The struggle with gout: the letters of Francis Gregor of Trewarthenick in Cornwall

'The Gout' by James Gillray, 1799. Source: The Wellcome Collection.

In this blog, I look at one man’s struggles with gout during the last years of his life based on letters from Francis Gregor, of Trewarthenick, near Tregony, in Cornwall, to his close friend Francis Glanville, written between 1812 and 1815, and held in the archives at the Archives and Cornish Studies Service, at Kresen Kernow, in Redruth.

Both were members of the Cornish landed gentry. Gregor was born in 1760 and after training as a lawyer at Lincoln’s Inn, he returned to the family estate following the death of his father, another Francis, in 1786.

Francis junior soon involved himself in local politics first as Sheriff of Cornwall, in 1788, then as a county MP, from 1790 until 1806, during which time he served as an officer in the local militia. Glanville, born in 1762, lived at Catchfrench, near Liskeard, and was MP for Plymouth between 1797 and 1802. Some letters are addressed to Glanville at the address of former Plymouth MP Robert Fanshawe, who was made Commissioner of Plymouth Dock from 1790 to 1815, and whose daughter, Elizabeth, became Glanville’s second wife. Glanville also had business interests in London as Gregor often wrote to him at Portman Square.

Gout, as a condition, has been well known throughout history and as long ago as the time of Hippocrates (460-370 BC) it was categorised as the ‘arthritis of the rich’ owing to its prevalence within men, and mostly men, who followed a certain lifestyle. In the eighteenth century, gout became so common that it became a popular topic for artists and writers like Tobias Smollett and James Gillray. Its spread has been attributed to lead poisoning particularly through the consumption of imported wines and spirits in wooden barrels secured with lead fastenings. Recent research has suggested the higher intake of sugar may also have been an important contributary factor in its proliferation. Either way, these products could only be consumed by those wealthy enough to afford them.

'Introduction of the Gout' by George Cruikshank, 1818. Source: The Wellcome Collection.

Various remedies abounded. One of the most popular in the early nineteenth century was the Eau Medicinale, developed by former French army officer Nicholas d’Husson, which was touted as a panacea that purified the blood. It proved a controversial remedy. In 1811, John Ring, a member of the Royal College of Surgeons, in London, wrote to the Medical and Physical Journal urging ‘the necessity of a little more caution in the use of [Eau Medicinale].’ He gave the case of a ‘Mr Smith, of Bishop’s-yard, Charles-street, Grosvenor-square’, as a salutary example. While the Eau had previously operated as a cathartic, problems started in November 1810 when Mr Smith suffered gout in his foot. Once again taking the Eau, Smith suffered pains in his stomach which grew more violent so that on the ‘Friday night the black vomiting came on, and on Saturday afternoon he expired.’ Smith it appeared had taken ‘a larger dose than his constitution could bear.’

In his A Treatise on the Gout, published in 1811, Ring wrote: “A medical man may remove the fit; but it is only in the power of the patient himself to prevent its return.”

The main problem was that the disease hit men from the affluent part of society:

'Those who have been accustomed to live in a state of ease and affluence, and to be pampered with every kind of luxury, are not the persons who will readily submit to strict discipline and controul, [sic] to severe privations, or to the constant and regular exercise, which the radical cure of such a stubborn complaint indispensably requires.'

Not all doctors were against the Eau. John Bailey, a Harwich doctor, also wrote to the Journal of his experience administering the medicine. It, too, caused sickness but within a couple of days, his patient, a man of about 50, was ‘sitting up, cheerful, and free from uneasiness of every description.’ As Bailey stressed, the medicine was ‘undergoing a very extensive probation, in the hands of some of the first medical and chemical characters in the metropolis.’

<p>Historic gout</p>
<p>The Elisha Whittelsey Collection, The Elisha Whittelsey Fund, 1959<br></p>
The Elisha Whittelsey Collection, The Elisha Whittelsey Fund

Gout sufferers were keen to try anything to relieve the pain, Gregor included, and from the 1810s, the use of the Eau mushroomed. The first mention of Gregor’s use of the Eau was in a letter from September 1812, which begins with the discussion of the ‘Catholic question’ and touches on ‘Buonaparte’s’ invasion of Russia. Then there is a curious juxtaposition of thought process whereby Napoleon’s actions appear to provoke opinions of another enemy well known to his friend. Gregor describes gout and ‘no small degree of sickness, and a dizziness in the head’ and admits to taking the Eau which as ‘a common purge relieves me.’

