According to Hippocrates ‘eunuchs are not subject to gout nor do they become bald’ (Aphorisms VI, 28). The explanation for this insight into male balding eventually emerged over two millennia later from the work of the American anatomist James B Hamilton published in the American Journal of Anatomy in 1942. Prior to this, it was well known that balding is an inherited trait and that it is more common in men than women. It was also known that scalp hair loss occurs in women with androgen-secreting tumours. But it was Hamilton who made the key connection that male balding requires both a genetic predisposition and testosterone.

Throughout history, gout has been associated with rich foods and excessive alcohol consumption. Because it is clearly associated with a lifestyle that, at least in the past, could only be afforded by the affluent, gout has been referred to as the ‘disease of kings’.

Five aphorisms of Hippocrates on gout

Hippocrates also noted the link between the disease and an intemperate lifestyle, referring to podagra as an ‘arthritis of the rich’, as opposed to rheumatism, an arthritis of the poor. Six centuries later, Galen was the first to describe tophi, the crystallized monosodium urate deposits that can follow longstanding hyperuricemia. Galen associated gout with debauchery and intemperance, but also recognized a hereditary trait [3] that had previously been referred to by the Roman senator Seneca

Hippocrates was renowned for his power of observation, thought by many to be his greatest skill. His followers were known for practicing bedside medicine. A collection of his writings entitled Aphorisms³ contains more than 200 observations of medical practice, disease process, and pathologic theory. Many of these are still relevant today.

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