Rheumatism: Its History from Paleo-Pathology to the Advent of Experimental Science by Thomas G. Benedek (review)

The author is a professor of medicine in the Division of Rheumatology at the University of Pittsburgh who conducted an extensive literature review on the evolution of rheumatism. He traces hypotheses and discoveries from the ninth and early sixteenth centuries, then the seventeenth and eighteenth centuries, leading to the early modern era of evidence-based diagnosis and treatment of rheumatic conditions.

The section on ancient rheumatology examines bone structures from preserved mummies and excavated body parts to query whether rheumatoid arthritis is indeed a modern disease that was observed after the Industrial Revolution or whether it has been present throughout human existence. Because rheumatoid arthritis often affects the extremities, in particular the hand, wrist, and elbow, the upper limbs disintegrated over time and were not available for analysis. However, preserved spinal columns indicate that rheumatoid arthritis was indeed present in ancient times as distinct from spondylitis, which may occur from a variety of conditions including tuberculosis.

The word “rheumatism” is a generic term used interchangeably with “gout” in early history. Rheumatism derived from the Greek word rrheo, which means flow, whereas gout derived from the Latin word gutta, to drop. Both terms denote diseases moving throughout the body and affecting various body parts.

The first chapter examines ancient writings to trace observations on rheumatism from the Hippocratic Corpus. Leading figures during the ancient era saw it as an imbalance of elements of the body that could be treated with bloodletting.

As the book progresses to more recent times, the author expands his focus to include gout, which was postulated as a disease of the wealthy who consume large quantities of meat. These observations led to recommendations of a less indulgent diet and alcohol abstinence, recommendations that were challenged by several noted figures who believed they were ineffective. Although rheumatic diseases encompass a wide variety of conditions including rheumatoid arthritis, lupus, scleroderma, and other inflammatory diseases, this book starts with arthritis but then deviates to address gout and its effects on organ systems. The discussion traces the progression of gout through the observations and research of Boerhaave, Benjamin Rush, and even the illustrious Giambattista Morgagni.

Treatment of gout did not advance until chemical analysis of synovial fluids in the 1700s revealed uric acid crystals that were believed to be highly inflammatory to tissues. Tests were discovered to diagnose gout, leading to landmark treatment with colchicine and salicin in the eighteenth century. British physicians William Heberden and Alfred Garrod delineated the difference between rheumatic fever and rheumatism, which includes rheumatoid arthritis and gout. These studies expanded on uric acid chemistry and its relationship to gout by examining various efforts to identify uric acid crystals in both joint fluid and serum.

Benedek’s final chapter provides a timeline of uric acid discovery from the 1600s to the quantification of uric acid in urine in 1846. Modern era experiments showed that uric acid injected subcutaneously is highly inflammatory to tissues. The discovery of a blood test for gout by Emil Fischer, who studied the proteins of the purine group, led to his receipt of the Nobel Prize in 1902.

This textbook represents a herculean effort to review research on rheumatism, with fascinating observations of gout’s devastating effects on the toe and other organs. Rather than presenting complex data, the author writes in an observational style, presenting the material in a clear and understandable approach that is a joy to read. The arduous collection of passages derived from archives through ancient times to more modern collections of specific discoveries exemplifies the author’s passion for understanding rheumatism. The only minor critique is the rather imbalanced concentration on gout and the perhaps missed opportunity to comprehensively explore other rheumatoid conditions that also have an illustrious history.

In summary, this book is a remarkable effort to present rheumatism to the general readership rather than to researchers of this condition. Presenting the contributions...