Gout: The Patrician Malady (review)

Roy Porter and G. S. Rousseau. Gout: The Patrician Malady. New Haven: Yale University Press, 1998. xiv + 393 pp. Ill. $35.00.

Although this book traces the history of gout back to antiquity, its heart is an account of the disease as the insignia of the gentleman in Georgian Britain. As Roy Porter and G. S. Rousseau show, gout was commonly depicted as a disease of heredity and excess, something that affected rich men--those who ate and drank, slept around, kept late hours, and squandered fortunes. It was incurable and chronic, but possible to live with; indeed, it was something one might wish to have: not only did it drive out more-threatening ills, the Georgian gentry and their physicians portrayed it as insulation from infection by the lower orders. Its hereditary nature was a sign of good breeding; one acquired it in a similar way to rank or political sway, by birthright, not by labor or merit. But, if it insulated the elite, it also allowed for fun at their expense. It was, for example, both a sign of dissipation and a reminder that the days of debauchery were gone, a symbol of decrepitude.

As a "constitutional" disease, Porter and Rousseau argue, gout came to be portrayed in terms that mirrored eighteenth-century political discourse, as a "hereditary right" or "enviable possession" for which a "radical cure" was unnecessary. By implication, any attack on the hereditary principle in gout could have wider political resonances--as when in 1771 the medical pamphleteer William Cadogan controversially disputed gout's hereditary, incurable nature. The sting in the tail of the good news of a cure was what it said about those who were affected by the disease: Cadogan claimed that gout was self-inflicted, caused by idleness, intemperance, and vexation, and might be cured by a more temperate lifestyle than that enjoyed by the port-swilling Georgian gentleman. Porter and Rousseau argue that the polarization of positions in the subsequent controversy reflected the political polarization of the times: Old Corruption assaulted by reformers, the aristocracy by liberals.

The authors claim that by the end of the nineteenth century such a portrayal of gout had none of the sway it had enjoyed in the early part of the century. Increasingly, it became associated with a bygone age, one undermined by a new interrogation of rank, masculinity, sexuality, and moral worth. The disease gradually disappeared from literature: the pervasiveness of the trope meant that it no longer had to be explained at length, nor was it any longer a significant part of the self-representation of the gentleman. Medical and popular portrayals of the disease began to separate out with changes in the social relations of medicine, and with the development of localistic and chemical models of gout that challenged older constitutional models. The book ends in the late nineteenth century, as medical representations of gout become more prosaic and the disease itself becomes less prevalent, at least in the West.

As such a narrative suggests, Porter and Rousseau's attitude toward metaphor is very different from that of Susan Sontag. Where Sontag stresses the pernicious effects of metaphor, Porter and Rousseau highlight its protective, perhaps even permissive, qualities. Far from mystifying disease, as Sontag suggests, they argue that metaphors help to make sense of illness, not only for the sick, but also for others who may differ radically in their interpretation of the condition. As such, metaphors provide a window onto the historical cultures that create them, and Porter and Rousseau show how eighteenth-century medical discourse on gout constituted part of a broader British political and social discourse that broke down during the nineteenth century. In a detailed analysis of visual and literary representations, they also show how gout generated a particular set of playful jibes at the gouty elite--jibes that might work against the elite, but that could be more problematic against more vulnerable social groups or tragic diseases. At...