Gout: the Patrician Malady,
by Roy Porter and GS Rousseau (Yale University Press, £13.95)
When my friend Adam Beck told me he was suffering from gout, I sniggered. As did all his other friends when he told them. For, although he is in just about all other respects a recognisably contemporary human being, the disease made us think of him in another light: that there was, forsooth, something of the 18th century about him, now we thought of it, and we imagined him with his bandaged foot resting on a stool as he looked forlornly at the decanter of port and table of rich viands he was now having to forego. Arf, arf!
"You bastards," he said, "it really hurts" - and yet we did not listen, or care; but here is a 17th-century description of the affliction from Thomas Sydenham, who wrote a treatise on it in 1683 and was the first to provide a full clinical and diagnostic picture of it in any language: "The pain resembles that of a dislocated bone . . . grow[ing] gradually more violent every hour . . . the parts affected . . . become so exquisitely painful as not to endure the weight of the clothes nor the shaking of the room from a person's walking briskly therein." After that, things worsen. Sydney Smith said it was "like walking on my eyeballs".
So this is the thing about gout: it is an intensely painful condition, something like having kidney stones in your feet, and yet people smirk when mentioned. We entertain dim memories of a hundred prints by Rowlandson or Gillray or Hogarth, the gouty foot as the stooge of clumsy fate, to be bumped and knocked and jostled into by the clumsy nemeses of the sufferer's own self-indulgence. No other disease is as ludic; not even the clap.
For it is also aristocratic: it may not be invariably connected to a rich diet, an easy lifestyle, but that is the way it is perceived. Gout is, in Porter's and Rousseau's typically striking formulation, "the condition par excellence signalling excess and guaranteeing isolation"; the 17th-century Lord Warwick's gout lasted for nearly 20 years, driving him so insane with irritability that he forbade anyone to touch or speak to him.
Which was not an entirely bad thing in itself. Not only was gout meant to protect one from more dangerous ailments; it engendered virtue in itself. According to one encomium, gout is chaste, as it does not like even to be touched; it is "majestic": "One lies in bed like a king on his throne, one goes to meet no one, one arises for no one, one accompanies no one, and one finally visits no one, even when one has been visited."
Yes, you may ask, but why is this Pick of the Week? Because this is a work of the most astonishingly focused scholarship and insight. Although not a conventional popular-science book, "this will be for many years the definitive treatment of the topic", said the distinguished Pat Rogers in the TLS, which is that publication's equivalent of the five-star review.
The research is both so dense and wide at the same time that it is awe-inspiring, humbling even. This isn't exactly a light read, to be soaking up sun-block and ice-cream splashes on beaches worldwide this summer (although that is a great fantasy). But you will learn so much, in passing, of literary and medical history (the history, you come to realise, of plausible theories) that you will emerge from it significantly enriched. How we come to terms with our suffering is one of the narratives of humanism: and this book, as one such tale, is supremely eminent.
