My previous blogs about Anne de Bourgh’s health asked these questions: What illness made Anne sickly? and Might Anne have had scarlet fever? You may recall that Anne de Bourgh is the heiress of Rosings Park in Jane Austen’s beloved novel Pride and Prejudice. In Austen’s novel, Elizabeth Bennet describes Anne as being “sickly and cross.” For nearly twenty years I wondered what made her so.

The answers to the above questions were among the first I addressed when I began to write about Anne. (My version of her story was published in my novels Rosings Park and Cousin Anne.) Among the illnesses I considered as contributors to her disagreeable nature were pneumonia, chronic tussis (a lingering cough), and rheumatism. These were among the acute and chronic diseases reported in London in 1803,1 a time when Anne de Bourgh was a teenager by my calculations.

19th-Century Use of Magnets for Rheumatism

Use of magnets for rheumatic affections

Use of magnets for rheumatic affections, 1842

In the early days of researching Rosings Park, I browsed various medical books and journals downloaded from Google Books. A brief article in the Provincial Medical and Surgical Journal of 1842 caught my eye. It described the use of magnets in treating rheumatism.2 Magnets were said to relieve pain in the treatment of rheumatic ophthalmia, among other conditions. Even today, numerous websites promote the use of magnets for rheumatoid pain management, but a well-designed 2013 clinical study found no benefit of magnet therapy (beyond the placebo effect) for 70 subjects who wore magnetic wrist straps or a copper bracelet.

Anne de Bourgh’s Rheumatic Affection

Next I found a case study, also published  in 1842, in which a 40-year-old lady had become both bilious and irascible due to indulging in a diet rich in fatty foods and peppers. She soon succumbed to a severe rheumatic fever.3 Hmm. Rheumatic fever.

Streptococcus pyogenes, the bacterium responsible for scarlet fever and other infections (Source: Wikimedia Commons)

Streptococcus pyogenes, the bacterium responsible for rheumatic fever, scarlet fever, strept throat, and other infections (Source: Wikimedia Commons and the Public Health Image Library of the Centers for Disease Control and Prevention)

Today we know that rheumatic fever is a complication of a strept throat infection, although it can also arise after scarlet fever. In fact, one bacterium is at the heart of all three conditions: Streptococcus pyogenes. An untreated strept infection can cause inflammation, fever, and vomiting, and lead to scarlet fever or rheumatic fever. Scarlet fever produces a characteristic skin rash. Rheumatic fever can cause joint pain and damage to heart valves.

Another complication of rheumatic fever is arthritis. Here might be the reason Anne de Bourgh was sickly and cross: when she was a child she had rheumatic fever brought on by an untreated strept infection. Her case of rheumatic fever produced arthritis and possibly a heart valve problem.

In today’s developed countries, strept throat would be treated and cured with an antibiotic, which would reduce the patient’s chance of developing rheumatic fever or scarlet fever. But Anne de Bourgh was not so lucky. Her strept throat was “untreated.” That is, it could not be cured by an antibiotic for two reasons: 1) antibiotics were not available during the Regency period, and 2) Regency-era treatments did not address the underlying bacterial cause. (The germ theory of disease was unknown at that time.) Rather, Anne might endure any number of early 19th-century treatments for these conditions, such as those prescribed in the 1842 case study.

Dr. Humbugallo, an itinerant vendor, selling his medicines (Source: Wellcome Library, London. Wellcome Images #L0015838 CC BY 4.0)

Dr. Humbugallo, an itinerant vendor, selling his medicines (by Thomas Rowlandson) (Source: Wellcome Library, London. Wellcome Images #L0015838 CC BY 4.0)

Treatments for Rheumatic Fever in 1842

Case study for Anne de Bourgh's illness

1842 case study for Anne de Bourgh’s illness3

In 1842 treatments for rheumatic fever were dreadful and not much different from those that would have been used in the Regency period. There would, of course, be an application of leeches—in this case, 18 of the little critters—to the stomach, because the symptoms of acute inflammation were manifested in the stomach and liver. Then, a powerful enema containing aloes dissolved in castor oil was administered. Next, the lady’s hands and feet were wrapped in oil silk and flannel. The room was warmed by a small fire to about 65° F and the lady given cold water to drink.3

After the application of leeches and the enema, she was given pills containing rhubarb and ipecacuanha, both designed to stimulate the secretion of liver fluids, followed by a mixture of camphor-julep (good for fevers) and a solution of potass to stimulate perspiration, urinary, and salivation.

On day 2, her abdomen was fomented with mustard and water for several hours, after which she endured another purgative enema. At intervals, she was fomented with a poultice of linseed meal mixed with laudanum (opium) to relieve her joint pains. And so it went.

Eventually the lady recovered and learned to take special care of her digestive organs. Thank goodness. After enduring the early 19th-century treatments for complications arising from strept throat and rheumatic fever, I cannot blame Anne for feeling sickly and cross! Indeed, her natural constitution must have been quite hardy for her to have survived a strept infection at all.


1Anon. Medical and Physical Journal, Vol. XI (January – June), 1804, p. 83 (PDF p. 94).
2Anon. Use of the magnet in rheumatism. In: Provincial Medical and Surgical Journal, Vol. II (No. 25), Saturday, September 24, 1842, p. 241 (PDF p. 246).
3Anon. From: Dr. Gully’s Simple Treatment of Disease, reported in the Provincial Medical and Surgical Journal, Vol. II (No. 25), Saturday, September 24, 1842, pp. 501-502 (PDF pp. 506-507).