Welmer

Only an elite few are familiar with the exquisite pain that is gout, that "disease of kings" that strikes in the wee hours like a thief in the night, leaving its victim howling and cursing as he hops on one foot or hobbles to the medicine cabinet for a dose of painkillers.

Podagra, the most common manifestation of gout, strikes the big toe like a firm blow from a hammer, then hangs on and gnaws at the joint like an angry little beast with very sharp teeth. If the pain were a noise, it would be feedback emitted from a giant speaker at a rock concert; if it were light, it would be a laser to the retina. "Inflammation" is the term used to describe the physiological reaction that causes the pain, redness and swelling that accompany an acute attack of gout, and although appropriate for its association with burning and heat, perhaps "sustained nuclear fusion" would be a better term, as the afflicted joint feels as though it is being held to the surface of the sun.

Tiny, barbed crystals, shaped like jagged spears and formed by the precipitation of uric acid in synovial fluid, pierce cell walls and trigger the immune response that introduces the sufferer to an esoteric realm of pain; a brotherhood whose membership is ordinarily earned through years of diligent dedication to excess, and marked by this searing badge of honor.

One can’t blame the disease entirely on gluttony — it is after all far more prevalent in people with metabolic characteristics conducive to hyperuricemia (elevated serum uric acid), and strikes men at a far higher rate than women. However, the association of gout with the royal lifestyle and its unlikely number of highly accomplished victims has given it a certain status among diseases. If the sufferer is a hefty, ambitious executive with strong drive and a lust for power he can relate to King Henry VIII. A gouty political leader with influence spanning much of the world could ponder the life of Emperor Charles V, crippled by gout at a relatively young age from his voracious consumption of beer and insatiable appetite for beautiful Flemish ladies (it was long thought that gout never strikes men before they have enjoyed the physical pleasures of women). A tormented artist with a brilliant, creative mind, hobbling as he sets chisel to stone, can take solace in the fruitful travails of Michaelangelo, who labored on his masterpieces with a gouty knee. For gouty statesmen and inventors, there is Benjamin Franklin; for scientists Sir Isaac Newton, for writers Henry James, and the list goes on…

Regardless of its long, distinguished and exclusive pedigree, gout, like many other luxuries, has become increasingly available to the masses since the onset of modernity. Increasing body mass, more leisure and access to rich foods has precipitated a steady increase in its sufferers over recent decades. However, gout remains the affliction of a select elite — an elite whose members can limp about with distinction and pride, knowing that the sublime pain to which they subjected is only the duty collected on a life of pleasures both coarse and refined.