The Life and Death of An American Statesman.

John Hay was born in a small mid-western town and sent by his physician father to Brown University for his education. He returned to Springfield IL where he was hired by Abraham Lincoln as a personal secretary and stayed with Lincoln through the assassination. He then returned to private life, married into a wealthy family and developed a successful literary and investment career. In 1879, he joined the State Department and later became Secretary under presidents McKinley and Roosevelt. He negotiated many important treaties including those related to building the Panama Canal. Later in life, his health deteriorated with symptoms of angina pectoris and heart failure. Limited medical understanding of these matters at the time are reviewed but were then of little benefit. Probably his most effective therapy was rest during weeks of carbonated baths at Bad Nauheim. Hay died suddenly, shortly after arriving home from the last of these trips.

Gout in the Gilded Age: The Case of Richard Morris Hunt.

Richard Morris Hunt, a distinguished American architect of the late 19th century (the Gilded Age), had onset of gout at age 41 years. His attacks became more frequent and severe, eventually leading to chronic pain and disability. His medical care by highly regarded physicians resulted in very limited benefit, but through his dedication and work ethic, he remained productive until his death at age 67 years.

The King Is Dead: Clark Gable's Heart Attack.

Clark Gable was born in a small Ohio mining town and never finished high school. Stage struck as a young man, he did menial jobs while working his way up to movie stardom-his most famous role was in "Gone with the Wind." He married 5 times. During WWII, he enlisted in the Army Air Corps, flew a few combat missions as a gunner and won the Distinguished Service Cross. Personally, he was intermittently obese, a drinker, smoker, hypertensive and predictably in 1960, he suffered an acute myocardial infarction. His clinical course was benign until the 10th hospital day, when he died suddenly. No resuscitation was attempted. At the time of his death, preventive cardiology, mouth-to-mouth ventilation, closed chest cardiac massage, defibrillation and coronary care units were in their infancy. The history of these and subsequent therapeutic practices are reviewed, but Gable died a bit too early for their application.

Wireless: The Life and Death of Guglielmo Marconi.

With little training in physics, Guglielmo Marconi developed the invention that stunned the world by wirelessly connecting ships and continents. Ten years before his death, he sustained a myocardial infarction followed by unmistakable angina pectoris. His personality and unhappy family life limited his ability to cope with his disease and to deal with Italy's most respected physicians. But their descriptions of his diagnosis and management are surprisingly few. Poor record keeping, intentional news suppression of his failing health or limited medical opportunities could be the reason for this lack of information. He died in 1937 when the value of electrocardiograms and X-rays were recognized (he had neither), but therapeutic options were severely limited. To gain insight into his care, we compared contemporary Italian understanding of coronary heart disease to British and American teachings. When he died of an acute coronary syndrome, heart failure and dysrhythmias, he was attended only by medical staff, but by none of his large family.

Queen Alexandra's Knee.

In 1867, Alexandra, the 22-year-old Princess of Wales, late in her third pregnancy, had sudden onset of a febrile illness. There was a brief period of migratory arthritis, followed by persistent, severe inflammation in 1 knee. A diagnosis of rheumatic fever was made by her physicians, but the course of her illness differed greatly from the expected one. In this report reviewing her disorder, the suggestion is made that she more likely had gonococcal arthritis and that the infection was transmitted to her by her husband, the future King Edward VII, then known as "The Playboy Prince."

Did Michelangelo Have Gout?

Michelangelo, the great Renaissance artist, is often included on lists of celebrated gout patients. His letters describe a single acute attack of foot pain at the age of 80, but a case for early onset has been presented, based on a fresco by a contemporary artist, Raphael. A figure resembling Michelangelo at the age of 36 appears to have nodules resembling tophi over his knees.In this report, we review Michelangelo's medical history, discuss the proposal that he had tophaceous gout, and address the significance of "knobby" knees in his works and those of other artists.

Peggy's Pain and the Creation of Gone With the Wind.

Margaret Mitchell (1900-1949), author of the best-selling novel Gone With the Wind had chronic, widespread pain for most of her adult life. She was accident prone and sustained injuries leading to unexpectedly prolonged periods of recovery and had unusual illnesses that puzzled her physicians. Starting at an early age, Mitchell, or "Peggy" as she was called by family and friends, had a burning ambition to be a writer, and her painful, chronic illness created conditions that allowed her to achieve this goal. In this report, the details of her health problems are reviewed. During her life, her diagnoses were problematic and remain so now, but would most likely include fibromyalgia and irritable bowel syndrome.

Rheumatic disease in wartime: gouty generals in battles lost or won.

Leadership by a commander is an important determinant of military outcomes. This report describes 2 19th-century wars in which the commanding general was afflicted with severe, disabling gout. In the First Afghan War (1839-1942), the result was disastrous, but in the Spanish-American War (1898), subordinates ignored the general's orders and saved the day.

A Renaissance Pope with arthritis following frostbite.

Pius II, a 15th century Pope, developed chronic foot pain following frostbite at age 30. Later in life he was progressively disabled by arthritis elsewhere and by colic, which may have been due to kidney stones. The differential diagnosis of his rheumatic disease and its effect on his career are discussed.

Reconceptualizing John F. Kennedy's chronic low back pain.

When the medical records for John Fitzgerald Kennedy were made public, it became clear that the 35th President of the United States suffered greatly from a series of medical illnesses from the time he was a toddler until his assassination in November of 1963. Aside from having Addison disease, no condition seemed to cause him more distress than did his chronic low back pain. A number of surgical procedures to address the presumed structural cause of the pain resulted in little relief and increased disability. Later, a conservative program, including trigger point injections and exercises, provided modest benefit. Herein, the mechanisms underlying his pain are evaluated based on more contemporary pain research. This reconceptualizing of John Fitzgerald Kennedy's pain could serve as a model for other cases where the main cause of the pain is presumed to be located in the periphery.

The tale of a city saved by gout and a letter from Jesus.

In the 6th century a Persian invasion of the eastern provinces of the Roman empire resulted in the devastation of several cities. Edessa alone was spared, and it was widely believed that this city had divine protection because of postal communication over 5 centuries earlier between its gouty ruler and Jesus Christ. These events are reviewed in detail herein. Some appear to have a well-documented historic basis but others, including the letter from Jesus, have been considered highly questionable by various authorities. The story provides an interesting connection between gout and historic events in the ancient world.