Gout: The Partrician Malady

Gout has fascinated medical writers and cultural commentators from the time of ancient Greece. Historically seen as a disease afflicting upper-class males of superior wit, genius, and creativity, it has included among its sufferers Erasmus, the Medici, Edward Gibbon, Samuel Johnson, Immanuel Kant, and Robert Browning. Gout has also been the subject of powerful medical folklore, viewed as a disease that protects its sufferers and assures long life. This dazzlingly insightful and readable book investigates the history of gout and through it offers a new perspective on medical and social history, sex, prejudice, and class, and explains why gout was gender specific.

In their study of an ailment that has tormented the big toes of some big men--Kant, Samuel Johnson, Ben Franklin, Thomas Jefferson--Porter and Rousseau turn the argument of Susan Sontag in Illness as Metaphor and AIDS and its Metaphors on its head. Sontag thinks disease should be freed of its freight of cultural associations and stigmas.

But disease and metaphor inevitably go hand in hand. This was especially true in the days when gout was mysterious, before Queen Victoria's future physician showed it was caused by uric-acid crystals producing excruciating pain in the extremities. Milton told a friend that if he were only free of gout pain, blindness would be tolerable. The pain felt "as if I was walking on my eyeballs," writes one sufferer. Since one had to be rich to live long enough to get gout, and most victims were males (many of whom drank port laced with gout-intensifying lead), it won a reputation as just punishment for high living, and even a kind of badge of meritocratic honor. It was God's gift to caricaturists like Hogarth, Cruikshank, and Gillray. George Eliot used gout as a symbol for a sick society in Middlemarch. The data fascinates, but the professors don't wear their learning lightly. Still, they do score some good phrases. Explaining that there aren't many portraits of gout sufferers because few victims would pose, they write, "Who wants to be remembered as a septuagenarian freak of Falstaffian glob?" --Tim Appelo