2005

The Crippled Dove

Presentation of Case

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.

Final diagnosis