Not a posh ailment

March 5, 1999

Asa Briggs's review of Roy Porter and G. S. Rousseau's book, Gout: The Patrician Malady, (THES, February 19) helps to propagate the dangerous notion that gout is an ailment of posh people.

Whether this was ever true is arguable, but certainly today there are plenty of non-aristos, like me, who get gout. Sadly, British doctors are still so influenced by the image of George III with his bandaged foot on a velvet cushion that they often advise sufferers to refrain from port wine and "baron of beef". In fact, though beef and port are both suspect, the drink for gout sufferers to avoid is not port but the very plebeian beer.

The raised levels of uric acid that cause the crystalline deposits stem from particles called "purines". A 633ml bottle of beer contains 32.4mg of purines, a glass of wine 1mg, and a double whisky (80ml) just 0.1mg (brandy: 0.4mg). This information comes from the "gout handbook" given me by my Japanese doctor on arrival in Kyoto two years ago. Since then I have abstained from beer and had no gout attacks. In the year before that I lived in Britain, abstained from port and red wine, drank beer and had two, very painful, unglamorous attacks.

Frankly, gout's patrician associations are getting in the way of correct treatment in Britain. It is one of the few ailments steadily on the rise in Britain and Japan. Some 99 per cent of victims are male, and the average age of first attack has fallen rapidly, from the fifties in 1965 to the thirties today in Japan. No wonder Porter and Rousseau stop their study at 1963. Nowadays all this talk of gout as "the patrician malady ... a malaise one would want to possess even as it possessed one's own body" just sounds silly.

Tom Gill

Department of cultural anthropology Kyoto Bunkyo University, Japan

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