the last illnesses of robert and horace walpole

THE YALE JOURNAL OF BIOLOGY AND MEDICINE 56 (1983), 131-152

The Last Illnesses of Robert and Horace Walpole

ARTHUR J. VISELTEAR, Ph.D., M.P.H.

Associate Professor of the History of Medicine and Public Health, Section of theHistory of Medicine, Yale University School of Medicine,

New Haven, Connecticut

Received April 28, 1983

Urinary lithiasis and gout were uncommonly prevalent in the eighteenth century. This essayconsiders the history of both afflictions and especially tells of the last illnesses of Sir RobertWalpole, who died from complications of stone, and his son, Horace, who throughout his lifewas a sufferer of gout.

This is a story of two diseases, stone and gout, and of two men, father and son,Sir Robert Walpole (1676-1745), First Earl of Orford, and his son Horatio (1717-1797), better known as Horace, the Fourth Earl of Orford. It is a story that I beganin London archives in 1963 and which I have been continuing at the Lewis WalpoleLibrary in Farmington, Connecticut [1]. To complete the earlier project I was for-tunate to have the advice of C.D. O'Malley, Noel Poynter, Elmer Belt, Joseph Kauf-man, and Chauncey Leake; to prepare the present paper I gratefully acknowledgethe assistance of the staff of the Lewis Walpole Library, the staff of the Yale Historyof Medicine Library, Thomas Forbes, Dorothy Hanks of the National Library ofMedicine, and Susan Wheeler Byck, acting curator of the Clements Fry Collectionof Medical Prints.

INTRODUCTION

Sir Robert Walpole, First Earl of Orford and Prime Minister to two monarchs,died on March 18, 1745. The announcements of his death appeared in the Londonnewspapers -one was a satirical poem [2]; others merely repeated the original bul-letin:

Yesterday Morning, about One o'Clock died, at his home in ArlingtonStreet, Piccadilly, of an Inflamation of his Lungs, aged 71 Years, the RightHon. Robert Walpole, Baron of Houghton, and Earl of Orford, Knight ofthe Most Noble Order of the Garter, and one of his Majesty's Most Hon.Privy Council . . . [3].

The Daily Gazeteer also published a report of Sir Robert's death, simply relatingthat Sir Robert had expired "after a tedious illness" [4].

It was not learned that the "tedious illness" was urinary calculi until John Ranby

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Delivered in the History of Surgery Lecture Series on February 7, 1983, Yale University School ofMedicineAddress reprint requests to: Arthur J. Viseltear, Ph.D., Section of the History of Medicine, Yale

University School of Medicine, 333 Cedar Street, New Haven, CT 06510Copyright 0 1983 by The Yale Journal of Biology and Medicine, Inc.All rights of reproduction in any form reserved.

ARTHUR J. VISELTEAR

published his Narrative of the Last Illness of the Right Honorable the Earl ofOrfordin the second week of April, three weeks after Sir Robert's death. Ranby, PrincipalSergeant-Surgeon to King George II, was called to attend Sir Robert in May 1744and remained in attendance until after the postmortem. According to Ranby, SirRobert himself had asked that a narrative account of his illness be prepared, for hewas, wrote Ranby, "Desirous from his innate love to Mankind, when he could sur-vive no longer to profit them, of being the Means of conveying what good he couldto them after his Death . . ." [5].

Ranby's Narrative was his attempt to set the record right, but to many it appearedas a subtle apologia pro vita sua and not so subtle indictment of the physicians forcommitting gross errors in diagnosis and treatment during the course of Sir Robert'sillness. Horace, Sir Robert's son, similarly believed that the doctors, for whom hehimself had absolute disdain, had simply done his father in. Sir Robert, anguished,mentally distraught, and in the throes of despair, also condemned the physicians.

This Lixivium has blown me up. It has torn me to pieces. The affair is overwith me. That it be short . . . is all I desire. Give me more opium; knock medown . . . Dear Horace, if I must die, 'tis hard to die in pain [6].

Ten years later, Horace experienced his first episode of gout. In a letter to RichardBentley, he described his affliction in a pungent declaration: "Never was poor in-vulnerable immortality so soon brought to shame! Alack! I have the gout!" In 1760,he wrote to Henry Conway: "I am laid up, an absolute cripple . .. [I] am carried tobed by two men, and could walk to China as soon as cross the room." And in 1765,this in utter exasperation to Horace Mann: "If you knew with what difficulty andpain I write to you . . . I have been extremely ill . . . Oh, it is a venomous devil!" [7].To be sure, the eighteenth century witnessed other afflictions more severe and cer-

tainly more fatal than stone or gout. Englishmen died of smallpox, malaria, tuber-culosis, rickets, measles, typhoid, and typhus, and if they escaped disease there wasalways death from accident, murder, execution, or war [8]. But none seemed to cap-ture the imagination better than stone or gout, perhaps because these conditions af-flicted both high-born and wealthy. Both stone and gout were the subjects ofnumerous treatises written by respectable physicians, empirics, and laymen, as wellas countless quacks who knew a good thing when they saw it [9].The respectable medical authorities often disagreed with each other regarding the

causes and control of these afflictions, but they certainly were in absolute agreementas to the effects on those who were sufferers. Richard Blackmore, for example,wrote that stone was a condition so painful that:

. . . Had not the All-wise Divine Author, planted in our Nature, so strong anAversion to Death and Dissolution, it is highly probable that many, grownutterly impatient of undergoing such a weight of Misery, would lay handsupon themselves, and soon put an end to their calamities and their livestogether . . . [10].

Similar expressions about gout also appear in the literature. One which best cap-tures its characteristic severity was penned by the eighteenth century English clericSydney Smith (1771-1845) who wrote: "When I have the gout, I feel as if I am walk-ing on my eyeballs" [11] (Fig. 1).

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THE LAST ILLNESSES OF ROBERT AND HORACE WALPOLE

FIG. 1. "The Gout." Colored etching by James Gillray, 1799. Courtesy Clements C. Fry Collection,Yale Medical Library.

PART ITHE STONE AND SIR ROBERT WALPOLE'S LAST ILLNESS

The classic treatments for urinary calculi in the eighteenth century were expectant,surgical, and medical. Expectant treatment consists merely of waiting for the stoneto pass out of the body, but both surgical and medical treatment of the stone haverather long histories.

