In Chapter 18 of Jane Austen’s Persuasion, Mary Musgrove writes to her sister Anne Elliot of their father’s tenants, the Crofts. “I have this moment heard that the Crofts are going to Bath almost immediately: they think the Admiral gouty.”
So exactly what is gout? How does one contract gout? What are the treatments for gout, especially as they would have address in Jane Austen’s England?
From the Arthritis Foundation, we learn, ” Gout is a form of inflammatory arthritis that develops in some people who have high levels of uric acid in the blood. It occurs in about 4 percent of American adults, but is more likely to affect men than women. Acute gout, or a gout attack, happens when something (such as a night of drinking) causes uric acid levels to spike or jostles the crystals that have formed in a joint, triggering the attack. The resulting inflammation and pain usually strike at night and intensify over the next eight to 12 hours. The symptoms ease after a few days and likely go away in a week to 10 days. Some people never experience a second attack, but an estimated 60% of people who have a gout attack will have a second one within a year. Overall, 84% may have another attack within three years. For many people, the first symptom of gout is excruciating pain and swelling in the big toe. Gout may also appear in the ankle or knee. Uric acid can form needle-like crystals in a joint and cause sudden, severe episodes of pain, tenderness, redness, warmth and swelling.”
During the Georgian period, gout was attributed to luxurious living. From History Today, we find, “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. 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.”
In my series on the signers of the Declaration of Independence, several of the signers are listed of dying of gout. But can gout kill a person? In truth, gout can contribute to unhealthy cholesterol and lipid levels and although they are essential for the normal functioning of cells, when certain amount of lipids are enlarged or deposited in blood vessel walls and this clogging leads to a heart attack or stroke.
Nicholas Culpepper’s Complete Herbal, Consisting of A Comprehensive Description of Nearly All Herbs with Their Medicinal Properties and Directions for Compounding the Medicines Extracted from Them lists the following herbs for the treatment of gout: alehoof, angelica, archangel, barley, betony (wood), brank ursine, cabbages, cuckoo pint, goutwort, hellebore (black), kidney-wort, lily of the valley, mustard (black), nettle (common) pellitory of the wall, pennyroyal, poppy (wild) and rhubarb (monk’s). Let us have a look at several of these that were suggested by Culpepper and what he wrote of them.
Alehoof (or Ground Ivy) is commonly found under hedges and on the side of ditches, under houses, or in shadowed lanes and other waste lands. They flower somewhat early. It is bitter in taste. Alehoof is used for inward wounds, exulcerated lungs, etc. Boiling alone or with other herbs, it was said to ease griping pains, windy and choleric humours in the stomach, spleen or belly. It was said to help with yellow jaundice and for expelling venom or poison, as well as the plague. It was used to provoke urine and women’s courses. (page 21-22)
Brank Ursine is also called bear’s breech. It is of the thistle family. The roots are many, great, and thick, blackish without and whitish within, full of a clammy sap. They boiled leaves are used to mollify the belly by “making the passage slippery. The decoction drunk inwardly is excellent and good fro the bloody flux: the leaves bruised, or rather boiled, and applied like a poultice, are very good to unite broken bones, and strengthen joints that have been put out.” (page 59)
KidneyWort is also called Wall Pennyroyal or Penny-wort. It grows plentifully on stone walls, rocks, etc. The seed ripens in mid to late May. “The juice or distilled water if drunk is good to cool inflammations and unnatural heats, a hot stomach, a hot liver, or the bowels; the herb, juice, or distilled water applied outwardly, heals pimples, St. Anthony’s fire, and other outward heats. It also helps some sore kidneys, torn by the stone, or exulcerated within: it provokes urine, is available for dropsy, and helps to break the stone. Being used in a bath, or made into ointment, it cools the painful piles or hemorrhoidal veins. It gives ease to hot gout, the sciatica, and the inflammation and swellings in the testicles; it helps the kernels or knots in the throat, called the king’s evil’ the juice heals kibes and chilblains, if bathed with it, or anointed with ointment made from it, and some of the skin of the leaf upon them; it is also used in green wounds to stay the blood, and to heal them quickly.” (page 206)