Multimedia: Gout: The Patrician Malady
Authors: J Dequeker
Journal: BMJ (1999)

Roy Porter, G S Rousseau


Yale University Press, £25, pp 393 




ISBN 0 300 07386 0

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Rating: ★★★

Gout has been recognised since antiquity, and descriptions of the disease date back to the Babylonian empire. It was certainly well described by Hippocrates. Called the “king of diseases” and the “disease of kings,” gout is more the “disease of plenty.” In Gout Porter and Rousseau track medical thinking about the disease across the centuries, from Hippocrates and Galen to Paracelsus, Harvey, Archibald Garrod in the Victorian era, and beyond. They discuss the cultural, moral, religious, and personal qualities associated with the condition, examining social commentary, personal writings, cartoons and visual arts, and literature (including novels by Dickens, Thackeray, and Joseph Conrad).

Many of the quotations still ring true: “gout the bitter fruit of luxury” (Cheyne), “the seeds of this evil are frequently derived from the parents!” (Blackmore), “those most vulnerable were men with hail and athletic constitution,” who must pursue “abstinence in eating, temperance in drinking strong liquors and proper exercise.” Folklore deemed gout a disease of the better sort, a superiority tax, a celebrity complaint “fit for a man of quality.” Gout was the distemper of a gentleman whereas the rheumatism was the distemper of a hackney coachman.

In addition, gout was viewed by Georgian doctors such as Walpole “as one of the nature’s solutions to depravities of the humours. If not entirely expelled, peccant humours or morbific matter were exiled to far-flung parts. Hence it should be left to do its work.” Gout could be seen as a desideratum, a life insurance rather than a death sentence. While gout was in possession of the body, no truly deadly enemy such as palsy, dropsy, or apoplexy could strike.

However, Walpole’s contemporary Samuel Johnson pursued quite different strategies: “That the gout is a medicine I never perceived, for when I had it most in my foot, I had the spasms in my breast. At best the gout is only a dog that drives the wolf away and eats the sheep himself, for if the gout has time for growth, it will certainly destroy and destroy by long and lingering torture.”

King George IV mutinied against the royal physicians’ policy of “quieta non movere” and phlebotomy: “I have borne your half measures long enough to please you; now I shall please myself and take colchicum.”

Gout has been the sign of distinction, the patrician malady to top all others. One of the aims of this book is to delve deeply into how people come to “choose” to be ill and, being ill, which sickness they select and how they sell it. In this inquiry Porter and Rousseau explore in an exemplary manner medical writings, literary texts, journals and diaries, and the visual arts.

Weaving these threads together, the authors provide an enjoyable account that integrates the medical and the moral, the scientific and the humanistic, the verbal and the visual across an impressive sweep of time. Although recently published, the book’s appearance has the flavour of the 1950s, with old fashioned notes (40 pages) and an extensive bibliography and index that historians will love.