Historians of surgery consider lithotomy, along with trepanation and circumcision,the earliest operations. Cutting for the stone was highly common in the eighteenthcentury, and has an illustrious history of its own, but suffice it to say that, despitethe uncommon dexterity of some surgeons, the procedure was not without its risksdue to septicemia and trauma. The inherent fear of lithotomy and the dangers atten-dant to the procedure prompted physicians, empirics, and quacks to search for lessdangerous remedies, for example, some medication that could be taken orally, or in-jected directly into the bladder, to dissolve stones in their "seat of origin." Suchdrugs were known as lithontriptics, literally "stone wasters."The medical treatment for the stone also dates from antiquity and, over time,

authors considered many botanic remedies including, but not limited to, cassia,crocus, myrrh, cinnamon, the seeds of sessile, maidenhair fern, and the root of thelaurel. Aretaeus, in the second century A.D., noting the classic symptoms of stone asa fullness of the kidneys, distension of the ureters, grievous pain in the loins,spasms, tremblings, rigors, and "alienation of the mind," recommended oil andvinegar mixed with parsnips. Other authors recommended baths, poultices, heat,cupping, bleeding, and enemas, while some spoke with surprising confidence in the

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ARTHUR J. VISELTEAR

essence of goat's blood [12], mashed millipedes, and pickled or roasted sparrow [13].A bizarre recipe for stone appears in John Schroder's History ofAnimals as they areUseful in Physic and Chirugery, which is to make a decoction of the urine of ayoung boy who has drunk a good wine. This is then to be distilled with cow feces.The distillate or, as he calls it, the "spirit of the urine," is then mixed with phlegm.Schroder called the concoction "Vertus" and recommended it as a universal cure, butadmitted that it had one drawback: "it stinks grievously" [14].The idea of a lithontriptic persisted throughout the sixteenth and seventeenth cen-

turies and, by the eighteenth century, various theories of stone formation- ofviscous phlegm, lapidistic and petrifying spirits, of tartarous, aluminous, stiptic,and mucilagenous qualities, of faeculent, dreggy tartar- had been advanced. Butthe theories proved less important than two empirical remedies which attained greatnotoriety, "Mrs. Stephens' Medicine for the Stone" and James Jurin's "LixiviumLithontripticum," the latter being the lixivium decried in Sir Robert's letter toHorace. Both lithontriptics claimed to be "stone wasters," were extremely popular,and were championed and promoted by respected citizens who collected and collatedhundreds of affidavits from sufferers of stone whose conditions had been mitigatedor cured [15].

Mrs. Stephens' medicines reached such notoriety that a parliamentary commissionwas appointed to review her claims. Serving as Trustees of the Commission were theArchbishop of Canterbury, the Lord High Chancellor, the Lord Privy Seal, threedukes, two earls, two viscounts, the Speaker of the House of Commons, theChancellor of the Exchequer, two Fellows of the Royal Society, five physicians, in-cluding Thomas Pellett, President of the Royal College of Physicians, and threesurgeons, William Cheselden, Caesar Hawkins, and Samuel Sharp.A clinical trial was designed and four patients treated with the medicine. The cases

were similar: each patient, for example, was searched (i.e., sounded with a catheter)to determine if stone were present in the bladder; each patient received the medicine;after a time each patient passed fragments of stone and a white mucus in the urine;each patient found his symptoms greatly relieved; each patient was sounded a sec-ond time revealing no stones in the bladder-ergo, Mrs. Stephens' medicines were asuccess [161!On March 5, 1740, the Trustees signed a certificate attesting to the fact that Joanna

Stephens' recipe for stone (Fig. 2) had been examined and that they were "convinced,by experience, of the Utility, Efficacy and dissolving power thereof" [17]. Twoweeks later, Mrs. Stephens received from the Office of the Exchequer and a gratefulnation the sum of £5,000 and, from that date hence, is never heard of again!

Before passing judgment on the English Parliament of the eighteenth century,remember the National Cancer Institute's own clinical trial with laetrile, enforced byour own twentieth-century Congress [18]. In the same way that laetrile was ultimatelysubjected to a thorough clinical trial, Mrs. Stephens' medicines were also subjectedto chemical and clinical study. The chemical experiments were designed by twoFrench chemists of the Academie royale des sciences, C.F. Geoffroy and S.F.Morand, and by David Hartley and Stephen Hales, both Fellows of the Royal Soci-ety. All four, working independently of each other, tested the effect of her recipe onstones in vitro. They placed fragments of urinary calculi in jars, applied heat, andpermitted the stones to "digest" in various solutions of water, urine, the urine ofsomeone taking Mrs. Stephens' medicines, and solutions of her medicines in theiroriginal preparation (Fig. 3).

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FIG. 3. "Stones in the Process of Dissolution." From David Hartley's "Supplement to a Pamphlet en-titled A View of the Present Evidence For and Against Mrs. Stephens's Medicine." Appended to StephenHales' Account ofSome Experiments and Observations on Mrs. Stephens's Medicines. London, T Wood-ward, 1741, p 66.

Each believed that the medicines, by virtue of their high lime content, did indeeddissolve stones in vitro. Geoffroy, for example, determined that the medicines con-tained the classic vegetable diuretics reduced to charcoal. The honey simply madethe soap more soluble, mitigated the acid salt, and rendered the decoction lessdisagreeable to patients. Geoffroy also determined that the soap dissolved stones invitro and additionally believed that the oil relaxed or lubricated the urinary tract andthe alkaline salts dissolved the resinous substances which served as a "cement" to thevarious layers of the stone [19]. Morand administered the medicine to forty patientsof stone and found that all were greatly relieved from their symptoms and attendantpain. Their urine was found to have a strong alkaline smell and each patient passed aslime (a white sediment) and small crystalline or stony flakes, proving to his satisfac-tion that the medicines did reach the urine and that a dissolution had taken place.To the chemists and physicians, then, the medicines worked. Morand, for exam-

ple, concluded that if the Certificate of the Parliamentary Trustees had been offeredto him, he would not have hesitated to subscribe with the others that "the medicinesare useful and efficacious in curing the stone in the bladder" [20].

