I was struck by the alteration in herself – She was very pale – her voice was weak and low and there was about her, a general appearance of debility and suffering; but I have been told that she never had much actual pain. She was not equal to the exertion of talking to us, and our visit to the sick room was a very short one – Aunt Cassandra soon taking us away …16
In a letter to her brother Charles of 6 April 1817, Jane tells of further problems with her health:
I have been really too unwell the last fortnight to write anything that was not absolutely necessary. I have been suffering from a Bilious attack, attended with a good deal of fever. – I was so ill on friday & thought myself so likely to be worse that I could not but press for Cassandra’s return, with Frank …17
The attacks, or crises, were becoming more severe, making Jane feel apprehensive at her rapid deterioration. Jane wrote a despairing letter to her friend Anne Sharp; it contains several more important clues as to from what she was suffering:
in spite of my hopes & promises when I wrote to you I have since been very ill indeed. An attack of my sad complaint seized me within a few days afterwards – the most severe I ever had – & coming upon me after weeks of indisposition, it reduced me very low…. My head was always clear, & I had scarcely any pain; my chief sufferings were from feverish nights, weakness & Languor.
She told Anne that she had arranged to go to Winchester so as to be under the care of a well-known surgeon there, Mr. Lyford.18 This was Giles King Lyford, Surgeon-in-Ordinary at the County Hospital. (It will be remembered that Giles’s uncle, John Lyford, surgeon of Basingstoke, had previously attended Jane’s mother Mrs Austen).
Shortly afterwards Jane wrote to her nephew James E. Austen-Leigh, and said that her appearance was still distressing to her:
I will not boast of my handwriting; neither that, nor my face have yet recovered their proper beauty, but in other respects I am gaining strength very fast.
She also told James that she was eating her meals in a rational way and was employing herself, though lying on the sofa most of the day.19
James E. Austen-Leigh describes how, during what was to be Jane’s final illness, ‘two of her brothers, who were clergymen [i.e. James and Henry], lived near enough to Winchester to be in frequent attendance’.20
Nowhere are Jane’s loving feelings towards Cassandra made clearer than in a letter that she wrote in May 1817 to Frances, daughter of James Tilson (who was a partner in her brother Henry’s former London bank), when she was seriously ill. Whatever their past differences may have been, all was now forgiven and forgotten. Jane wrote:
I will only say further that my dearest sister, my tender, watchful, indefatigable nurse, has not been made ill by her exertions. As to what I owe to her, and to the anxious affection of all my beloved family on this occasion, I can only cry over it, and pray for God to bless them more and more.21
In Persuasion, the heroine Anne Elliot attributed the fact that she had become prematurely ‘faded’, ‘thin’, and ‘haggard’, to a failed romance. This implies that Jane may well have done the same. In fact, the real cause of Jane’s debility lay elsewhere, as will soon be seen. As for Anne, her bloom returned once more when she was assured of the true love of Captain Wentworth.
