Walking on eyeballs

Gout: the patrician malady

Roy Porter & G S Rousseau <em>Yale University Press, 393pp, £13.95</em>

The whims, foibles and obsessions of editors are wonderful to behold. They would fill a book. Suffice for the present to recall one. On hearing that I suffered from gout, Ian Jack, the then editor of the Independent on Sunday, could not conceal his amusement. When he had finished chuckling into his rook's nest of a beard, he told me to forget politics, which I was then covering for the paper, and write him a feature on gout.

A few days before, I had been felled by the worst attack in 20 years. I had woken on New Year's Day with the devil gnawing away at my big toe, just as in James Gillray's cartoon. However, the editor's word is law, and I produced a thousand words. "Not enough!" he cried. "More! More! At least twice as much!"

Disconsolate, I sought refuge in Annie's Bar at Westminster, where my old Observer colleague, Simon Hoggart, commiserated. Since gout is the ailment that dare not speak its name, for fear of ridicule, I formed the idea of a new pressure group to "out" secret goutistas, such as Michael Heseltine and the writer Nigel Williams. "Yes," effervesced Hoggart. "And you must call it GoutRage!" Thus encouraged, I filled the whole page. The article prompted more letters from readers than anything I ever wrote about politics.

So the authors of Gout: the patrician malady must have had even more fun chronicling the medical history, cultural significance and social importance of a disease that is commonly derided as the outcome of self-indulgence, particularly port. Fine. So why does my brother, who is a bricklayer, get it?

The facts are simple. Gout is a form of arthritis caused by the build-up of crystals of sodium urate formed from an excess of uric acid in the blood. They form deposits in the joints, usually in the big toe or ankle, causing swelling and excruciating pain. Sydney Smith described it as "like walking on my eyeballs".

It is a disease with pedigree. The condition was well known to the Hippocratic writers of the fifth century BC. Archaeologists found a "spectacular case" of primary gout in a mummy unearthed in Philae, Upper Egypt. And Seneca, Nero's tutor in the first century AD, lamented: with "every kind of lasciviousness" abroad, "why need we be surprised at seeing so many of the female sex afflicted with the gout?" In Elizabethan times, it was "a quasi-deity born of the union of Bacchus and Venus".

There was no cure, but because it was characteristically a disease of the better-off, there was no shortage of quack remedies and books of medical advice.

In his Treatise on the Gout of 1683, Thomas Sydenham concluded that it "destroys more rich persons than poor persons" and "more wise men than fools, which seems to demonstrate the just and strict impartiality of Providence". Thereafter, gout spawned a remarkable literature in prose and verse, and an unrivalled visual heritage of pictures and cartoons (well described by the authors). It is still going strong - for example, in the Wizard of Id strip cartoon in the London Evening Standard.

So is the disease. Historically, gout was largely confined to the rich countries of the west. It was unknown in Africa, South America or in Asia. As recently as 1952, gout was said to be absent from China, Japan and the tropics, and rare among Africa's black population. The spread of westernised diets and habits has changed all that. Uric acid levels are now as high in Tokyo as in the west, and gout in Japanese men has increased. The same trend is discernible in Soweto. Gout is one of the "diseases of civilisation" being exported to the developing world.

Roy Porter and G S Rousseau conclude that gout cannot be shrugged off as a trivial complaint: "an archaic disease, an ailment of the elite, a condition inconsequential because self-inflicted. Gout has been, and remains, a major cause of human suffering."

A medical breakthrough in 1963 produced Allopurinol, a wonder drug that lowers uric acid levels without the harmful side effects of previous treatments. My understanding doctor, who delicately describes alcohol as "a potentiator, not the cause", prescribed 300 milligrams every day. But it is still only a treatment. There is no cure, except a change in lifestyle so radical that it would probably bring on heart failure.

Paul Routledge is the biographer of Gordon Brown and Peter Mandelson