Stephen Hales, who had also isolated the lime as the active ingredient, then askedthe critical question: Does the fact that soap-lye dissolves stones in vitro mean that itwill be an effective dissolvent in vivo? His answer was "yes": In all probability suchmust be the case because "to the concurring evidence of the happy effects" -that is,the success so many patients have had with the medicines- it was possible to add thefact that the soap-lye worked in vitro [21]. One corroborated and supplemented the

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other, a conclusion supported by John Rutty, another eighteenth-century researcher,who wrote that the evidence of in vivo and in vitro experiments are "reciprocalillustrations and confirmation of each other" [22].Four years later, in November 1744, Sir Robert Walpole, himself one of the

Parliamentary Trustees, was found to suffer from vesicle calculi. In early December,Ranby, who had made the original diagnosis, consulted with Sir Edward Hulse,First Physician to King George II, and Dr. James Jurin, one of the major figures ofeighteenth-century society, who had "advanced" Mrs. Stephens' medicines and pro-duced in the early 1740s his own recipe, which he called the "Lixivium Lithontrip-ticum." The physicians confirmed the diagnosis, but found their patient balky anduncooperative. Sir Robert, for example, would not permit them to insert a catheter,nor would he on any account agree to surgery. Their course of action, then, was toprescribe a draft of syrup of marshmallows and two drams of Jurin's lixivium. SirRobert promptly improved and for almost eight weeks was much relieved of hissymptoms. On February fifth, however, he passed a large stone, a quantity ofbloody urine, and, later in the evening, fifteen small stone fragments. The pain wasintense, and opium was prescribed, as it had been in late November and earlyDecember.A third physician was asked to consult on February ninth and believed Sir

Robert's predicament the result of coagulated blood and stone fragments remainingin the bladder. He recommended that Sir Robert be catheterized and, the pain beingso intense, Sir Robert reluctantly agreed. William Cheselden, surgeon to ChelseaHospital and one of the ablest of his profession, was called the next day, but unhap-pily failed in his attempt to clear the obstruction. Cheselden recommendedlithotomy, but again Sir Robert refused. From that time forth, Sir Robert steadilydeclined, and he died a month later [23].

Horace recorded in his Book of Materials, a collection of notes or passages forreference, the events of Sir Robert's last days. Sir Robert had asked Ranby if hewould improve and Ranby gave him no hope. Sir Robert, resigned to his fate, thentold Ranby that he desired that his body be opened when he died. Ranby replied"Good God, my Lord, don't talk of that!" "Nay," said Sir Robert, "it will not be till Iam dead and then I shall not feel it -nor you neither" [24].A postmortem was performed by Ranby who reported that the bladder was

distended four inches and contained clots of coagulated blood and several smallstones. Although the bladder was inflamed in spots, the kidneys and ureters were in-tact and without defect [251. No mention was made by Ranby of the urethra, whichprompted Jurin to write: ". . . I should here profess my amazement that the Urethraescaped Examination - the Urethra! in which an Obstruction had more than oncefoiled your Endeavors to pass the Catheter . . ." [26].Ranby wrote his Narrative of the last days of Sir Robert and its publication sparked

a pamphlet war, which focused primarily on Jurin's lixivium but also placed theblame on Cheselden for his inability to catheterize Sir Robert. Ranby denouncedJurin's lixivium as a "fiery, sharp-edged corrosive." How could a medicine composedof the strongest capital lye and lime, agents strong enough to cauterize, be takenorally?, he asked [27]. The answer appeared in an anonymous pamphlet:

Why such an outcry and so much bombast to frighten people from takingperhaps the only medicine that had succeeded in a case hitherto thought in-superable by a power of physick. Certainly Ranby had not thought a stone inthe Bladder was to be dissolved by taking Whipped Cream [28].

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Those who defended the lixivium blamed Ranby and the inability of the surgeonsto pass the catheter; they also blamed the stone itself. The "real culprit," wroteJurin, was that Sir Robert was harboring "one calculus of ten thousand." As didMorand, Geoffroy, and Hales, Jurin had found that some calculi moulder intopowder in solutions of soap while some break up into sharp, angular scales orslivers. Some were even impervious to any "digestion in lixivium." It was these lattertypes of stones that were the most troubling and, in Sir Robert's case, the culprits [29].

Writing in the English journal Medical History, Dr. E.A. Spriggs recently con-cluded that Sir Robert died of kidney failure after impaction of a large stone in thebladder outlet. Dr. Spriggs believes that the stone broke up, perhaps owing to theJurin's lixivium, but also believes that there were severe side effects which weakenedSir Robert's already frail constitution. By that time, Dr. Spriggs concluded,"damage to the urinary system was irreversible" [30].

Horace Walpole found it difficult to write anything about his father's death and,if he blamed Ranby, Jurin's lixivium, or Cheselden it is not known, as no referenceexists in the published or unpublished Walpole letters, except a contradictory and in-correct reference in which he writes to Mann that his father "died of the most painfulof all distempers with little or no pain" [31]. Earlier, Horace had written to Mannrather pitifully, that it was impossible for him to tell anyone about his father's death.

Don't expect me to enter upon the subject. After the melancholy twomonths that I have passed, and in my situation, you will not wonder that Ishun a conversation, which could not be bounded by a letter-a letter, thatwould grow into a panegyric, or a piece of moral; improper for me to writeupon and too distressful for us both! A death is only to be felt, never to betalked over by those it touches [32]!

PART IIGOUT AND HORACE WALPOLE'S LAST ILLNESS

The history of gout dates as far back as the history of stone and its history in-cludes almost every notable name in seventeenth- and eighteenth-century medicine,including Sydenham, Boerhaave, Blackmore, Falconer, Cadogan, and Cheyne. Suf-ferers from the gout in the eighteenth century include Fielding, Congreve, Smith,Samuel Johnson, Benjamin Franklin, and William Pitt, lovers all of the good life.As Blackmore wrote, and others happily believed, "[the gout] is bred in the dissoluteand voluptuous indulgence of sensual appetites of the wealthy" [33]. Sydenham,writing a century earlier, agreed:

Gout attacks such old men as, after passing the best part of their lives in easeand comfort, indulging freely in high living, wine, and other generous drinks,at length from inactivity, the usual attendant of advanced life, have left offaltogether the bodily exercises of their youth [34].

