Gout Gets Even
The notorious malady of the 18th century is on the increase in the UK.
Gout, the 18th century’s signature condition, is on the rise in contemporary Britain, with a 60 per cent increase in the last 15 years. In the Georgian era gout’s association with luxurious living led to its status as a badge of honour or a signal the sufferer had reached a certain level in society. As the physician William Heberden commented: ‘This seems to be the favourite disease of the present age in England, wished for by those who have it not, and boasted of by those who fancy they have it.’ In contrast, today’s manifestation of the disease is associated with the nutritional effects of poverty rather than affluence.
Undoubtedly a painful condition, gout usually begins with acute pain and swelling in the big toe and then extends to other joints such as fingers, often accompanied by feverish sweating. Eighteenth-century cartoons of corpulent gentlemen with their feet in buckets or up on footstools may look comical, but the truth is that the ailment is excruciating and disabling. Richard Grenville wrote in a letter to his sister Hester Pitt (whose husband also suffered the complaint): ‘Gout is gone but has left me such a swelling quite up to the top of my Thigh, as does not seem even disposed to abate.’ Three weeks later: ‘I can walk almost without a stick, but have still a swell’d Leg, the remains of gout; a swelld hand and lame arm which keep me confined.’ Sufferers were predominantly male, although older women were also susceptible, so we find Sarah Churchill writing towards the end of her life: ‘I would desire no more pleasure than to walk about my gardens and parks; but, alas! that is not permitted; for I am generally wrapped up in flannel, and wheeled up and down my rooms in a chair. I cannot be very solicitous for life upon such terms, when I can only live to have more fits of the gout.’
Nevertheless, on some occasions gout was actively desired, as the belief was that it was incompatible with and would therefore drive out other illnesses. Horace Walpole called it ‘a remedy and not a disease’. Betsy Sheridan, sister of the playwright Richard Brinsley Sheridan, wrote to her sister Alicia LeFanu: ‘My Father is at last thank God fairly in the Gout – And has received the congratulations of Dr Millman on the occasion. The fact is that all his Phisicians have wish’d for this event but seem’d fearfull that he had not strength enough to throw off his disorders in that way.’
Gout had many disguises. Roy Porter and G.S. Rousseau identified over 60 different types in one 18th-century treatise, including ‘galloping gouts’ and ‘flying gouts’. Other conditions were falsely labelled gout, including headaches and stomach complaints; the belief was that it came about as the result of an excess of one of the four humours flowing (or ‘dropping’, since the name is derived from the Latin gutta, a drop) to a weakened area of the body. Consequently gout was considered to be caused by ‘a sedentary life, drinking too freely of tartarous wines; irregular living, excess in venery; and obstructed perspiration and a supression of the natural evacuations’. Now we know that gout results from too much uric acid in the blood, either because an excess is produced or the kidneys are not filtering it efficiently. It can be worsened by the consumption of foods rich in purines, including anchovies, venison and goose – all of which featured strongly in the 18th-century diet of the better off. Then, as now, obesity and a high alcohol intake are contributory factors.
William Rowley’s provocative treatise The Gout Alleviated (1770) compares ‘a gentleman of fortune’ – who feasts on ‘wild fowl, made dishes, rich sauces, puddings, tarts, &c. with glasses of various liquors’ – with ‘a poor man’, who during a hard day’s work contents himself with ‘meat, if it be attainable ... a little strong or small beer’ and bread and cheese for supper. It is thus almost natural, in Rowley’s view, that: ‘The generality of men of fashion have the gout before they are 50 … The gout is scarce ever seen amongst the lower order of people.’ Today the greatest number of gout cases are found in the north-east of England, an area with the highest level of unemployment and of alcohol-related illness.
Modern drugs to treat gout include the anti-inflammatory Colchicine, which has as its active ingredient the poisonous extract of autumn crocus, from the same genus as the hermodactyl that was used for this purpose by the ancient Greeks. Some 17th- century recipes for curing gout do include hermodactyl, but by the 1700s it was discarded as potentially dangerous until Nicolas Husson, an officer in the French army, concocted a quack remedy called Eau Medicinale, which had colchicum as one of its secret ingredients and was adopted enthusiastically by the medical establishment around 1820. Instead, the 18th-century remedies mainly focus on soothing the inflammation through poultices and purges. A Dr Cook’s ‘recipe for the gout’ dating from 1769 was simply a blend of onion juice and vinegar, heated and applied to the area of pain. Dr Clark of Edinburgh’s remedy of eating two or three red herrings before going to bed and his instruction to chew straw for the accompanying violent thirst would have been likely to make the problem worse. More palatable might be Margaretta Bampfylde’s suggestion of tea made from speedwell buds, which ‘if you make it too strong it will have the same effect as an opiate’.
There was also a stress on the right diet, something that sufferers are advised to consider today. A Dutch physician, Herman Boerhaave, prescribed milk and bread or porridge for breakfast and supper, with only barley, oats, rice or millet and vegetables for dinner, not too dissimilar to the current NHS recommendations. It would certainly have been more successful than the ‘regimen to prevent the gout’ followed by Sir Edward Filmer, who restricted himself to eating ‘what ever was most agreeable to his appetite’ capped by ‘4 or 5 glasses of good strong red port wine’.