastating to the Roman state:

  Hence gout and stone afflict the human race;

  Hence lazy jaundice with her saffron face;

  Palsy, with shaking head and tott’ring knees.

  And bloated dropsy, the staunch sot’s disease;

  Consumption, pale, with keen but hollow eye,

  And sharpened feature, shew’d that death was nigh.

  The feeble offspring curse their crazy sires,

  And, tainted from his birth, the youth expires.

  A third symptom of lead poisoning is the agonizing joint pain known as saturnine gout, after the planet Saturn that was early on believed to be made of lead. There was no remedy for any form of gout in ancient Rome and no remedy in 1898 when all the first edition of The Merck Manual could offer was sulphuric acid diluted in lemon juice to prevent the body’s absorbing lead; alum, castor oil, magnesium sulphate, potassium iodide, and sulphur as laxatives; belladonna to calm the intestines; morphine and opium for the pain; and eggs and milk, presumably to soothe the stomach if not the foot.

  Power, prevention, and sexual prowess

  Plain, false, or saturnine, the gout cloud did have a sliver of a silver lining. While writhing in pain, the sufferer could bask in the aura of wealth and power attested to by that inflamed toe. Thomas Sydenham (1624-1689), the seventeenth century British physician generally recognized as a founder of modern clinical medicine—the Encyclopedia Britannica calls him “the English Hippocrates”—and a gout sufferer himself, accurately reflected the prevailing wisdom when he wrote, “Gout, unlike any other disease, kills more rich men than poor, more wise men than simple.”

  In the language of classic medicine, gout was morbus dominorum et dominus morborum, the “disease of lords and lord of disease.” The origins of this cozy relationship are described in the fable Mr. Gout and the Spider, a tale that’s been told at least since the ninth century. One well-known version appears in The Poore-Mans Plaster-Box, a medical handbook published by Puritan minister Richard Hawes in 1634 for his country parishioners in Kentchurch, Herefordshire, in southwest Britain.

  One evening, the story goes, as Mr. Gout and Mr. Spider were traveling the countryside, they began to look for shelter for the night. Gout went off to a poor man’s home; Spider to a rich man’s. When they met the next morning to compare experiences, each had the same complaint: “Mine was worse than yours.” “As soon as I touched the leg of the poor man,” said Gout, “he started moving around so wildly that I couldn’t get any sleep.” “That’s nothing,” said the Spider. “As soon as I began to build my web, the rich man’s maid came and tore it down.” The next night, changing places, the two discovered happy homes. The poor man left Spider’s webs intact; the rich man pampered gout with soft pillows and tasty meals designed to sooth both the toe and the spirit. And that sealed the deal: gout for the rich, spiders for the poor.

  Like spiders, rheumatism was also the poor man’s fate, a situation nicely explained by the patrician Mr. Chester in Charles Dickens’ Barnaby Rudge. “You will excuse her infirmities,” he says of the maid employed to open doors. “If she were in a more elevated station of society she would be gouty. Being but a hewer of wood and drawer of water she is rheumatic.” One literary lion rebelled at this convention. Daniel Defoe, both a failed businessman and a man afflicted with gout, wrote the hero’s father into Robinson Crusoe as, yes, a poor man with gout, thus defying common wisdom, which remained common almost two hundred years later when The London Times commented that, “The common cold is well named—but the gout seems instantly to raise the patient’s social status.”

  But Crusoe’s father was a social anomaly.

  Historically, the quintessential gout patient has been forty, fat, and filthy rich, or at least powerful. Shakespeare had the type down cold with John Falstaff, the “goodly portly man, i’ faith, and a corpulent; of a cheerful look, a pleasing eye, and a most noble carriage” in Henry IV, Part 1. By Part II, he was no longer so cheerful, invoking “A pox of this gout! or, a gout of this pox! for the one or the other plays the rogue with my great toe.”