And later in his chapter on gout, he adds this:

For humble individuals like myself, there is one poor comfort, which isthis; viz., that gout, unlike any other disease, kills more rich men than poor,more wise men than simple. Great kings, emperors, generals, admirals, andphilosophers have all died of gout. Hereby Nature shows her impartiality:Since those whom she favors in one way she afflicts in another [35].

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Nonetheless, gout was no stranger to other classes of society, as perhaps may bediscerned from this Mother Goose rhyme:

Lazy Tom with jacket blue,Stole his father's gouty shoe.The most harm that Dad can wish him,Is that his gouty shoe may fit him [36].

In the eighteenth century the cures were primarily dietetic, or bleeding, blistering,sweating and physical exercise (a favorite cure of Sydenham's, who recommendedhorseback riding), as well as a complete change in the "whole habit of the body,"meaning moderation in diet and drink [37].

That food and drink were plentiful in the eighteenth century there is no doubt.According to Rosamond Bayne-Powell, the amount of food eaten in England filledforeign visitors with amazement (Fig. 4). Defoe blamed his fellow countrymen forgluttony and especially for devouring enormous quantities of meat, which Cadoganand others regarded as the chief cause of gout. According to Lord Hervey, there wasa Duke of Grafton who ate an ox a day and was taking a course of Bath waters "toenable him to eat two!" It was not just meat that was consumed in large quantity,but also fowl, sea food, fresh trout and salmon, and shellfish. Oysters were so plen-tiful that Dr. Johnson bought them for his cat. Puddings were also very much invogue. Over sixty-odd different puddings were dished up for the wealthy who fre-quented the London Tavern. Consisting of bread, raisins, milk, flour, and ginger,and a not inconsiderable number of eggs, they also consisted of vegetables, suet,veal, green gooseberries, carrot, spinach, and oats. The Englishman also drank: therich foreign wines by the barrelful (the Malagas, Canarys, Madeiras, ports, andclarets) and the poor beer, cider, and gin. Dr. Johnson, who loved port, and who oc-casionally drank three bottles at a sitting, believed that "claret was for boys, port formen, but for those who aspired to be heros, the drink was brandy." And many soaspired, as the consumption of brandy was very large, as was the consumption ofcordials and that old English standby, punch, made by mixing rum or brandy withwater, or with lemon juice, sugar, and spice.

All these were represented at the classic English dinner party. Some were ex-travagantly lavish. Lord Hervey, for example, describes one given by the Austrianenvoy in which thirty-eight dishes were served and the guests ate to repletion forthree-and-a-half hours. Another dinner, modest, of "elegant economy," was servedto a party of eight and consisted of turkey, boiled neck of mutton, greens, soup,plum puddings, salmon, salad, beefsteaks, onions, fillet of veal, peas, Dutch cheese,apple pie, crab, cheesecakes, currant and gooseberry pie, and orange butter, and adessert of strawberries and cream, sweetmeats, jelly, and flummery (a deliciouscombination of ground almonds and cream, covered with chocolate). Samuel Pepys(who was cut for the stone by Thomas Hollier on March 26, 1658, and whothereafter celebrated the anniversary of his lithotomy by toasting his surgeon for thenext forty-five years) describes a "simple" meal he served to nine friends as con-sisting of fricassee of chicken and rabbit, leg of boiled mutton, three carp, a side oflamb, roasted pigeon, four lobsters, three tarts, a lamprey pie, a dish of anchovies,all washed down with assorted wines (38].

Oddly, Horace Walpole, our second protagonist, was abstemious to a turn.Unlike his father, who was robust, portly, and regal (Fig. 5), Horace was lean andtall (Fig. 6). Indeed, the fare served by Horace to his visitors was meager to say the

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FIG. 6. "[Horace Walpole] After breakfast, and in his study; Before dinner, when drest [sic], and in theCabinet; After dinner, and in the Gallery." Drawing by John Carter, 1788. Courtesy Lewis WalpoleLibrary, Farmington, Connecticut.

least, and, toward the end of his life, he became parsimonious as well as abstemious,drinking tea and eating bread and butter while his guests were made to dine onrather poorly cooked mutton, which one visitor, William Beloe, said he personallydidn't like and, in the bargain, was not served cheese, as he should have been, whichhe rather did like [39]!Horace Walpole: what an odd man he was! After leaving Cambridge without a

degree, he set out to chronicle the social and political history of his age. He set downhis observations in the form of intimate letters to certain of his friends, and, whenone died, he would find another with whom to share his social insights and observa-tions of the England of the eighteenth century. But he is a controversial figure.Macaulay, writing in 1833, believed Horace "the embodiment of malice, affectation,and triviality." There is scarcely a writer, writes Macaulay, in whose works "it wouldbe possible to find so many contradictory judgments, so many sentences of ex-travagant nonsense." Macaulay continues:

[Horace] was the most eccentric, the most artificial, the most fastidious,the most capricious of men . .. His features were covered by a mask within amask. When the outer disguise of obvious affectation was removed, you werestill far as ever from seeing the real man. He played innumerable parts andoveracted them all. When he talked misanthropy, he out-Timoned Timon.When he talked philanthropy, he left [John] Howard at a measurabledistance. He scoffed at courts, yet kept a chronicle of their most trifling scan-dal; he scoffed at society, yet was blown away by its slightest veerings ofopinion; he scoffed at literary fame, yet left copies of his private letters, withcopious notes, to be published after his decease; he scoffed at rank, yet

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never for a moment forgot that he was an Honorable . . . [He] appears tohave thought he saw very far into men; but we are under the necessity ofaltogether dissenting from this opinion. We do not conceive that he had anypower of discerning the finer shades of character . . . [Instead] he sneered ateverybody . . . spelt every man backward . . . turned every man the wrongside out . . . [His was] a busy idleness, an indifference to matters which theworld generally regards as important, a passion for trifles [40].