Notes
1. Caroline Austen, My Aunt Jane Austen, p. 5.
2. James E. Austen-Leigh, A Memoir of Jane Austen, p. 230.
3. David Cecil, A Portrait of Jane Austen (London: Penguin Books, 1980), p. 112.
4. Letter from Jane Austen to Cassandra Austen, 27/28 October 1798.
5. Letter from Jane Austen to Cassandra Austen, 24/26 December 1798.
6. Letter from Jane Austen to Cassandra Austen, 2 June 1799.
7. Letter from Jane Austen to Cassandra Austen, 25 January 1801.
8. Letter from Jane Austen to Cassandra Austen, 30 April 1811.
9. Letter from Jane Austen to Cassandra Austen, 5/8 March 1814.
10. Henry Austen, Biographical Notice of the Author (1818) in James E. Austen-Leigh, A Memoir of Jane Austen, p. 138.
11. Caroline Austen, My Aunt Jane Austen, p. 13.
12. Letter from Jane Austen to Cassandra Austen, 8/9 September 1816.
13. Letter from Jane Austen to James E. Austen, 16/17 December 1816.
14. Letter from Jane Austen to Alethea Bigg, 24 January 1817.
15. Letter from Jane Austen to Fanny Knight, 23/25 March 1817.
16. Caroline Austen, My Aunt Jane Austen, pp. 14–15.
17. Letter from Jane Austen to Charles Austen, 6 April 1817.
18. Letter from Jane Austen to Anne Sharp, 22 May 1817.
19. Letter from Jane Austen to James E. Austen, 27 May 1817.
20. James E. Austen-Leigh, A Memoir of Jane Austen, p. 130.
21. Letter from Jane Austen to Frances Tilson, 28/29 May 1817.
22
Jane’s Mystery Illness Explained
In 1964 an article appeared in the British Medical Journal entitled ‘Jane Austen’s Illness’ by Sir Vincent Zachary Cope, Consulting Surgeon to St Mary’s Hospital, Paddington, London. Jane died, said Cope,
from an ailment the nature of which has never been ascertained, or, so far as I am aware, seriously discussed. No information was furnished by the doctors who attended her, and her relatives were reticent about her illness, so that we are compelled to rely chiefly on the few comments made by the patient herself in the letters that have survived. Fortunately Jane Austen was an accurate observer, and though she made light of her troubles until near the end one can rely on her definite statements.
By perusing Jane’s letters and those of her family, Cope set about attempting to identify the illness that prematurely terminated Jane’s life. Of the symptoms suffered by Jane, Cope concludes that whereas many of them might be accounted for by a number of disease conditions, there are very few disease conditions which could account for them all.
Cope describes how he read Jane’s letter to Fanny Knight of 23/25 March 1817, many times before it struck him that in her use of the words, ‘recovering my looks a little, which have been bad enough, black and white and every wrong colour’, she was describing ‘that symptom which is almost pathognomonic of Addison’s disease’. Cope goes on to explain that this appearance is due to pigmented areas of the skin mingling with non-pigmented areas. There is no disease other than Addison’s disease, he says, that could produce a face that was ‘black and white’ and at the same time give rise to the other symptoms described in her letters.1
Addison’s disease is named after the person who first described it: English physician Dr Thomas Addison (1793–1860) of Guy’s Hospital who, in 1855, published an important work on The Constitutional and Local Effects of Diseases of the Suprarenal Capsules (now commonly known as the adrenal glands). He summarised the main features of the disease as follows:
The leading and characteristic features of the morbid state to which I would draw attention are: anaemia, general languor and debility, remarkable feebleness of the heart’s action, irritability of the stomach and a peculiar change of colour in the skin.
It should also be noted that this is a rare disease; the onset of which is insidious. From time to time there may be severe attacks of nausea, vomiting or diarrhoea. Pigmentation of the skin only occurs late on in the disease and gradually increases – its colour ranging from a bronzy yellow to brown, or even occasionally black. This shows itself, particularly, over exposed parts of the body, such as the face and hands, and wherever prolonged pressure is applied to the skin, such as beneath a waist belt and, occasionally, on mucous membranes as in the mouth. The patient’s temperature is usually, somewhat subnormal.2
Although Addison’s disease was not described until after Jane Austen’s time, it is now known to be caused by a malfunction of the adrenal glands (one of which is situated above each kidney) which normally produce the so-called corticosteroid hormones – hydrocortisone and aldosterone. A deficiency of
the above hormones, which is found in Addison’s disease, causes the pituitary gland to react by secreting excessive amounts of adrenocorticotrophic hormone (ACTH), and also of melanocyte stimulating hormone (MSH). It is the latter which causes the skin to increase its production of melanin pigments – hence the excessive pigmentation.
Another feature of Addison’s disease is the occurrence, at intervals, of so-called Addisonian crises which occur due to the failure of the adrenal glands to produce corticosteroid hormones, which normally help the body to cope with stress. In the Addisonian crisis, the patient develops extreme muscle-wasting, becomes dehydrated, confused and comatose. He or she also suffers from hypotension (low blood pressure) and often hypoglycaemia (a deficiency of sugar in the blood). As Addison’s disease progresses to the chronic stage, the patient becomes tired, weak and suffers with vague abdominal pains and weight loss.3 This begs the question, what causes the adrenal glands to fail?