  As you may have noticed, the gout sufferer has almost always been a he. In his Aphorisms, Hippocrates noted that “a woman does not take the gout, unless her menses be stopped” or she begins to behave like a man. During Nero’s reign, the philosopher and statesman Lucius Annaeus Seneca, a.k.a. Seneca the Younger or just plain Seneca (c. 3 BCE–65 CE), fretted that although women were not ordinarily destined to lose their hair or suffer gout, “because of their vices, [they] have ceased to deserve the privileges of their sex; they have put off their womanly nature and are therefore condemned to suffer the diseases of men.” But as noted above, what looked like the wages of sin was really Toxicology 101: Like dementia and sterility, hair loss and joint pain are symptoms of lead poisoning.

  Today, the ratio of men to women with gout remains about 4:1 in favor of (against?) men. Until recently, those were assumed to be primarily Caucasian men, but modern statistics refute this. In November 2011, at the Association of Rheumatology Health Professionals Annual Scientific Meeting in Atlanta, a team of scientists from Johns Hopkins reported that after combing through the records of 15,792 men and women in the Atherosclerosis Risk in Communities (ARIC) Study and accounting for all the usual variables—gender, age, weight as measured by the Body Mass Index (BMI), diet (protein, organ meat, shellfish, alcohol), chronic conditions (hypertension, diabetes, kidney function), income, education, smoking, and body levels of uric acid—they found a 50 percent higher risk of gout among African American men. And women.

  Gout was also believed to convey sexual prowess. “Eunuchs do not take the gout, nor become bald,” Hippocrates wrote. “A young man does not take the gout until he indulges in coition.” Remember, gout was originally called podagra after the daughter of the Greek god of wine and the goddess of love. Counterintuitive as it might be, some even considered gout an aphrodisiac. In his essay, “On Cripples,” Michel Eyquem de Montaigne (1533–1592) wrote that when the legs “do not receive the food that is their due … the genital parts … are fuller, better nourished, and more vigorous. Or else that, since this defect prevents exercise, those who are tainted by it dissipate their strength less and come more entire to the sports of Venus.” More to the point, others suggested, just lying around on your back doing nothing much tends to turn your mind to thoughts of a baser nature— which you might not be able to complete owing to the pain in your big toe. Finally, a kind of it-could-be-worse mentality credited the disease of lords with the ability to ward off less noble, but potentially more disastrous illness. The eighteenth century literati were fulsome in their praise of gout as preventive medicine. In a poem to celebrate his friend Rebecca Dingley’s birthday (“Bec’s Birthday” [1726]), Jonathan Swift (1667–1745) wrote of “The gout that will prolong his days.” British historian, playwright, and novelist Horace Walpole (1717–1797) believed that gout “prevent
s other illness and prolongs life. Could I cure the gout, should not I have a fever, a palsy or an apoplexy?” And Ben Franklin (1706–1790), author of Poor Richard’s Almanack and a man accustomed to publishing sensible advice, described his own straight-forward conversation with his disease in Dialogue Between Franklin and The Gout (1780):

  GOUT. Well, then, to my office; it should not be forgotten that I am your physician. There.

  FRANKLIN. Ohhh! What a devil of a physician!

  GOUT. How ungrateful you are to say so! Is it not I who, in the character of your physician, have saved you from the palsy, dropsy, and apoplexy? one or other of which would have done for you long ago, but for me.

  FRANKLIN…. [O]ne had better die than be cured so dolefully. Permit me just to hint, that I have also not been unfriendly to you. I never feed physician or quack of any kind, to enter the list against you; if then you do not leave me to my repose, it may be said you are ungrateful too.

  GOUT. I can scarcely acknowledge that as any objection. As to quacks, I despise them; they may kill you indeed, but cannot injure me. And, as to regular physicians, they are at last convinced that the gout, in such a subject as you are, is no disease, but a remedy; and wherefore cure a remedy?—but to our business,—there.

