Charles V, Holy Roman Emperor (1519–1558), who also ruled as Charles I, king of Spain (1516–1556), was one of Europe’s most powerful rulers. Under his reign, the Aztec and Inca empires of the New World fell to the Spanish. Charles V also suffered from severe gout, a pathological condition caused by the disruption of nucleotide metabolism. This painting by Titian shows the emperor’s swollen left hand, which he rests gingerly in his lap. Recent analysis of a part of his finger, saved as a religious relic, confirms the diagnosis of gout.