But this is unfair. Wilmarth S. Lewis (B.A. Yale, 1918), the bibliophile, collector,and editor of the Yale Walpole volumes, dismissed Macaulay's biographical essay asa "caricature," "a distorted likeness," an essay "dashed off by a young man flinginguntruths about like confetti" [41]. Mary Berry, a century earlier, wrote thatMacaulay's opinion had been not only "hasty" but "entirely and offensively unlikethe original" [42]. Moreover, others, Carlyle and Lord Byron, for example, admiredhim. R.W. Ketton-Cremer, Walpole's best known biographer, also wished to correctthe record. Horace was not a "heartless fribble," as Hazlitt believed, but a man ofsubstance and feeling [43]. Indeed, as Austin Dobson has written, Walpole was a"wit, a virtuoso, a man of quality" [441. Ketton-Cremer admits, however, that,whereas Walpole's critical taste was good, and his Castle of Otranto very good,Walpole rates not at all as a man of letters. His real talent, instead, was as achronicler and letter writer, for in his letters, continues Ketton-Cremer, there isscarcely a dull page. Here one finds "wit, charm, delicacy, novelty, surprise, andpungency," as we shall see [45].

After his father's death, Horace entertained a great dislike for physicians. "Iabhor physicians . . . they do no good," he wrote to Conway. "In physicians Ibelieve no more than in divines. The Devil has three names: Satan, Beelzebub andLucifer, names given to him in his three capacities of priest, physician and lawyer[46], a sentiment analogous to that of Samuel Johnson, who said that he did not careto speak ill of any man behind his back, but he "believed the gentleman was anattorney!"Horace suffered his first bout of the gout in 1755. His accounts are moving, epic

in proportion. He relates his experiences with uncommon clinical and emotionalprecision, and although he admits that "nothing is so troublesome as to talk ofchronical complaints," relishes, indeed revels in his affliction.

To Stafford: "You will laugh, but I am ready to cry, when I tell you I have no mo-tion . . . Yes, I have got the gout, the gout in earnest. You see virtue and leannessare no preservatives" [47].

To Conway: "I am laid up, an absolute cripple . . . I am bandaged in flannels andswathed like Paul Pliant on his wedding night [48] . . . Nobody would believe mewhen I said I had the gout. They would do leanness and temperance honors to whichthey have not the least claim" [49].

To Lady Suffolk: "The severity of the pain seems to be over, though I sometimesthink my tyrants put me in his chains to t'other foot . . . I am reduced to nothing butbones and spirits" [50].

To Holland: "My weakness is excessive, and I am now lying at length on mycouch, while I write to you and not without pain" [51].

To Holland, later in the month: "I can't write much longer . . . I am at present a

143

ARTHUR J. VISELTEAR

poor creature, and write with so much difficulty that I am sure you will excuse me"[52].

And then, in middle age, a severe bout of melancholia overcomes him as the goutbecomes more severe. He becomes morbid and filled with a cloying self-pity.

To Montagu: "The loss of [my] youth is melancholy enough, but to enter into oldage through the gate of infirmity is most disheartening. My health and spirits makeme take but slight notice of the transition, and under the persuasion of temperancebeing a talisman, I marched boldly on towards the descent of the hill, knowing that Imust fall at last, but not suspecting that I should stumble by the way" [53].

Again to Montagu: "I am tired of the world, its politics, its pursuits, and itspleasure . . . Christ! Can I ever stoop to the regimen of old age?" [54].

To Lady Mary Coke: "I tumble down ten times a day, and am sensible that Iought to grow old; but, I don't know how. I still flatter myself that I shall live to befoolish again" [55].

To Lady Suffolk: "If I could make these accounts more favorable, I should not bepleased, but I know what an untractable brute the gout is . ." [56].

And to Mann a year later: "To be forced back into the world when I am sick of it;to live in London that I detest, or to send myself to Paris, that I like as little; to findno benefit from a life of temperance, to sit by a time instead of braving winds andweather; in short, to grow to moralize. . . Oh, 'tis piteous enough. I dread owning Iam ill . . . In physicians I believe little . . . in short, I was not made for an invalid"[57].

So morbid did he become that, when he wrote in 1779 to Lady Ossory, "I seemyself a poor invalid, threatened with a painful and irksome conclusion" [58], sheworried that he planned to take his own life. Horace responded:

I assure you, Madame, I have no affectation of philosophical indifferenceto life. I like to live whenever I am free of pain . . . but I have so comfortlessa prospect before me- if I have any prospect before me- that it is nocounterfeit levity when I speak with a coolness of a moment that may spareme many sufferings, and what I dread still more, helpless decrepitude [59].

Horace emerged from these morbid and doleful thoughts. The gout went intoremission, his health returned, and he continued, for example, his antiquarian pur-suits and supervision of the design and construction of his home, Strawberry Hill(Fig. 7). Strawberry Hill was a Gothic masterpiece, complete with battlements,crenelations, and Gothic windows, and much acclaimed. The relentless Macaulay,however, denounced it as a "grotesque house, with a pie-crust roof" [60].He also returned to his writing. The Memoirs of George II and George III are well

known, as are his most famous works, the Castle of Otranto (1764) and ThreePrinces of Serendip (1754) [61]. But other than these classics, he also wrote an oddromance, A True Love Story, and a play, The Mysterious Mother, so startling that itwas never produced, but instead privately printed for a few friends on his own print-ing press at Strawberry Hill. A True Love Story tells of the love of Orondantes forAzora, a beautiful African slave. For the plot-conscious Walpole, their love isthwarted and Azora, who is pregnant, falls into labor and miscarries-not a fetus,

144

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but four black puppies! The Mysterious Mother, thought by some biographersHorace's attempt to deal with his unresolved Oedipal complex, is about a young manwho falls in love with his mother's maid. In the meantime his mother's lover diessuddenly and, when she learns that her son is planning an assignation with her maidat a time when he should be mourning, she plans a terrible revenge. She sends themaid away and takes the maid's place for the love tryst. The inevitable occurs andnine months later the mother delivers a child, Adeliza. In the meantime, shebanishes her son; but, equally inevitably, he returns and ultimately falls in love withnone other than Adeliza, at one and the same time his sister and daughter! Themother, horror stricken at these events, confesses and takes her life, Adeliza enters aconvent, and Edmund goes off to war and his own unhappy end [62].