  Defoe, Swift, Walpole, and Franklin were only four of gout’s middle-aged male victims. The list is so long and impressive that you just have to wonder how strongly their gout influenced their public behavior.

  Did the pain of that big toe drive Alexander and Charlemagne into battle, make Henry VIII so cranky he just had to change wives every few years, embitter Benedict Arnold, and turn Karl Marx into an opponent of the upper class into which his ailment supposedly placed him? If Martin Luther hit his thumb when nailing those 95 theses to the door of the Wittenberg Castle Church, was that a minor inconvenience compared to his gout? Did Galileo challenge the map of the universe and invite theological condemnation just to take his mind off his foot? Did concentrating on sounds he heard only in his head distract Beethoven from his own throbbing toe? Did the shock of that apple falling on Isaac Newton’s head turn his attention from physics (as in remedy) to physics (as in gravity), an event often assumed to be apocryphal, but actually to be found in a contemporary biography, Memoirs of Sir Isaac Newton’s Life (1752), by fellow gout-sufferer William Stukeley. The book, published twenty-five years after Newton’s death, is online today at the website of the Royal Society in Britain where you can read Stukeley’s account of how “[a]fter dinner, the weather being warm,” he and Newton “went into the garden and drank thea [sic], under the shade of some apple trees. He told me, he was just in the same situation, as when formerly, the notion of gravitation came into his mind. It was occasion’d by the fall of an apple, as he sat in contemplative mood. Why should that apple always descend perpendicularly to the ground, thought he to himself …” And when the pain of gout inhibited motion, how long would patients have had to wait for the invention of the wheelchair had King Philip II of Spain’s painful toe not required the first relatively modern documented moving chair, shown here in a drawing thought to be dated sometime around 1595, three years before the king and his toe exited the world.

  Finally, what role did the misery of his own imperfect, gouty toe play in Leonardo’s fascination with anatomy and the perfect Vitruvian Man?

  We will never know. But we do know this: Gout played a rarely reported, highly personal role in the lives of five men in America, England, and France, who managed or tried to contain the emancipation of the United States from Great Britain.

  Gout’s white shoe fraternity

  Human beings are contentious by nature, especially when gathered together into families, tribes, or nations. Push them a bit, and they will take up arms for all kinds of causes, reasonable and otherwise: A (married) Spartan queen’s elopement with a Trojan prince; a French king’s refusal to grow back the beard shaved after his return from the Crusades, leading his wife to divorce him, marry the King of England and demand her dowry back, which King #1 refused to pay, thus leading King #2 to declare war on King #1; a British seaman’s ear amputated with one slice of a Spanish commander’s sword; the sinking of an American warship in Havana harbor, or the assassination of an Austrian Grand Duke.

  This list of conflicts—the Trojan War (1193–1183 BCE), the War of the Whiskers plus the War of the Austrian Succession (1152–1453), the War of Jenkins’ Ear (1740–1748), the Spanish–American War (1898–1901), and World War I (1914–1918)—would be incomplete without the “War Hastened by A Gout Attack,” better known as the American Revolution.

  William Pitt, the Elder, 1st Earl of Chatham, Viscount Pitt of Burton-Pynsent (1708–1788), twice prime minister of Great Britain and known fondly as the “Great Commoner” for his service in the House of Commons until he was lifted not-quite-happily into the House of Lords in 1766, did not like the French. Disagreements with various kings and other important personages in England kept Pitt from being named Prime Minister until 1766 when he served for two years and seventy-six days, but he was able nonetheless to wield his razor sharp wit and tongue to convince his colleagues to underwrite Prussian engagements against the French in Europe and to send the British Navy to harry the French in ships off the coast of France, as well as in such outposts of French exploration and conquest as the West Indies and Africa during the Seven Years War. His policies enabled Britain to consolidate power in North America and on the Indian subcontinent, hold on to bases in the Mediterranean, and acquire territory in the previously French-dominated Africa and West Indies. Then, having turned England from a kingdom into an Empire, Pitt was determined to hold it together for as long as possible, a situation which required not only outwitting the French, but also keeping the American Colonies relatively peaceful.

