Gout: Sanhedrin 48b

The gemarrah discusses the transfer of the curse that David conferred upon Yoav to the descendents of Shlomo.  The last was a foot disease.  The gemarrah suggests that it was podagara

ואמר רב יהודה אמר רב שאחזו פודגרא א"ל מר זוטרא בריה דרב נחמן לרב נחמן היכי דמי א"ל כמחט בבשר החי מנא ידע אי בעית אימא מיחש הוה חייש ביה ואיבעית אימא מרביה הוה גמיר לה ואיבעית אימא (תהלים כה, יד) סוד ה' ליראיו ובריתו להודיעם

The curse of those who “hold onto a staff” was fulfilled among Solomon’s descendants in Asa, as it is written concerning him: “But in the time of his old age, he was diseased in his feet” (I Kings 15:23). And Rav Yehuda saysthat Rav says: This means that he was seized with gout [podagra]. Mar Zutra, son of Rav Naḥman, said to Rav Naḥman: What are the circumstances and symptoms of this disease? Rav Naḥman said to him: The pain is similar to the pain of a needle piercing live flesh. The Gemara asks: How did Rav Naḥman know what gout is like? The Gemara answers: If you wish, say that he himself suffered from the disease. And if you wish, say that he learned it as a tradition from his teacher. And if you wish, say that he knew this through divine inspiration, as the verse states: “The secret of the Lord is with them that fear Him; and He will show to them His covenant”(Psalms 25:14).

Rashi:

פודגרא - כן שם החולי אף בלשוננו:

We, in medicine,continue to  use the word podagra for gout. It is interesting to see how lasting this curse has been. 

The 1908 Nobel Prize in medicine was awarded to  two men of Jewish ancestry: Paul Ehlich and Elie Metchnikoff.  Metchnikoff had discovered cellular immunity, especially phagocytosis.  Phagocytosis is the process whereby cells, especially cells of the immune system, white blood cells, engulf ( eat) objects. 

Classic gout is caused by sodium urate crystals.   These are needle like crystals  that are ingested by immune cells.  These needle crystals start the immune response that causes the pain of gout. 

In  medical school, I was taught that the needle crystals puncture the bags of enzymes in the cell, releasing them into the joint and causing the pain.  This would conform to the the model of "needles through living flesh."  I also recall that Metchnikoff had discovered this process. 

I  dreamed that Metchnikoff had seen this gemarrah and that led him to look for this phenomenon  with the microscope. The knowledge of the puncturing secret of podagra allowed him to see this happening, despite the primitive microscope that he used.

   Now,  that seems unlikely.  Although his maternal grandfather  was a Jewish writer in Russia, he was an early maskil and was eventually baptized a Lutheran.  Still, it is possible that he studied talmud with his grandson ( probably on Shabbath, while smoking a cigarette). 

Looking into the matter further, the current understanding of gout inflammation and pain is not so simple.  The uric acid crystals are ingested by the immune cells, but the significance of their piercing nature is less than clear.  I could not easily find a mention of Elie Metchnikoff making the observation of uric acid crystal ingestion  by immune cells. 

In Kings, there is a story about Elisha and bears in a forest.  The gemarrah tells us, there were no bears, there  was no forrest.  But the story is still good. The gemarrah hints  a secret that was revealed over time. The secret is fractal.  The story is still good.