Samuel Wilks, a pupil of Addison’s and also his co-worker, declared that Addison’s disease was always caused by the suprarenal capsules (adrenal glands) becoming infected with tuberculosis – an infectious disease caused by the bacterium Mycobacterium tuberculosis. Tuberculosis is passed from person to person in airborne droplets, by coughs and sneezes, and it can also be contracted by drinking the milk of tuberculous cattle. The disease, in this latter case, is caused by a similar organism, Mycobacterium bovis.
Tuberculosis commonly begins with the infection of one organ of the body at a so-called primary site. Following this, the infected person will either go on to develop immunity, or the disease will spread to other secondary sites. Any organ of the body may be infected: the commonest being lungs, intestines, bones and glands. (Incidentally, Jane’s great-grandfather John Austen died of ‘consumption’ in 1704 – consumption being an early name for tuberculosis, a disease which appears to consume the body).
In 1911 (when the incidence of tuberculosis among the population was probably little different from what it had been in Jane Austen’s time), an article on Addison’s disease in the Encyclopaedia Britannica read as follows:
The morbid anatomy [anatomy of diseased organs] shows that in over 80% of the cases … the changes in the suprarenals [adrenal glands] are those due to tuberculosis, usually beginning in the medulla [central region of the gland] and resulting in more or less caseation [the destruction of the organ by its conversion into a cheese-like material].
(Note that this figure of 80% is somewhat lower than Wilks’s 100%.)
… that this lesion is bilateral [i.e. affects the adrenal glands on both the right and the left side] and usually secondary to tuberculous disease elsewhere, especially of the spinal column.
It seems more than likely, therefore, that Jane was suffering from tuberculosis, and that this is what had destroyed her adrenal glands. This would explain her night fevers – a typical symptom of tuberculosis (but not of Addison’s disease). Also, if tuberculosis was present in her spinal column which, from the above statement, seems likely, then this could account for the backache of which she complained – this symptom again being atypical of Addison’s disease. How, therefore, did Jane contract tuberculosis?
THE PREVALENCE OF TUBERCULOSIS
In early nineteenth-century England, it is estimated that a quarter of all deaths were due to tuberculosis, and the following examples, which were known to Jane, reveal just how prevalent it was. In November 1798 Jane described how Anna Lefroy had seen ‘a great deal of the Mapletons while she was in Bath’, David Mapleton being a surgeon-apothecary in that city. The Mapletons had a 17-year-old son, of whom Jane remarked: ‘Christian is still in a very bad state of health, consumptive [tubercular] and not likely to recover’.4 In fact, Christian lived on until 1839. On 12–13 May 1801, Jane declared, in respect of 22-year-old Marianne Mapleton, sister of Christian, ‘I am always told that she is better … Her complaint is billious fever’.5 However, shortly afterwards, Jane recorded that Marianne’s disorder had ‘ended fatally’.6 So had Marianne also contracted tuberculosis?
Further evidence that the disease was rife in the community in which Jane lived is born out by Mrs Lefroy, who in June 1801, described how her husband had recently visited one James Corbett, who was ‘in a deep consumption’.7
Jane herself may have contracted tuberculosis from infected milk or other dairy produce, or she may have contracted it via droplet infection through a chance encounter with an infected stranger. However, it is more likely that she caught it from another member of her family, namely her brother Henry.
