Gout and the Waters of Bath, Part 1

Science in Jane Austen: What is the gout, why did people go to Bath for it, and did the waters of Bath help?

“Mr. Allen . . . was ordered to Bath for the benefit of a gouty constitution” (Northanger Abbey, chapter 1).

The gout sends Jane Austen’s characters to Bath. In Northanger Abbey, Mr. Allen’s gout brings his wife and the heroine Catherine Morland along, leading to Catherine’s adventures. Admiral Croft in Persuasion goes to Bath for his gout, conveniently reconnecting his brother-in-law Captain Wentworth with Anne Elliot. Dr. Grant of Mansfield Park removes to Bath for “gouty symptoms,” which his predecessor Mr. Norris also suffered from. Sense and Sensibility, Emma, Lady Susan, and The Watsons also mention gout.

Austen’s uncle James Leigh-Perrot, who lived in Bath half the year, had the gout, and her brother Edward had a brush with it once. In her letters she mentions friends being treated in Bath for the gout, so Jane Austen was familiar with the illness and its treatments.

What is gout?

When my son told me he thought he had gout in his toe, I was amazed. I thought that was a disease out of history, and was surprised to find that gout is a malady still suffered by many today. According to the Mayo Clinic,

“Gout is a common and complex form of arthritis that can affect anyone. It’s characterized by sudden, severe attacks of pain, swelling, redness and tenderness in the joints, often the joint at the base of the big toe.

An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable.”

This agrees with Parson Woodforde’s description of his first attack of gout in 1790: “a violent pain in my right great toe on my foot about the middle joint and swelled a great deal indeed . . .” In a later attack in 1795 he says he could barely touch his foot to the floor, and all day and night he was “not free one minute from violent pain.”

Gout devil Gillray
“The Gout” pictured as a devil biting the toe, by James Gillray, 1799

What causes gout?

In Austen’s day, gout was believed to be caused by eating rich foods, drinking too much alcohol, and a sedentary lifestyle (not enough exercise). Thus it was considered a rich man’s disease. However, one poor character in Emma, the old clerk John Abdy, is debilitated by gout. When real-life parson William Holland’s poor neighbour got the gout in 1800, Holland congratulated him “on becoming a gentleman, as the gout never attacks any but a gentleman.” His neighbour “shook his head and said he could not be a gentleman without money.” In Northanger Abbey, John Thorpe assumes that Mr. Allen “drinks his bottle a day,” causing his gout, though Catherine assures him Mr. Allen is “very temperate.”

According to modern science, the body breaks down compounds called purines to make uric acid, which is usually dissolved and excreted. But if too much uric acid is produced or too little is expelled, urate crystals form and build up in the joints, causing the pain and inflammation of gout.

A variety of foods increase purines or uric acid in the body, and thus increase the risk of gout. These include meat, seafood, beer and other alcoholic drinks, and drinks sweetened with fructose. Obesity also causes the body to make more uric acid and eliminate less. So Regency doctors were correct in their observations; gout can be caused by eating too much rich food and drinking too much alcohol, though it may have other causes.

Certain medications and traumas can also trigger gout, and it can be hereditary (Regency doctors knew that also). Men are more likely than women to get it, usually when they are 30-50 years old. According to the Arthritis Foundation, about 4% of Americans have gout—6 million men and 2 million women.

Comforts of Bath Gout
Doctors examining a gout patient, from Thomas Rowlandson’s series on The Comforts of Bath, 1798.

How was gout treated in Austen’s England, and would we do the same now?

Medical Recommendations for Gout in Austen’s England
Go to Bath

That meant, partly, go to a doctor. Bath hosted many well-known doctors, while there was limited medical expertise in rural England. Austen’s parents may have decided to move there in 1801 partly because of declining health; they appreciated the availability of doctors and medical care in Bath.

√ Seeing a doctor would be recommended today also, of course.

Doctors recognized, and still recognize, different varieties of gout and various possible treatments. Jane Austen’s friend Lady Bridges was told she had “a good sort of Gout”; presumably mild or easily treated. As Rowlandson’s cartoon above illustrates, doctors did not always agree with each other. Austen lists some remedies in her letters that were prescribed for her friends, and others are found in medical papers of the day. The following two recommendations sound familiar today:

Diet

“The most undeviating moderation and temperance” is necessary, according to Dr. Gibbes of Bath in 1812: limiting or avoiding alcohol and rich foods. Austen’s friend with gout was “restricted to much such a diet as James’s bread, water and meat, and is never to eat so much of that as he wishes.” The allowance of meat is surprising, but obviously it was in small amounts.

√ Modern doctors might not be that extreme, but they recommend avoiding alcohol, fructose-sweetened drinks, and limiting foods such as meat, fish, and poultry.

Exercise

Walking: Austen’s friend was “to walk a great deal — walk till he drops, I believe gout or no gout. It really is to that purpose. I have not exaggerated.” Admiral Croft in Persuasion, who went to Bath for his gout, was told to walk all day “to keep off the gout.” In general, those who went to Bath were outdoors more and walking more than they might have been doing at home, and this in itself might have helped them get well, as Austen notes in another letter.

√ Modern doctors recommend exercise and weight loss to help with the gout. No doubt a very restricted diet and a lot of walking would have helped patients in Austen’s day to lose weight, also.

But what about the waters of Bath? Did they help? Next week in Part 2 we’ll consider other remedies, including drinking the waters and bathing in them, and how they might or might not have helped.

Sources

“Gout,” Mayo Clinic.

“What is Gout?” Arthritis Foundation.

Jane Austen’s Letters, fourth edition, edited by Deirdre LeFaye. Letters of June 19, 1799; Sept. 16, Oct. 14-15, Nov. 3, and Nov. 6-7, 1813.

Eavesdropping on Jane Austen’s England by Roy and Lesley Adkins, chapter 11, “Medicine Men.” London: Abacus, 2013. (Woodforde and Holland quotes)

A Treatise on the Bath Waters, Part 1, by George Smith Gibbes. Bath: Meyler, 1812.

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