By December 1812, however, Gregor, who conceded to his friend that he might ‘lessen my quantity of wine a little’, was concerned enough to relocate to Bath where the waters were used internally and externally to clear the system and where doctors would place impositions of dietary regimes and restrictions on alcohol. 

It is not certain what regimes Gregor underwent but, while in Bath, he responded to concerns raised by Glanville about the Eau. Gregor wrote: ‘I have observed what you say about the Eau Med … I have long known that the London opinions are against it and have heard similar reports from the Country.’ Yet Gregor went on to defend his choice:

'I sh[oul]d certainly not take such doses as you mention or 1/3rd of them under any circumstances, except on an attack on the stomach … and I am decided in opinion that I must occasionally suffer a fit to take its course … I am certainly [also] of opinion that if I had not done so last autumn I sh[oul]d never experienced some violent attack or the other.'

However, Gregor added that ‘I shall act with due caution, I will not blindly throw away life.

<p>Old historic medicine bottles</p>
<p>Roman baths, Bath, UK</p>
The waters at Bath

Between the winter of 1812 and spring, 1813, Gregor was in full control of his faculties and had even resorted to ‘four or five glasses [of wine presumably], and never take any thing after Tea’ which he said would be his ‘present and will be my future Regimen.’ Throughout the rest of 1813 there is barely a mention of any illness. Then in November, as Gregor prepared to visit the next Quarter Sessions in January to discuss proposals for a new lunatic asylum in Cornwall, he wrote about attending ‘if the Gout does not attack me.’ Apparently a vain wish. Rarely did Gregor start his letters with a medical update but, in the first week of December, he wrote:

'[T]he Gout makes such rapid and to me unexpected advance that I may find writing less convenient to-morrow, tho[ugh] I mean to take the Eau Med in full dose this night having borne a sufficient degree of disorder by way of preparation.'

Gregor was determined to not let the gout affect him too much and he signed off in a defiant manner in a postscript: ‘I am better – but if I had not taken the Eau, I sh[oul]d have had a duplicate of last year – as it is I shall be on horseback before Saturday.’ 

Gregor appeared to have his condition under control through 1814 but, in March 1815, there were clear signs that not all was well when he had to ask ‘an amanuensis’ to write: 

'I am however by no means very ill and neither dispirited nor materially weakened, the pain of my gout has been [very] severe but notwithstanding this accompanied by a sickness so disqualifying that I did not venture to resort to the Eau in this opinion I was supported by Dr Taunton.'

Gregor’s wife, Jane, added a postscript saying her husband was ‘entirely of himself; he is certainly better these last two days.’ Within a couple of months everything seemed to be back in order. Gregor was in full flow again with his letter writing but he was more honest about his condition. In May, he wrote: 

'The disorder however has left me weak, and the recovery of my strength is but slow, notwithstanding my appetite is good…I dare not exert myself much nor can I suffer long intervals between meals…I am of opinion that this circumstance is attributed to the peculiar character of my disorder in this instance, which very evidently affected the interior more than in any former occasion.'

However, matters grew steadily worse for Gregor. Jane and younger brother William took up the task of informing Glanville about his friend’s health. By the second week in June, they feared the worst. On June 19, William told Glanville that Gregor had had another attack and his brother had ‘contemplated Death as very fast approaching.’ Despite recovering, William was ‘sensible, that when we speak of such an Enemy as the Gout is, who is equally insidious as he is violent […] our hopes must be qualified.’ 

Within a week Jane wrote to Glanville, who was in London, that they had managed to lift him from his bed so it could be remade, suggesting that the once active militiaman was now bedridden, but this was after ‘the most terrible crisis’ when she thought all might be over.   On July 1, William Gregor once again took to informing Glanville of his friend’s progress, after he received his ‘kind and affecting letter on my return home’:

'Yesterday was indeed, a distressing day to all of us: He underwent very great sufferings – I found him labouring under a very great oppression upon the chest, with occasional paroxysms of breathlessness, that seemed at times to threaten life.'