HENRY AUSTEN
As long ago as 29 October 1801, Henry’s wife Eliza had written to her cousin Phylly expressing concern about her husband
who for five months never enjoyed an hour’s health – His complaints were a Cough, Hectic pain in the side and in short every thing which denotes a galloping consumption [a rapidly spreading form of tuberculosis] in which I believe all his acquaintance thought him.8
On 3 November 1813 Jane wrote to Cassandra about Henry, who had not been well. She wrote that Henry’s
… illness & the dull time of year together make me feel that it would be horrible of me not to offer to remain with him [i.e. at his home in London] – & therefore, unless you know of any objection, I wish you would tell him with my best Love that I shall be most happy to spend 10 days or a fortnight at Henrietta St [where he now lived] – if he will accept me.9
Three days later, Jane wrote again to Cassandra: ‘Dearest Henry! What a turn he has for being ill! & what a thing Bile is!’10 In other words, Henry’s symptoms and Jane’s were similar in this respect.
Henry’s health did not improve, for Jane’s niece Caroline described how, in the autumn of 1815, when Jane was visiting him at his house, now Hans Place, London, ‘He was seized with a low fever and became so ill that his life was despaired of’.11 He survived, however, and was nursed for some weeks by Jane. On 17 October of that year Jane herself stated that Henry was ‘not quite well’ and suffering from ‘a bilious attack with fever’.12 This fever was still present when Jane wrote to Cassandra again the following month. In his Memoir, James E. Austen-Leigh describes Henry’s fever as ‘dangerous’ and his convalescence from it as, ‘slow’.13 As already mentioned, fever, especially at night, is a symptom of tuberculosis, as are ‘bilious attacks’.
It seems likely, therefore, that Henry was suffering from tuberculosis and that Jane contracted it from him. After all, she had nursed her brother for several weeks and it is known that the longer a person is exposed to someone with tuberculosis, the more likely he or she is to become infected. Jane had been in close and prolonged contact with Henry since the autumn of 1815. Her own symptoms had commenced at the beginning of the following year 1816. This correlates with the average incubation period for tuberculosis being twenty weeks, though it can be as short as two weeks.14
If Henry did indeed have tuberculosis, why did he not succumb to the disease? The answer is that the body reacts to an attack of tuberculosis by enclosing the infected area in fibrous tissue, which has the effect of preventing the spread of the infection. (If the bacteria leak out then the infection may spread). Whatever the truth of the matter may be, Henry survived and lived to the age of 78.
EDWARD (AUSTEN) KNIGHT
Jane’s brother Edward, was another member of the family who suffered poor health, and on 24/25 December 1798, Jane wrote to Cassandra about him thus:
I hope with the assistance of Bowel complaints, Faintnesses & Sicknesses, he will soon be restored to that Blessing likewise. – If his nervous complaint proceeded from a suppression of something that ought to be thrown out … the first of these Disorders may really be a remedy, & I sincerely wish it may …15
In other words, Jane believed that it was necessary for Edward to endure the above symptoms, prior to him recovering.
On 2 June 1799 Jane wrote to Cassandra from Bath, indicating that Edward’s health was still not good:
What must I tell you of Edward? – Trut
h or Falsehood? – I will try the former, & you may chuse for yourself another time. – He was better yesterday than he had been for two or three days before, about as well as while he was at Steventon that he drinks at the Hetling Pump [which derived its water from the Hetling spring], is to bathe tomorrow, & try Electricity [or ‘galvanisation’, medical treatment whereby a pulse of electric current is used to stimulate the contraction of the muscles of the body] on Tuesday.16
About a week later Jane reported that:
Edward had been pretty well for this last Week, & as the Waters have never disagreed with him in any respect, We are inclined to hope that he will derive advantage from them in the end …17
However, by 19 June the situation had changed:
Edward has not been well these last two days; his appetite has failed him, & he has complained of sick & uncomfortable feelings, which with other Symptoms make us think of the Gout.18
What was the cause of Edward’s illness? The following remarks by Jane indicate that even his doctor did not know. She said:
[Edward] attributes his present little feverish indisposition to his having ate something unsuited to his Stomach – I do not understand that Mr Anderton [Edward Anderdon, apothecary of Queen’s Square, Bath] suspects the Gout at all.19
Edward was clearly suffering from a chronic illness. His symptoms of sickness, poor appetite, bowel complaints and faintness indicate that he, too, may have been suffering from tuberculosis.
Jane Austen Page 16