Rheumatic Disease in Wartime

Gouty Generals in Battles Lost or Won

Robert S. Pinals, MD


J Clin Rheumatol. 2014;20(7):373-375. 

In This Article

Abstract and Introduction


Leadership by a commander is an important determinant of military outcomes. This report describes 2 19th-century wars in which the commanding general was afflicted with severe, disabling gout. In the First Afghan War (1839–1942), the result was disastrous, but in the Spanish-American War (1898), subordinates ignored the general's orders and saved the day.


In an earlier report on an 18th century war, I pointed out that rheumatic disease might be among the many factors affecting military outcomes.[1] Now, moving into the 19th century, I will illustrate this point in 2 conflicts, the first Afghan War (1839–1842) and the Spanish-American War (1898). In both cases, the commanding general was afflicted with severe, disabling gout, resulting in a failure of leadership at a critical time during the campaign. In the first instance, the battle was lost, resulting in one of the greatest catastrophes in British military history.[2–4] In the second example, the battle was won, mainly due to the initiative of lower-ranking officers among the American forces invading Cuba.[5–7]