In the interlude between attacks, Horace was a favored dinner companion. Hisreputation as a raconteur was well known and his wit is revealed in the many anec-dotes set down in his letters and recorded in the diaries of those who knew him, suchas Lord Glenbervie, Joseph Farrington, and Mary Berry.Lord Glenbervie, for example, recorded some of Horace's anecdotes, related in

October 1796, a few months before his demise yet in full possession of his wit and"anecdotal skill." Glenbervie writes that Horace told of the Duchess of Queensberry,who, when young, was Lady Kitty Hyde. She was extraordinarily beautiful. Oneday, as she was riding down the Strand with her mother, their carriage was momen-tarily delayed by a cart stalled at a crossing. A second cart, also delayed, stoppedalongside and the driver took notice of Lady Kitty. He clenched a pipe in his teethand, after a moment, said to Lady Kitty: "My dear, my pipe is gone out, pray lendme those eyes of yours to light it again." Horace then added that "A Frenchmanmight think this worthy of the character of Paris, and those who think everythingrefined and polite prevailed in Athens even among the lowest ranks would say it wasworthy of Athens" [63].A second anecdote told of the first Duchess of Queensbury's cousin, whom

Orford called the "mad Earl." This was Edward Hyde, third Earl of Clarendon,Governor of New York and New Jersey from 1701 to 1708. Orford said he was a"clever man," but his great insanity was dressing himself as a woman. Orford saidthat when governor in America he opened the Assembly dressed in that fashion.When some of those about him remonstrated, his reply was, "You are very stupidnot to see the propriety of it. In this place and particularly on this occasion, I repre-sent a woman [Queen Anne] and ought in all respects to represent her as faithfully asI can" [64].When gout returned, Horace, shunning physicians and quacks alike, would find

relief in two practices: donning foot coverings, which he called "bootikins" (Fig. 8),and dipping his gouty feet into ice water.

To the Reverend William Cole in 1775: "You must tie [the bootikins] as tight asyou can bear, the flannel next to the flesh; and when you take them off, it should bein bed. Rub your feet with a warm cloth, and put on warm stockings, for fear ofcatching cold while the pores are open" [65].

In countless letters, he proclaimed the efficacy of the bootikins, which hedemonstrated by stamping up and down on the marble hearth at Strawberry Hill.The bootikins were made of oiled silk, padded, lined with wool, and reached abovethe knee, like ballet dancers' warm-up socks. Horace also found relief in his cold-water cure, often sharing it with others.

146


FIG. 8. "A Military Salutation." Colored etching [P. Roberts?], 1807. Courtesy Clements C. Fry Col-lection, Yale Medical Library. No illustration of Horace Walpole's "bootikins" is available; thosedisplayed in this etching probably come close to his design.

To Mann in 1765: "Dip your feet in cold water . . . I have tried hot medicines andcold, warmth and air, water and ice, brandy and fruit . . . but water and ice is best"[66].And, in 1766, when all else failed, Horace would repair to Bath where the wealthy

went to take the cure. The drill was to rise at 7, be in the bath by 8:30, remain im-mersed neck-deep for an hour, and then play cards, rest, or eat for the rest of theday. Walpole wrote that he was bored; others had the time of their lives (Fig. 9).Some, however, were terrified. In Smollett's Humphrey Clinker, Squire Brambletook one look at what was expected of him and ran off to tell his physician:

"I grant that physick is a great mystery in its own nature and like othermysteries requires a strong gulp of faith to make it go down . . . Two daysago I went to Bath and the first object which met my eyes was a child full ofscrofulous ulcers . . . I am now as much afraid of drinking as of bathing, forafter a long conversation with the [Bath] doctors about the construction ofthe pump and cistern, it is very far from being clear that the patients in thePump Room do not swallow the scourings of the bathers!" [67].

Also in the Walpole letters there appears another curious lament, to which I al-luded earlier. Walpole was ectomorphic, abstemious, and temperate; virtue andleanness, he wrote, had not been "preservatives" in his case.

147

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ARTHUR J. VISELTEAR

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FIG. 9. "Comforts of Bath." Plate 9. Etching with slight aquatint by Thomas Rowlandson, 1798.Courtesy Clements C. Fry Collection, Yale Medical Library.

To Montagu: "I had trusted my abstinence for keeping me from [the gout] . . . If Ihad any gentlemanlike virtue, as patriotism or loyalty, I might have got somethingby them: I had nothing but that beggardly virtue temperance, and she had not in-terest enough to keep me from it" [68].

And then he also adds ...

"If either my father or mother had had it, I should not dislike it so much. I am her-ald enough to approve it if descended genealogically-but it is an absolute upstart inme" [69].

. . . which has led some, Lady Mary Wortley Montagu, for example, to speculatethat Horace was not Sir Robert's son at all, but instead the illegitimate offspring ofLord Hervey and Horace's mother, Catherine Shorter.Samuel Johnson, who experienced his first attack of gout when he was sixty-seven

years old, was also puzzled to note that neither of his parents had been sufferers; "itwas my own acquisition," he said [70]. About this interesting topic, Van Swieten,known best for his commentaries on Boerhaave's medical treatises, was quoted inthe February 1765 number of The Universal Magazine, as follows:

There is an hereditary gout . . . and I myself have been acquainted withmany, in whom the cause of it could not otherwise be investigated and ac-counted for than by a hereditary preparation; for they lived soberly, chastely,moderately, and yet, even in their youth, had some fits of the gout . . . Itmust certainly appear exceedingly wonderful, in regard to hereditarydiseases, that in the minute molecule of a future man, there should sotenaciously be riveted that, which after the expiration of thirty-years, will not


fail to form a disease, having slept, as it were, in profound silence for so greata time [71].

This aspect of the gout bewildered Walpole, puzzled Dr. Johnson, and was to belooked into more deeply by Van Swieten. In an age when epidemiological investiga-tions were rather primitive, with the exception of Jurin's analysis of inoculation datafor smallpox in the 1720s [72] and Sir George Baker's classic investigation of plumb-ism in the cider-producing communities of Devonshire in the 1760s [73], it is under-standable that this line of investigation was not pursued more thoroughly.Toward the end of his life, Horace became more infirm. There were times he

became so infirm that his secretary, Thomas Kirgate, wrote his letters. He wasplagued by tophi and wrote to Mann that one of his fingers, "which has long been aquarry for chalkstones, and is now inflamed, has burst, and is so sore that [I] cannothold a pen" [74]. To Mary Berry in 1795 he wrote almost daily of his increasingdisabilities, and, by the end of 1796, his health was beyond repair [75]. Attended bya few friends, his secretary, and servants, he died in his father's home in ArlingtonStreet, where Sir Robert himself had died fifty-two years earlier. According to LordGlenbervie, he was in "much pain . . . and [suffering] from a great imbecility or lossof memory, of which he was sensible, so that his condition was lamentable and hisdeath a real relief to himself and his friends" [76].

