Gout: The Fashionable Disease

SUFFERING, THY NAME IS GOUT

Gout (also known as podagra when it involves the big toe) is a painful condition caused by elevated levels of uric acid which crystallize and are deposited in joints, tendons, and surrounding tissues.

Usually characterized by recurrent attacks of acute inflammatory arthritis, often a tender, hot, swollen joint at the base of the big toe, other joints such as the heels, knees, wrists and fingers may also be affected. Other symptoms that may occur include, kidney stones, fever and fatigue.

The word Gout stems from Latin gutta, ”drop” (French goutte), and describes a flow ”of matter from the body’s vitals to the extremities.”

Gout is painful and often debilitating, but the typical image of this famed malady is of port-swilling, dyspeptic aristocrats.  

Known in ancient Egypt, Greece, and Rome, where it was identified with luxury and decadence, gout has always been associated with high living.  

 Gout has an 18th-century aura. Bewigged grandees boastfully nursed their big toes. Men of letters — Voltaire, the novelist Smollett, the poet Cowper — and the scientist Sir Joseph Banks were victims. Some were fat, like Dr. Johnson, others thin, like Horace Walpole. They wishfully consoled themselves that the gout would protect them from other diseases, but Walpole also developed rheumatism.

 

Its 18th century growth seems to have related to  the Methuen Treaty with Portugal which brought large quantities of port into Britain, the use of lead in wine casks, and the increasing affluence of the populace which exposed more people to protein-rich diets.  

There was a snobbery of gout. The great 18th-century arbiter of social caste, the Earl of Chesterfield, announced that rheumatism was for hackney coachmen but ”gout is the distemper of a gentleman.”

Exercise, and abstinence from wine and sex, were thought to prevent it. Cures included bleeding and purgatives, as well as a repellent diet of ”easily digested food.” Sea voyages were recommended because seasickness made one vomit. It was said that the swollen-footed Oedipus (among other heroes of Greek story) was a sufferer.

Gout was even thought to be hereditary. It ”ran in good families.” It is one of the illnesses that, at certain moments in history, acquire cultural glamour, while rheumatism, its Cinderella cousin, never made it as a fashionable disease.

If you believe Jane Austen, giddy romantic girls would sooner fall in love with a consumptive scoundrel than a good man with mild rheumatic symptoms. It had class, as well as a classless grace or predemocratic cachet.

Many believed gout a medical blessing, thought to protect victims from more serious diseases, and that it was antidote to ”murdering Maladies” like consumption, and dangerous fevers.

It was incurable but not fatal, and sufferers tended to be long-lived. Johnson concluded that gout ”is only a dog that drives the wolf away and eats the Sheep himself,” and insisted on having his gout ”evicted.” His friends thought he ”died of repelled Gout.”  

Benjamin Franklin debated whether gout was his friend or his enemy. The best advice was thought to be to hold on to your gout, and make sure it stayed in the foot. This did not help Edward Gibbon, whose gout didn’t protect him from a hydrocele, or swollen testicle, the size of a melon, which went septic after surgery and killed him.

The worst fate was imagined by Swift, as usual: ”As if the gout should seize the head, / Doctors pronounce the patient dead.”

Inevitably, gout became a cultural icon. It made you interesting. It belongs instead with ”hysteria,” ”neurasthenia,” ”neurosis,” differing oddly from these lesser aura-conferring maladies in its gross physical visibility.

I doubt if there was any other period in which social distinction and moral complacency could be derived from a grotesquely enlarged toe.

Excerpted from Claude Rawson’s review  of GOUT -The Patrician Malady, Roy Porter and G. S. Rousseau : http://www.nytimes.com/books/98/12/06/reviews/981206.06rawsont.html

OTHER REFERENCES:

http://www.whitehallclermontfoundation.org/html/gout_stool.html

http://pegsandtails.wordpress.com/2010/06/08/making-a-gout-stool-part-one/   

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