Gout and the Waters of Bath, Part 2

“Gout and decrepitude! . . . Poor old gentleman.” –Sir Walter Elliott’s comment on Admiral Croft when the admiral is sent to Bath for the gout in Persuasion.

In Part 1 we saw that Jane Austen’s novels often mention the gout, a very painful type of arthritis which is still common today. Gout is caused by an excess of uric acid in the body, which develops into painful urate crystals in the joints. Exercise and avoiding alcohol and rich foods are remedies used both in Austen’s England and today. How else was the gout treated, and did the waters of Bath help?

More Regency and Modern Treatments for Gout

Cleaning Out the Body

(In Austen’s England) For cases of gout (and many other diseases) that included fever, doctors used bleeding, as well as purging and emetics (inducing diarrhea and vomiting) to bring down fever and swelling before using milder remedies. Purging and emetics were considered a way of cleansing the body. When Austen’s friend Lady Bridges first got the gout, her doctor “took twelve ounces of blood from her.”

X (Today) These are NOT remedies used today for gout. Some claim that donating blood has health benefits including reducing excess iron in the body, assisting weight loss, and stimulating blood cell production. So it’s possible that in small amounts bleeding might have been helpful, if it didn’t lead to infection, as it easily could in Austen’s day. When you donate blood, they take about a pint, 16 ounces, which is more than was taken from Austen’s friend. People now might use “detox” diets for cleansing their systems, or laxatives for constipation, but inducing vomiting and diarrhea is not recommended for a disease like gout.

Medications

A long list of herbs were used, which may or may not have helped. Some have lovely names, like angelica, archangel, lily of the valley, and pennyroyal, while others sound ugly, like brank ursine, goutwort, and hellebore; there are many more.

X,√ Various medications that decrease inflammation and prevent complications are used today. One prescribed is colchicine, which was originally extracted from Colchicum plants. Colchicum was used as an herbal medicine to treat gout since ancient times, and is recommended in a doctor’s treatise on gout in 1822.

Parson Woodforde used rhubarb to treat the gout and other illnesses. However now rhubarb is on the list of foods to avoid if you have the gout, since it contains oxalates, which contribute to gout. Cabbage was another recommended cure, and some today recommend red cabbage to help with the gout, thought I haven’t seen medical confirmation.

EDW090796009  01
The Comforts Of Bath – The Pump Room. Thomas Rowlandson (1756-1827). The man in the wheelchair and the man with the cane probably have gout. They are going to “drink the waters.”
Drinking the Waters

As for most illnesses, gout sufferers were advised to “drink the waters.” The water was pumped up from the hot springs, separately from the water used for bathing. It was to be drunk hot (107-116 F. from the pumps), usually in the morning between 6 and 10 AM on an empty stomach. Some, like Austen’s uncle, drank a second dose later in the day. Visitors drank up to two quarts a day, but more often just a cup or two.

Dr. Gibbes in 1812 claimed that drinking the waters reduced the desire for alcoholic drinks as well as increasing urination; both would have helped the gout. He said the waters could “excite a feverish heat.” In 1799 Jane Austen’s brother Edward Knight was suspected to have the gout because of “a little feverish indisposition” and stomach issues. However the apothecary blamed indigestion rather than gout. Austen writes, “The occasional particular glow in the hands & feet, which we considered as a symptom of that Disorder, he only calls the effect of the Water in promoting a better circulation of the blood.”

√ ? Drinking a lot of water is a modern medical recommendation for gout. Whether drinking the specific waters of Bath, high in minerals, made a big difference is not clear. They contain ions of calcium, magnesium, sodium, phosphate, and chloride as well as many trace minerals. The waters do apparently increase urine and perspiration. Since one of the causes of gout is excreting too little uric acid, it’s possible the waters might help eliminate more of it. I also found modern claims that magnesium, particularly Epsom salts (which include some ingredients of Bath waters), helps relieve gout. High blood pressure and kidney problems can also be associated with gout, and studies have shown that drinking mineral water may help with those two conditions.

pump room pump edited - 1
We “drank the waters” in the Pump Room in Bath, where the spring water flows constantly in this fountain. They taste warm and metallic, but not unpleasant.
Bathing in the Waters

Visitors to Bath could immerse themselves up to the neck in the hot waters (92-100 degrees F; different baths were different temperatures), which were renewed every day from the springs; the previous day’s water went into the river. They could stand, sit, or even recline in the water. Those who wanted hotter water could hold onto a railing and stand near the center, where it came in with higher pressure and heat. In other rooms, patients could be hosed with hot water specifically on body parts that needed it, without being immersed in the water. Or they might use the “vapour baths” and “sweating rooms,” probably similar to saunas. The baths might also have provided an opportunity to walk (getting exercise) in the water, for those in too much pain to walk on land.

√ ? This sounds like it would feel good for whatever might be hurting, especially painful joints! But there is not general agreement on the benefits of bathing in hot springs for treating illnesses. A couple of studies have shown immersion in water, particularly spa water, to be helpful for two other types of arthritis, but gout does not seem to have been tested. According to Bath and the Rise of Science, medical benefits from spa treatments are now believed to result from hydrostatic effects of the water, meaning the pressure it exerts on the body. This pressure forces water from the tissues into the bloodstream, leading to much higher urine output, removing more wastes and toxins. Lead poisoning from certain wines and cider (made in lead vats) was common during this era, and could cause gout and other illnesses; bathing may have helped the patient excrete the lead from his body.

Roman Baths 2 - 1
View of the “Roman Baths” today.  This part is no longer safe for swimming, but there is a spa elsewhere in Bath where you can soak in the waters.

 

So did going to Bath help gout sufferers? It probably did, at least by encouraging the person to exercise and drink more water, though of course that could have been done at home. Bathing may have relieved pain and helped eliminate toxins. Diet could be changed anywhere, but perhaps a new environment and supervision of a doctor gave higher motivation to be consistent. Bath also provided many distractions from the pain, in social gatherings and entertainment. For Jane Austen, sending gouty people to Bath helped develop her delightful plots and characters!

 

You might also enjoy “The Pump Room’s Little-Known and Well-Known Facts” and “A Gallery of Gout” (artwork related to gout).

Sources

Those listed for Part 1, and:

Gout, University of Maryland Medical Center

Innovation and Discovery: Bath and the Rise of Science, edited by Peter Wallis. Chapter 1, “Airs and Waters: The Hot Springs and Bath Chemistry,” by Peter Ford and Roger Rolls. Bath: BRLSI, 2011.

Growing Older with Jane Austen, by Maggie Lane, chapter 11, “The Dangerous Indulgence of Illness.” London: Robert Hale, 2014.

New Bath Guide. Bath: Cruttwell, 1817.

An Essay on the Medicinal Efficacy and Employment of the Bath Waters, by Edward Barlow, M.D. Bath: Longman, 1822.

Scientific Evidence-Based Effects of Hydrotherapy on Various Systems of the Body.”  References 47 and 53 relate to arthritis.

 

 

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