Joseph Farrington, the painter and diarist, also describes Horace's feebleness atthe end and adds that little could be done as Horace was "very unwilling to takephysick," by which he meant opium. In those last days, Farrington also notedmemory loss, abscesses, and loss of appetite. Farrington then tells us of thepostmortem:

His Lordship's body was opened, and though he is in his 80th year . . . andhad been much afflicted with gout, his organs were perfectly sound. Therewere no adhesions nor any defect in the vitals. He took no sustenance forsome days and may be said to have starved. He died in much pain [77].

A month earlier, on February 15, 1797, Horace had dictated his own obituarynotice to his secretary. The notice was sent in 1982 by a descendant of Horace'suncle, the Honorable Robin Walpole, to the Lewis Walpole Library in Farmington.I am indebted to Mrs. Catherine Jestin of the Lewis Walpole Library for showing itto me and permitting me to quote it. The note reads:

Yesterday died, at the very advanced Age of between Eighty and Ninety, athis House in Berkeley Square, Horace Walpole, fourth Earl of Orford, aftera severe Fit of the gout all over him.

Kirgate then penned this annotation: "Dictated by himself, February 15, 1797 in aderanged State" [78].

REFERENCES

1. The first part of this paper is adapted from my two earlier articles, "The Last Illness of Sir RobertWalpole, First Earl of Orford," Bull Hist Med 41:195-207, 1967, and "Joanna Stephens and theEighteenth Century Lithontriptics: A Misplaced Chapter in the History of Therapeutics," Bull HistMed 42:199-220, 1968

2. The London Evening Post, No. 2709, March 16 to March 19, 17453. The Daily Post (London), No. 7970, March 19, 1745; see also Gentleman's Magazine, 15, 164, 1745

150 ARTHUR J. VISELTEAR

4. The Daily Gazeteer, March 19, 17455. Ranby J: Narrative of the Last Illness of the Right Honorable the Earl of Orford: From May 1744 to

the Day of his Decease March the Eighteenth Following. London, Knapton, 1745, pp i-ii6. "Sir Robert's Last Words," from Horace Walpole's MS 'Book of Materials,' 1786, p 39, in Appendix

Four, Volume 26. Lewis WS (ed): The Yale Edition of Horace Walpole's Correspondence. NewHaven, Yale University Press, 1971

7. The letters all appear in the Yale Edition of Horace Walpole's Correspondence edited by W.S. Lewis.The volume shall not be cited unless additional pertinent information is deemed necessary

8. See, for example, A Collection of the Yearly Bills of Mortality, From 1657 to 1758 inclusive. Lon-don, A Millar, 1759, p 138

9. The reader may wish to consult Wilhelm Gottfried Ploucquet's Literatura medica digesta, Tubingen,1808, volume II, and Robert Watt's Bibliotheca Britannica, Edinburgh, 1824, volumes III and IV

10. Blackmore R: A Dissertation on the Gravel and Stone. London, Illsted, 1733, pp 1-211. Cited by Stetten DW: Gout. Perspectives in Biology and Medicine 2:185, 195912. Cary W: "The Hammer for the Stone; so named, for that it sheweth the most excellent remedie that

ever was known for the same." Appended- to Carie's Farewell to Physicke. London, HumphreyLownes, 1611, p 84

13. Paul of Aegina; The Seven Books of Paulus Agineta. Translated by Francis Adams. London, NewSydenham Society, 1844, p 542

14. Schroder J: ZwoXwoyt: or, the History of Animals as they are Useful in Physick and Chiurgery.London, E Cotes, 1659, p 42

15. See, for example, Hartley D: Ten Cases of Persons Who Have Taken Mrs. Stephens' Medicines forthe Stone. London, S Harding, 1738, and, by the same author: A View of the Present Evidence Forand Against Mrs. Stephens' Medicines, as a Solvent for the Stone. Containing One Hundred andFifty-Five Cases with Some Experiments and Observations. London, S Harding, 1739

16. See London Gazette, 18 March 1739/40. Quoted in D'Escherny D: Treatise of the Causes and Symp-toms of the Stone; and the Chief Remedies, now in Use to cure this Distemper. London, JHaberkorn, 1755, pp 17-19

17. Quoted by D'Escherny, pp 19-20 [16] and Hartley in his "Supplement to a Pamphlet entitled, A Viewof the Present Evidence For and Against Mrs. Stephens's Medicines," appended to Hales S: An Ac-count of Some Experiments and Observations on Mrs. Stephens's Medicines . .. to which is added aSupplement . . . By David Hartley. London, T Woodward, 1741

18. Relman AS: Closing the Book on Laetrile. New Eng J Med 306:236, 198219. Geoffroy CJ: Sur le remede anglois pour la pierre. Histoire Academie royale des sciences,

MDCCXXXIX:275-297, 174120. Morand SF: Examen des remedes de Mad'lle Stephens, pour la pierre. Histoire Academie royale des

sciences, MDCCXL:193-194, 174221. Hales S: Haemastaticks: or an Account of some Hydraulick and Hydrostatical Experiments made on

the Blood and Blood-Vessels of Animals: with an Account of some Experiments on Stones in theKidney and Bladder. In Statical Essays, volume II. London, Innys, 1733, p 26

22. Rutty J: Account of Some Experiments and Observations on Joanna Stephens's Medicine for theStone. London, Mandy and Cox, 1745, pp iv-v

23. See Ranby's Narrative [5]; Anon., An Epistle to John Ranby, London, 1745; Anon., Advice to JohnRanby, London, 1745; Anon., A Postscript to the second edition of "An Epistle to John Ranby,"London, 1745; Anon., A letter from a Physician in Town to Another at Bath, London, 1745; JohnRanby, An Appendix to the Narrative of the Last Illness of the ... Earl of Orford, London, 1745;Anon., A Second letter from a Physician in Town to Another in Bath, London, 1745; Anon., TheCharge to the Jury: or, the Sum of Evidence, on the Trial of A.B.C.D. and E.F., All M.D., London,1745

24. Horace Walpole [6]. An undated note, written in Horace's hand, and catalogued in the LewisWalpole Library as "Sir Robert's Last Words," records Sir Robert's courage: "'Tis impossible not tobe a little disturbed at going out of the world, but you see I am not afraid."

