Medical advice for gout sufferers in The Garden of Delights/El Jardín de las Delicias

New outside evidence* that Charles V was suffering from gout raises the medical question of whether the health regimen illustrated in The Garden of Delights/El Jardín de las Delicias is medically advisable. Did Philip II (assuming he suffered from the same condition) live longer because he heeded advice to exercise outdoors and avoid eating fish? The diagnosis helps to explain some of the oddest things about the triptych including the thin people in the center panel, the oversize fish and fruit and even the thistle plant in the center; why Philip II kept it; why its meaning became obscure; and why some observers dislike it. The diagnosis of gout resolves all sorts of art historical questions but raises a medical question of whether the lifestyle shown in the painting is something to imitate or not.

Art historically, the diagnosis makes it easy to trace at least some of the triptych’s enigmatic images from their source in an older Hieronymus Bosch triptych to their disappearance in the written record:

1) Images of oversize strawberries and fish (foods for a gout sufferer to avoid), a thistle, and some skinny people clowning around under a table can be seen in Hieronymus Bosch’s triptych of the Temptations of Saint Anthony, which was apparently well known since it was widely copied (although often without the people under the table).

2) The Garden of Delights/El Jardín de las Delicias, painted for Charles V, includes the same images in a more logical setting, since the fish and strawberries in the triptych of the Temptations of Saint Anthony could not have existed in the desert. The oversize fish and fruits represent things not to eat, or not to eat much of. A sardine is to be regarded as a very large fish, and a person is shown becoming sick from eating a small amount of a very large strawberry. There is a thistle, sometimes cited as a remedy for gout, near the center of the center panel.

3) Charles V’s court was peripatetic, and carrying around a large illustration of things not to eat might not have endeared him to his hosts in one city after another. He appears to have left The Garden of Delights/El Jardín de las Delicias with a member of his entourage, Hendrick III of Nassau. It may have been a political liability, analogous to the written requests for a certain type of bottled water that sometimes surface to embarrass politicians and rock stars today.

4) Philip II, who stayed in one place, also suffered from gout, and his liking The Garden of Delights/El Jardín de las Delicias has puzzled art historians for a long time. But he is on record as saying he never ate fish, and at least in later years as actually not having fish on the menu, and for saying the best thing to do for gout was to exercise outdoors and avoid physicians. The record on fruit is ambiguous, and might have to do with avoiding some fruits but not others.**

5) José de Sigüenza’s comments on The Garden of Delights/El Jardín de las Delicias include Philip II’s saying it was not heretical and an explanation of its old title as having to do with the vanity and brief taste and aroma of strawberries or madroños (“la otra tabla, de la gloria vana y breve gusto de la fresa o madroño y su olorcillo que apenas se siente cuando ya es pasado”). A likely explanation is that Sigüenza had in mind a general audience for whom fruit was not something to try to avoid. Eating or not eating strawberries is not an important thing to most people and thus can stand as an example of vanitas. A longer explanation would have meant reiterating the history of the king’s illness which ended with severe infections.

6) A fairly large proportion of the commentary on The Garden of Delights/El Jardín de las Delicias has to do with what seems like the peculiar, unconventional, and to some observers perverse conduct of the people shown in the center panel. This can be at least partially explained by the strangeness of recommended regimens for gout sufferers, which involve not eating specific foods, and not eating much overall. Foods that are good for everyone else are off limits to the person trying to lessen the severity of gout attacks. In the weird and disagreeable predicament of a person diagnosed with gout, it is healthier to be like the people in old, medieval paintings with their exaggeratedly thin legs and feet, and less healthy to be like the sturdy figures who populate most 16^th century art. From the gout sufferer’s perspective, the pointed toes that look silly to art critics might look cheerful. The medieval look might represent a fantasy of bygone times when gout was not so widespread.

*A team of physicians have definitely established that their 16^th century predecessors were not mistaken and the illness that afflicted Charles V was definitely gout. A 2006 article in the New England Journal of Medicine by Jaume Ordi, MD et al. details their analysis of part of the emperor’s finger which had become mummified and was kept separately in the sacristy in the Escorial, where they found the characteristic lumps (“massive gouty tophi”) and urate crystals that go along with the disease.

** See Henry Kamen, Philip of Spain (1997).

note: The medical advice described here and the Nahuatl chronology described in earlier posts are both part of the overall commentary on Ecclesiastes that is the main subject of the triptych.