The RCP Heritage Library manages the Heberden Library of the British Society for Rheumatology (BSR), a collection documenting the history of rheumatology from the 16th to 20th centuries. Today on the blog we take a look at a recent addition to the Heberden Library: Thomas Short’s, Discourse on tea, sugar, milk, made-wines, spirits, punch, tobacco (1750) which contains his ‘plain and useful rules for gouty people’.

Rheumatology is the study and treatment of medical disorders that affect the musculoskeletal system, particularly the joints and surrounding soft tissues, as well as autoimmune diseases that affect wider systems of the body. This includes conditions such as rheumatoid arthritis, osteoarthritis, lupus, osteoporosis, gout and many other conditions. Even today many of these conditions can be difficult to diagnose; historically far fewer different conditions were recognised and most peoples’ experiences of rheumatological disease were lumped together under the headings of gout and/or arthritis.

Gout is a disease caused by the presence of too much uric acid in the blood, which leads to urate crystals being deposited in the joints, often the big toe. It causes intense, sudden, stabbing pain with the skin above the joint becoming hot, red and swollen. It usually occurs in attacks of 5-7 days, and recurrences can be caused by drinking too much alcohol, eating heavy meals, or becoming dehydrated. It is more common in men than women, and is more common as people age.

Historically, gout was considered a disease of wealthy people, whose diets rich in wine and meat predisposed them to attacks. 18th century caricatures and prints commonly show the agony of a gout attack, whilst also satirising the luxury lifestyles of those affected.

A great many medical authors wrote books on how to treat gout and prevent occurrences, with bathing in mineral waters and control of diet frequent topics of discussion. The Heberden Library contains many works on the subject, and the most recent acquisition is: Discourses on tea, sugar, milk, made-wines, spirits, punch, tobacco, &c: with plain and useful rules for gouty people by Thomas Short (c.1690–1772), published in the year 1750.

Thomas Short was a physician born in Scotland, and who practised medicine in Sheffield. Short had wide interests: he visited many Yorkshire spa towns and analysed their mineral waters, he wrote about 16th and 17th century epidemiology and demography, he advocated against alcohol consumption, and he described the negative effects of obesity on health.

Short began his discussion of gout with a statement that is likely to surprise anyone who has ever experienced its symptoms. He wrote:

The Gout, when rightly managed, instead of a punishment and misfortune, is a means to lengthen life, and a sign of strong principles of health, and sound constitution

This remarkable assertion was borne of his own personal experience:

In the 43rd year of my life I was suddenly seized with a short regular fit [of gout], in the 44th had another. Did not much like neither the pain, confinement, nor needless shattering of my constitution

He reported that he was quite easily able to overcome its troubling symptoms, and that anyone else could do the same:

I left off wine, punch, (for ale I never did drink) flesh suppers, eat milk, constantly to breakfast and supper, 2 or 3 ounces of flesh to dinner, have not had a touch of it or any other diseases this 14 years, and intend never to have it more: Only I used River Bathing two or three Summers after, thrice or oftener a Week.  So this confirms me that not so many needed suffer these racking pains if they would be wise.

These recommendations – to avoid alcohol, limit meat-eating, to consume plenty of milk and to take regular exercise – were not the sum of his advice for preventing and treating gout: Short lays out a very detailed regimen throughout the course of his ‘advice’ chapter.

Prevention during winter

• Wrap up warmly from the end of September onwards, wearing woollen and flannel undergarments over the whole body, in order to ‘keep up perspiration as much as possible’. Change these undergarments weekly, and then gradually remove them in May, by cutting pieces off the limbs and body with a pair of scissars [sic], day by day’.
• Keep up perspiration and circulation by rubbing the limbs and joints with a brush daily.
• Stay indoors throughout winter, and get exercise there by using a dumbbell, playing billiards, walking gently, or riding on a kind of rocking horse.
• Only drink warm drinks, and drink white wines instead of red wines.
• Do not purge the bowels too often.

Prevention during summer

• Continue to rub the limbs and joints with a brush.
• Drink cool drinks and claret wine, and don’t eat too much solid food.
• Get up early and take exercise.
• Take cool baths every morning to ‘strengthen the limbs and harden the joints’. Part fill a large bath with luke warm water, and then top it up with cold water ‘and stay in it till it is so cold that [you] can scarce bear it, for about 20 or 30 minutes’.

Treatment of attacks when they occur

Short lists a great many medicines that could be taken before the start of an attack of gout, to try and prevent it progressing. The purpose of the first remedies to be used when a patient experienced fever and nausea, and before the main symptoms of gout had taken hold was to ‘gently invite the gouty matter to the limbs, and keep the head and stomach free’:

• sack whey (whey mixed with fortified wine and sugar) with ammonia added to it
• a milk enema made with with camomile flowers and seeds
• electuary (a sweet paste) of bayberries.

Once the main symptoms of gout were being experienced in one or more limbs, the treatment was designed to keep the gouty humour in the limbs, and to get it so ‘spend its fury on these parts as soon as possible’:

• Lie in a warm bed.
• Drink more sack whey or other warm drinks.
• Wrap all the limbs in flannel, but not in wool (the grease on which blocks the pores and prevents perspiration).
• Take medicines made from Gascoigne powder (a commonly available mixture of varying ingredients including crab claws, coral and pearl), alkermes (dried insects), camomile, wormwood, spirit of lavender, and laudanum (a mixture of alcohol and opium), which Short considered ‘the most excellent antiarthritic medicine known’.

Once the symptoms were wearing off, Short instructs the patient to get out of bed as soon as possible, and begin taking a rhubarb-based purgative made from powdered rhubarb, nutmeg, orange peel, and cochineal infused in the alcoholic spirit arrack. This would be supplemented with asses milk, German mineral water, white fortified wine, and exercise in a coach or on horseback.

This is only a part of Short’s regimen, which was clearly written for patients of a certain high social status, with access to complex mineral-based medicines, plenty of leisure time, and the sort of lifestyle in which horse-riding and coach travel were commonplace. This constituency was, of course, that most able to pay for medical advice in book form or directly from physicians.

Short’s gout advice only takes up about 25 pages at the end of a 400-page book, most of which is devoted to various consumables – sugar, milk, tea, alcohol of various kinds, and tobacco – regularly discussed for their medicine and dietetic properties at the time.  But even these few pages give a a rich insight into 18th-century medical theories and practice.

Katie Birkwood, rare books and special collections librarian

All the books in the Heberden Library are available for research at the RCP at Regent’s Park, London. Check out the catalogue online and email history@rcp.ac.uk to make an appointment to see any of the books.