25. Ranby [5], pp 44-4526. [James Jurin], An expostulatory address to John Ranby Esq. occasioned by his treatise on gun-shot

wounds and his narrative of the Earl of Orford's last illness. London, M Cooper, 174527. Ranby: An Appendix [23], pp 39-4128. A Second letter [23], p 929. Jurin J: An Account of the Effects of the Soap-lye Taken Internally for the Stone, in the Case of

James Jurin, M.D., written by Himself. 2nd ed. London, Manby, 1745, p 26


30. Spriggs EA: The Illnesses and Death of Robert Walpole. Medical History 26:421-428, 198231. Horace Walpole to Horace Mann, April 15, 174532. Horace Walpole to Horace Mann, March 29, 174533. Blackmore R: Discourses on the Gout, Rheumatism, and the King's Evil, London, J Pemberton,

172634. Latham RG (ed): The Works of Thomas Sydenham, M.D. London, New Sydenham Society, 11,

1848, p 12335. Ibid, pp 128-12936. Stetten [11], p 18637. Sydenham [34], pp 149, 15138. Bayne-Powell R: Housekeeping in the Eighteenth Century. London, John Murray, 1956, pp 66-177;

see also Drummond JC, Wilbraham A: The Englishman's Food.... London, Jonathan Cape, 1958,p 254, and William Cadogan's popular Dissertation on Gout, published in 1771

39. Beloe W: The Sexagenarian, or the Recollections of a Literary Life. I, pp 278-279, 29340. Macaulay [Lord]: Critical, Historical, and Miscellaneous Essays. Boston, Houghton, Mifflin and

Co, 1886, pp 143-193; Macaulay's essay review appeared in the October 1833 number of the Edin-burgh Review

41. Lewis WS: Rescuing Horace Walpole. New Haven, Yale University Press, 1978, p 642. Ibid43. Ketton-Cremer RW: Horace Walpole: A Biography. London, Duckworth, 1940, pp 17 ff; see also

Lewis WS: Horace Walpole. The Andrew Mellon Lectures in the Fine Arts, 1960. New York, Pan-theon, 1961, pp 68, 141

44. Dobson A: Horace Walpole. In Dictionary of National Biography, pp 627-63345. lbid, p 63246. Hutchinson R: Medicine in Horace Walpole's Letters. Annals of Medical History 6:56, 193447. Horace Walpole to Stafford, August 7, 176048. A reference to Congreve's popular play, The Double Dealer49. Horace Walpole to Conway, August 7, 176050. Horace Walpole to Lady Suffolk, July 3, 176551. Horace Walpole to Holland, July 15, 176552. Horace Walpole to Holland, July 25, 176553. Horace Walpole to Montagu, July 28, 176554. Horace Walpole to Montagu, July 28, 176555. Horace Walpole to Lady Mary Coke, November 17, 176556. Horace Walpole to Lady Suffolk, December 5, 176557. Horace Walpole to Horace Mann, September 9, 176658. Horace Walpole to Lady Ossory, November 1, 177959. Ibid, January 1, 176060. Macaulay [40], pp 145, 14961. Yale Walpole [6], volume 26; Walpole coined the word "serendipity," but the story, from an Indian

author named Amir Khusrau, who flourished in the early fourteenth century, was brought out withthe title Pereginaggio di tre giovanifigiuol: del Re di Serendippo by Christoforo in 1557 in Veniceand by Chevalier de Mailly in 1719 as Le Voyage et les adventures des trois princes de Serendip.

62. Kallich M: Horace Walpole. New York, Twayne, 1971, pp 92-122. About The Mysterious Mother,Lord Byron, however, had nothing but high praise. In his preface to Marino Faliero, Doge of Venice,Byron worte: "It is the fashion to underrate Horace Walpole; firstly, because he was a nobleman, andsecondly, because he was a gentleman; but to say nothing of the composition of his incomparable let-ters, and the Castle of Otranto, he is the 'Ultimus Romanorum,' the author of The MysteriousMother, a tragedy of the highest order, and not a puling love-play. He is the father of the firstromance, and surely worthy of a higher place than any living writer, be he who he may." Byron[Lord]: Marino Faliero, Doge of Venice. An Historical Tragedy in Five Acts. With Notes.... Lon-don, John Murray, 1821, p xx

63. Bickley F (ed): The Diaries of Sylvester Douglas (Lord Glenbervie). London, Constable and Co, Ltd,1928, I, pp 74-78

64. Ibid65. Horace Walpole to the Reverend William Cole, April 25, 177566. Horace Walpole to Horace Mann, August 12, 176567. Cited in Copeman WSC: A Short History of the Gout and Rheumatic Diseases. Berkeley, University

of California Press, 1964, p 92

152 ARTHUR J. VISELTEAR

68. Horace Walpole to Montagu, August 12, 176069. Ibid70. Cited in Rogers P: Gout. Times Literary Supplement, March 20, 1981, pp 317-31871. The Universal Magazine, February 1765; courtesy Lewis Walpole Library72. See Miller G: The Adoption of Inoculation for Smallpox in England and France. Philadelphia, Uni-

versity of Philadelphia Press, 195773. Baker G: An Essay Concerning the Cause of the Endemial Colic of Devonshire [1767]. New York,

Delta Omega Society, 195874. Horace Walpole to Horace Mann, January 22, 1780; see also letter dated February 13, 178675. Horace Walpole to Miss Mary Berry, December 6, 1795; cited in Toynbee P (ed): The Letters of

Horace Walpole, Fourth Earl of Orford, volume 15, 1791-1797. Oxford, Clarendon Press, 1905, p389

76. Lord Glenbervie [63], pp 131-13277. Grieg J (ed): The Farrington Diary, volume 1 (third edition). New York, George H Doran Co, 1923,

p 19678. Obituary notice dictated by Horace Walpole to his secretary, Thomas Kirgate, February 15, 1797;

unpublished, to be included in a volume of Additions to the Yale Edition of Walpole's Cor-respondence (1983); see also Horace Walpole's obituary in Gentleman's Magazine, part 1: 256-261,1797

the last illnesses of robert and horace walpole

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