Gregor, however, appeared to rally. A hastily written note, difficult to decipher entirely, perhaps written in some pain, thanks Glanville for news that ‘literally dragged me from the grave.’ Jane, though, wrote that her husband had undergone ‘such a dreadful day of suffering as he had last Friday was really almost too much for me to witness.’ The possibility of going once again to Bath was mooted ‘as gout is certainly [a] great part of his disorder, and the cause of it all.’   Gregor remained at Trewarthenick and continued to resist the illness that wracked his body. He even managed to write a full page to his friend expressing his joy at Napoleon’s defeat at Waterloo:

'I have heard y[ou]r letter read to Mrs G – containing a sketch of the Field of Battle. I have been throughout, even during the worst, very anxious and much interested ab[ou]t the state of affairs and have from day to day as events happened blessed God that I remained alive, and an Englishman during the time Buonaparte was defeated. As to myself, my actual danger seems little, but my recovery will be painful, tedious and interrupted, but my stamina has turned out good, and so far beyond expectations that I think with you I may look forward to some years of continued life worthy [of] my possession – for several days my [fervent?] prayer was for death, for my sufferings were intolerable but I here drop the subject.'

The sufferings proved insurmountable. On July 13, 1815, William wrote from Trewarthenick:

'About seven o’clock, in full possession of his memory & faculties & with manifest indications of bodily strength still remaining, whilst he was remarking upon some medicine, which he thought he might take, our Dear Friend suddenly exclaimed “I am going” fell back & expired almost without a groan or struggle! It is supposed that a sudden affection of the heart and the functions of the animal machine stopped! – Thus, we have lost a friend, who never can be replaced!'

Francis Gregor had a simple funeral and was buried in the family vault at the small parish church of St Cornelius, at Cornelly, near Tregony, not far from Trewarthenick, on July 20, 1815. He was 54.

 

Bibliography and further reading

C. Ronald MacKenzie, ‘Gout and Gyperuricemia: An Historical Perspective’, in Current Treatments in Rheumatology (2015), 1: pp.119-130, p. 121.

Cider too was often produced in presses made from lead. See: Christopher Rivard, Jeffrey Thomas, Miguel A. Lanaspa, and Richard J. Johnson, ‘Sack and sugar, and the aetiology of gout in England between 1650 and 1900’, in Rheumatology 2013:52, pp.421-426.

Rivard et al, ‘Sack and sugar’, pp.421-423,

MacKenzie, ‘Gout and Hyperuricemia’, p.126.

The Medical and Physical Journal, March 1811, Vol. 25, (145), p.207.

John Ring, A Treatise on the Gout (London: J. Callow, 1811), p.2.

Ring, A Treatise, p.2. Ring became friends with Edward Jenner and became a great supporter of vaccination.

The Medical and Physical Journal, February 1811, Vol. 25 (144), pp. 114-115.

Once the active ingredient in Eau Medicinale was discovered, in 1814, to be colchicum it began to fall out of favour and was replaced by colchicine, which is still used today to treat gout. See: MacKenzie, ‘Gout and Hyperuricemia’, p.126.

Gregor also resorted to another popular remedy, Dover’s Powder, and rhubarb and magnesium during his travails with the illness.

Roy Porter and G.S. Rousseau, Gout: The Patrician Malady (New Haven and London: Yale University Press, 1998), pp. 125-6. Gregor stayed at 9 Henrietta Street, Bath, during his treatment.

Kresen Kernow G1911/11; Gregor to Glanville, April 4, 1813.

G1911/11; Gregor to Glanville, April 4, 1813.

G1911/18; Gregor to Glanville, November 21, 1813.

G1911/20; Gregor to Glanville, December 4, 1813. Alongside the Eau Medicinale, Gregor used other remedies to combat and contain the gout including Dover’s Powder and rhubarb and magnesia which he found ‘an admirable assistant.’

Dr Richard Taunton, a physician at the Royal Infirmary, in Truro, from 1808. He was also appointed surgeon of the Cornwall Corps [Regiment?] of Fencible Cavalry, in November 1794; The London Gazette, November 1794.

G1911/31; Gregor to Glanville, March 21, 1815. 

G1911/33; Gregor to Glanville, May 24, 1815.

William Gregor (1761-1817) was an Anglican priest and a renowned scientist and mineralogist who discovered titanium, which at one time was known as ‘Gregorite’. Jane, née Urquhart, was the daughter of William Urquhart of Craigston, Aberdeen.

G1911/34; William Gregor to Glanville, June 19, 1815.

G1911/35; Jane Gregor to Glanville, June 26, 1815.

G1911/36; William Gregor to Glanville, July 1, 1815.

G1911/37; Francis Gregor to Glanville, July, 3, 1815.

G1911/37; Jane Gregor to Glanville, July 3, 1815.

G1911/37; Jane Gregor to Glanville, July 3, 1815.

G1911/38; Gregor to Glanville, July, [date illegible] 1815.

G1911/39; William Gregor to Glanville, July 13, 1815.