Health: The agony of good living

Sean Wilkinson wants the world to know that he has gout. He believes everyone should be aware just how painful it is, how miserable it has made his life, and how unfair it is to be constantly at the mercy of those who fail to see the serious side of a much-maligned disease. So concerned is Sean that gout victims aren't getting a fair deal, he has set up his own website on the Internet to get over the message that gout is a painful disease and that it should be taken seriously.

Gout was once, of course, a respectable, even fashionable disorder, that was borne by its victims as a symbol of affluence and of a thirst for the good life. But in more recent times it has become a disease to be suffered in silence, a condition that has become as unfashionable as the over-indulgence it epitomised.

But gout is not only a major continuing health problem - its incidence is increasing, and far from being a disease only of elderly men, many of its victims are under 50, and up to one in 10 sufferers are women.

"Though it's widely associated with the older days - with Christmas card scenes peopled by ruddy Mr Pickwicks drinking toasts - in truth, gout is very much still with us," says Professor Roy Porter, professor of the social history of medicine at the Wellcome Institute, University College, London, and co-author of Gout - The Patrician Malady. "It continues to threaten males in the developed world, and globally it is spreading.''

Gout is one of the commonest forms of arthritis, and often surfaces first as a sudden acute attack of pain during the night. It usually affects only one, or at most two, joints at a time, and it is most frequently the big toe or the ball of the foot, although other joints, including the elbow and knee, can also become inflamed. Within 12 hours the affected joint is swollen, shiny and red, and very painful.

Many sufferers believe the pain is the worst they have suffered and variously describe it as throbbing, excruciating or crushing. Some are more graphic, and talk of walking on hot coals or standing on heated iron spikes. One victim's more colourful description recounted in Professor Porter's book, was that it felt as if he was walking on his eyeballs.

Sean Wilkinson, who had his first bout of gout at 17, and who has an image of a painful big toe on his website, says the pain is crippling, and that it comes without warning: "It's like 1,000 knives stabbing you all at once. You can't sleep for days, and when you do, it's only for short periods,'' he says.

Gout is caused by the body's overproduction of uric acid, a chemical that plays an important part in food processing and which is usually filtered out by the kidneys. When too much acid gets into the blood, it can form crystals in the joints, and it is these which are responsible for the inflammation that is characteristic of gout.

It is the link with rich living that has historically been responsible for gout victims attracting more smiles than sympathy. The thought that the rich, and high and mighty brought the disease upon themselves by over- indulgence has always been gleefully satisfying to the poor. But rich living is not the only trigger for gout. As well as a high alcohol intake - especially beer and wine - there are other risk factors, including a family history of gout, obesity, and too much food that is rich in purines, like red meat, offal, shellfish, lentils, peas and beans. Some drugs taken for high blood pressure can also trigger attacks.

Gout mainly affects men, although some women, mostly those who are post- menopausal, can fall victim too. The risk is higher in people who suffer with kidney disease, diabetes mellitus, or sickle cell anaemia, and there are wide geographic differences too, with a low incidence in Russia and Spain, and a high risk in New Zealand, especially among Maoris, where one in 10 men suffer.

Treatment is twofold, first to get rid of the pain, and secondly to lower uric acid levels. Anti-inflammatory drugs will usually help solve the pain problem, and a change of diet and drinking habits may lead to a lowering of acid over time.

In chronic cases, however, where the crystals can spread to other parts of the body, including even the ears, acid-lowering drugs may be used. Another family of drugs work by increasing the amount of acid expelled by the kidneys.

Some sufferers also still swear by folk cures, like a poultice of boiled nettle water, or a basin of water with arrowroot, and down the years various more exotic remedies have been tried by gout's wealthy and exalted victims, like Queen Anne, Christopher Columbus, and Francis Bacon.

Lotions and potions of various leaves and herbs, as well as dead spiders, buckets of water, electric shocks, goat's milk, barley water, leeches and arsenic, have all been tried over the years, to no avail.

In the Middle Ages, the Earl of Shrewsbury favoured an oil made from a stag's blood, while in the 16th century Dr Henry Landwewr's medicated slippers caused something of a stir among the foot stools of London. Charles V, the Holy Roman Emperor, opted for the bark of a tree, while Coleridge went in for long walks and holidays in a hot climate.

In Georgian and Victorian times, everyone had a pet cure for gout - even Charles Dickens, who viewed lifestyle changes as important, and has Sam Weller advising Mr Pickwick: "If you're ever attacked with the gout, Sir, just you marry a widder as has got a loud voice with a decent notion of usin' it, and you'll never get the gout again. I can warrant it do drive away any illness that is caused by too much jollity.''

`Gout - The Patrician Malady', by Roy Porter and G S Rousseau, Yale University Press, pounds 25