The arthritis of Constantine IX.

Early clinical descriptions of rheumatoid arthritis are rare, and it has been suggested (Boyle and Buchanan, 1971) that for this reason the paucity of evidence of the disease in early skeletons (Copeman, 1969; Grossman, 1966; Ruffer, 1918; Smith and Jones, 1910), the lack of reference to the disease in the Bible or in the works of Shakespeare (Ehrlich, 1967), and the failure to depict the deformities of the disease by the classical masters of the Dutch, French, Italian, and Spanish schools of painting, that this is a disease of comparatively recent times. The arthritis of the Emperor Constantine IX (c. 980-1055), in keeping with theories at the time, was thought to be due to a disturbance of the basic humours. The account of the Emperor's illness was written by Michael Psellus in the Chronographia (Psellus, 1063), which forms an important source of the history of the Eastern Roman Empire from A.D. 976 to 1078. Michael Psellus was a Christian scholar, an adviser, friend, and tutor to successive Emperors, and he used his first-hand information of politics and the imperial court to write a memoir of his own times. His account vividly portrays the Byzantine way of life. He studied medical treatises, and is said to have practised the art of medicine. He was a careful observer of people and character studies are recorded with considerable psychological insight. Constantine Monomachus, who came to the throne because he was the third husband ofthe Empress Zoe, ruled between A.D. 1042 and 1055 (Figure, overleaf). Psellus described him as having an attractive personality, remarkable beauty, and considerable athletic prowess, and stated that he was an effective ruler and a good Christian, under whose rule the Empire prospered. After two paragraphs about the Emperor's appearance, Psellus devoted considerable space to the description of the Emperor's illness, which is here quoted in full. 'Such was the beauty with which the Emperor was endowed when he ascended the throne, but a year had not gone by before Nature, in her efforts to glorify him, seemed to falter before such wonder and delight; it was as if they gave up the task in exhaustion, and then des-