  It wasn’t easy. In 1765, when Pitt was absent due to a disabling bout of gout, Parliament passed the infamous Stamp Act commanding the Colonies to pay taxes to the British government to make up the cost of defending them (the Colonies) from attack by the French. As soon as he could, Pitt more or less hobbled back to Parliament, his gout in momentary retreat, and convinced his allies to repeal the Act. “The Americans are the sons, not the bastards, of England,” he announced. “As subjects, they are entitled to the right of common representation and cannot be bound to pay taxes without their consent.” But the next time Pitt’s toe laid him low, Parliament repealed his repeal, and in 1773 passed the Tea Act, levying duties on tea, which the colonists famously tossed overboard into Boston harbor.

  Clearly, Pitt’s on-again, off-again gout attacks did not trigger either the colonists’ drive for separation from the country they had left and so many of them had left behind or the British Parliament’s equally strong intention to keep the Colonies subservient within the Empire. But Robert Burns was right: The best schemes often go awry—especially when, as in this case, the leading players are indisposed. Pitt never supported independence for the Americans because he feared French domination of North America, but he was sympathetic to their situation even after the Revolution began. “If I were an American,” he said in November 1777, “as I am an Englishman, while a foreign troop was landed in my country, I never would lay down my arms—never! never! never!”

  That being true, if Parliament had stuck with the Pitt-driven repeal of the Stamp Act in 1765 and not raised taxes on tea, could there have been large or small alterations along the way to full independence? Probably not, but even as late as 1775, Pitt was not ready to give up. After consultation with Benjamin Franklin, he introduced a compromise bill to maintain the legislative authority of Parliament over its Colonies while granting the Continental Congress in Philadelphia the responsibility of setting each colony’s taxes to the British treasury. His proposal was turned down. One year later, as he had feared, Britain and the Colonies were at war. Luckily for the colonists, four equally eminent men who shared the American desire for independence—and one painful problem—were at work to make sure there would be arms sufficient to acc
ommodate the American patriotism.

  Franklin, Jefferson, de Vergennes, and Hancock. Say the names quickly and it sounds suspiciously like the list of partners in a white shoe law firm.6 Or the clique of really cool guys at an exclusive boys’ school, which it sort of was.

  By age nine, Thomas Jefferson (1743–1826) was studying Latin, Greek, French, and “natural history” at schools run by ministers near his birthplace in Albermarle County, Virginia; and he graduated from William & Mary in 1752 at nineteen. In 1819, after leaving the Presidency, he founded the University of Virginia, firmly in the tradition of secular classical education. Hancock (1737–1793) was the first man to sign the Declaration of Independence, in a script so much larger than everyone else’s on the page that his name became a synonym for a signature. He had attended the Boston Latin School, established by Puritan settlers in 1635 as the first public school in America, and graduated from Harvard College, class of 1774. In the manner of mannered French noblemen, Charles Gravier, Comte de Vergennes (1717–1787), foreign minister for Louis XVI, was educated by Jesuits in Dijon.

  The odd man out might appear to have been Franklin, the son of a Puritan Boston candle maker. Like Hancock, Franklin attended Boston Latin, but sinking family finances forced him to drop out a few months after he entered. His formal education ended when he was ten; after that he taught himself. Later, Franklin won his key to the cool kids’ club with two honorary master’s degrees (Harvard, 1753; William & Mary, 1756) and two honorary doctorates (University of St. Andrews, 1759; Oxford, 1762). By 1856, when Richard Saltonstall Greenough’s 8-foot-tall bronze statue of Franklin, the city’s first such portrait of a public person, was set in place at the site of the original Boston Latin School and the Old City Hall, Franklin’s adult achievements had clearly eclipsed his boyhood poverty.