The patient’s illness began abruptly at age 41
with an attack of “the gout” during a violent storm
on his return from the first of four voyages of discovery. Its
nature is uncertain, but seems to have consisted of an intermittent,
though relentlessly progressive, poly-articular arthritis affecting
the legs more than the arms or hands. Acute attacks of the disorder
most often occurred following exposure to cold and dampness while
the patient was at sea. Malnutrition and chronic insomnia also
may have contributed to the disorder, in that some of the most
severe attacks coincided with periods in which he was eating little
and sleeping not at all.
Although it has long been maintained that the patient was a Genoese
Christian by birth, some scholars now believe he was the son of
Catalans, and that his mother might have been a member of a prominent
converso (Jewish convert) family. We know almost nothing of his
family’s medical history. If he was the man from Genoa he
is generally considered to be, he had a younger sister and three
younger brothers (one of whom died young of unknown cause). No
other family member is known to have had “the gout.”
However, post mortem examination of remains presumed to be those
of one of the patient’s brothers (possibly of the patient
himself) show fusion of the fourth and fifth lumbar vertebrae
and incomplete spina bifida. Identical abnormalities are present
in the remains of one of the patient’s sons.
The patient was a mariner and an explorer. His writings demonstrate
fluency in Latin as well as more than a passing knowledge of the
works of Aristotle, Ptolemy, Marinus of Tyre, Strabo, Pliny and
Marco Polo. Therefore, he seems to have been well educated. However,
neither the source nor the extent of his formal education (if
any) is known. He married at age 28. His wife died six years later
of un-known cause after having produced one son. The patient then
took a mistress, by whom he had a second son. Whether he had other
sexual relationships is not known. However, sexual promiscuity
was common among the men who served under him, many of whom contracted
syphilis as a consequence.
Prior to his 41st year, the patient’s only recorded medical
problem was a wound of unknown location and severity he received
in a sea battle at age 25. At that time he also was temporarily
“crippled” following a swim of two leagues from his
wrecked ship to the nearby shore. As a young man the patient was
“tall, well formed, muscular, and of an elevated and dignified
demeanor . . . his complexion fair and freckled, and inclined
to ruddy . . . his eyes blue . . . his hair . . . a light color
[which] care and trouble . . . soon turned it grey . . . [and
then] quite white.” He was “sober and moderate in
eating and drinking.”
The patient seems never to have recovered fully from his initial
attack of “the gout.” In December of the year following
that first attack, he and many of his men came down with an illness
believed to have been influenza. Whereas most other victims recovered
quickly, the patient developed “complications” which
took nearly four months to resolve. At age 43, while sailing in
the vicinity of Puerto Rico, he developed “fever and somnolence,
which suddenly deprived him of his sight, his other senses, and
his memory.” Another attack of “gout” ensued,
so severe that the patient remained in bed for weeks. More than
five months elapsed before his condition improved.
At age 47, the patient suddenly “was seized by grievous
pains of gout in the leg, and four days after by a terrible fever,
but despite his illness, he remained sound of mind.” Two
months later, his eyes [became] so much affected with bleeding
and [were] so painful” he had difficulty seeing. His letters
written at that time are rambling and incoherent. A prolonged
period of enforced rest temporarily restored his health. However,
by age 51, he was “already an aged man according to the
notions of his day.” In fact, during his fourth and final
voyage of discovery, he was so sick and so frequently “lay
at death’s door” he had to issue his “orders
from a doghouse he had constructed on the poop deck” of
his flagship. In the midst of his deteriorating health, his “old
wound opened up.” During an exhausting and humiliating year
marooned on the island of Jamaica, he was “shaken by a malaria
fever” which rendered him delirious and an arthritis so
severe “he could not stand.” And yet, except for the
delirium that accompanied intermittent attacks of fever, his mind
remained sharp until the end.
After Jamaica, the patient’s condition declined rapidly.
Although a prolonged period of rest brought modest relief, by
his 54th year, his arthritis was so severe, that “most of
the time he was confined to bed.” In cold weather, his agony
was unbearable. Toward the end, his hands were so painful, he
could no longer write. Finally, on May 20, 1506, shortly before
his 55th birthday, “already quite paralyzed, bedridden with
‘the gout’,” the patient died.
Note: The date of the patient’s birth is uncertain. The
ages given in this protocol reflect the most widely accepted chronology
of his life. Some authorities believe that the patient actually
lived to be 60-70 years old and that 7 or 8 years should be added
to the ages listed in this Case Summary.
