Wednesday, January 30, 2013

What Happened to Gout?

I was reading the other day about another eighteenth-century gentleman who had gout, and then I asked myself: what happened to gout?

From Henry VIII to George IV it was the ailment of kings; recent tests on the mummified finger of Emperor Charles V showed that he was a sufferer. In the raucous eighteenth century it spread among the gentlemen of the clubs, becoming the disease that punished over-indulgence. Benjamin Franklin wrote a dialogue with gout. Samuel Johnson used his as an excuse to visit spas, where he may not have been cured by the sulfur baths but certainly made many new acquaintances.  Carl Linnaeus dosed himself with laudanum to deal with his gout pains. (Maybe that explains his obsession with the sexual parts of flowers.) Isaac Newton ranked gout among the worst afflictions of old age.

Then what happened? Gout is a kind of arthritis caused by excess uric acid in the blood. Excess drinking is a contributing factor; obesity is another. This explains its association with high living eighteenth-century gentlemen. But don't we have the same problems? Searching the web this morning I found a list of famous gout sufferers, and the most recent name was Benjamin Disraeli (died 1881).

But though gout has faded from the medical headlines, it is still with us as a disease. According to the CDC, as many as eight million Americans may have gout today. We just don't talk about it very much.

Why not? Snobbery, most likely. It was all the fault of those famous royal sufferers, I think, which made gout the disease of choice for the rich. Accurate diagnosis was quite difficult until after 1848, so it is hard for us to know if all those Regency dandies really had gout, or perhaps some other form of arthritis. Wags at the time noticed the discrepancy: Lord Stanhope once wrote that ‘gout is the distemper of a gentleman—whereas the rheumatism is the distemper of a hackney coachman,’ and Bearse's Devil's Dictionary has ‘Gout n—A physician's name for the rheumatism of a rich patient.’ Because gout was a disease of the rich, rich people liked to talk about it. But once doctors could really test for it they discovered that it struck all up and down the social spectrum. Nobody wanted to talk about having the same disease as the servants, so gout faded from the chatter of the salons, its place taken by newly fashionable diseases.

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