Jane Austen's World

By Brenda S. Cox

“God grant me patience, Pray for me Oh Pray for me.” –Jane Austen’s last recorded words, from Cassandra’s letter to Fanny Knight, July 20, 1817

You probably know that Jane Austen died young, at age 41, on July 18, 1817.

What did she die of? We don’t know, but many scholars have speculated. Most of these conditions had not even been identified in Austen’s time.

Her Symptoms

From letters we learn that Austen had:

• Fluctuating symptoms, better, worse, better, worse
• Pain in her face (Sept. 15 and 24, 1813, exacerbated by cold air), back (Sept. 8, 1816), and knee (Feb. 21, 1817), though not much pain near the end
• Discoloration of skin, especially face, “black and white and every wrong color” (March 25, 1817)
• Pale skin (from her niece Caroline’s observations)
• Recurrent fevers (March 25, April 6, 1817)
• Sleepless nights
• A clear mind (she wrote a poem on Winchester Races shortly before her death)
• Fatigue, weakness, langour, often needing to lie down (May 22, 1817, as well as months before that)
• A “Discharge” for a week, which the “applications” of a Winchester doctor alleviated (May 22, 1817)
• A seizure near the very end; when repeated, Cassandra describes it as faintness (July 20, 1817)

Her Self-Diagnosis

What did Austen think she had? On Jan. 24, 1817, she wrote, “I am more & more convinced that Bile is at the bottom of all I have suffered, which makes it easy to know how to treat myself.” And again on April 6, “I have been suffering from a Bilious attack, attended with a good deal of fever.”

Bile is often mentioned in Austen’s letters as a source of disease for her family and friends. The liver produces bile as part of the digestive process. She implies that she has a digestive disorder.

On Feb. 21, 1817, Austen wrote, “I am almost entirely cured of my rheumatism, just a little pain in my knee now & then, to make me remember what it was, & keep on flannel.” March 26, 1817, she wrote, “I have still a tendency to Rheumatism.” So at this point she attributed her pain and weakness to rheumatism in her joints.

Contemporary Treatments

In Austen’s time, doctors considered that the “humours” in the body: blood, phlegm, yellow bile, and black bile, had to be in balance. In Dr. Buchan’s popular Domestic Medicine (11^th ed., 1790), he writes, “Jaundice, indigestion, loss of appetite, and a wasting of the whole body” are “the consequences of a vitiated state of the liver, or obstructions of the bile” (56). 

For an intermittent fever, Dr. Buchan recommends ipecac, which will cause the patient to vomit up bile and clean out the system (150). For stomach issues caused by bile, he recommends bleeding, liquids and light foods (such as Mr. Woodhouse’s gruel), and warm baths (290-291).

For jaundice (probably what we would call hepatitis, which turns the patient’s skin and eyes yellow, from excess bile), Buchan says “numberless British herbs” supposedly cure it, but he observes that generally the disease goes away by itself, so the herbs don’t necessarily cause the cure. He goes on to recommend hempseed and several other herbs that he thinks work. He also describes other diseases as connected with bile.

John Wesley, the Methodist preacher, wrote a very popular book called Primitive Physic: Or, An Easy and Natural Method of Curing Most Diseases. It went through many editions and is still available today (I bought mine at the Wesley Museum in London). His goal was to list “cheap, safe, and easy medicines” available to “plain, unlettered” people. He marked those he had tried himself. Wesley started with lifestyle recommendations, such as, eat and drink moderately, and exercise regularly. Then he gave remedies for many diseases.

For “bilious cholic” (upset stomach ejecting bile), he recommends drinking warm lemonade or taking “sweet oil.” He gives nine remedies for rheumatism, including cold baths, warm steams, and eating barley-gruel with currants, roasted apples, fresh whey, and light pudding.

We don’t know what remedies Austen might have tried for her “bile” or rheumatism.

Mr. Curtis, her apothecary in Alton, and Mr. Lyford, her doctor in Winchester, tried to cure her, but we don’t know what diagnoses they made. For some possibilities, as well as more modern ideas, see “Did Jane Austen die from Nervous Consumption on July 18, 1817?” 

Modern Theories

Many modern scholars and doctors have speculated on what might have caused Jane’s death. Here are a few of their ideas:

Addison’s disease (tuberculosis of the adrenal glands)

This theory was put forward by Sir Zachary Cope in 1964. Austen’s langour, fatigue, skin discoloration, and stomach irritability fit with Addison’s. However, her niece described her as pale, while Addison’s generally gives a tanned appearance, according to Claire Tomalin in Jane Austen: A Life. The National Organization for Rare Disorders says, though, that Addison’s can cause white patches and darker patches, including black freckles on the face, so that might fit. However, her clear mind and lack of pain towards the end do not fit with Addison’s, apparently.

Lymphoma, such as Hodgkin’s Disease, a form of cancer

A study in June 2005 gives Hodgkin’s Disease as a more likely diagnosis. This causes an immune deficiency. The article considers Austen’s medical history of recurrent infections, including possible conjunctivitis which gave her eye problems, typhus when she was a child, and the whooping cough she contracted as an adult. She may have had an immune deficiency and lymphoma for years. Jane Austen’s birth, a month late, could have made her more susceptible to an immune deficiency. Trigeminal neuralgia, causing her face pain exacerbated by cold, could also be associated with a lymphoma.

Tuberculosis, or consumption

Another writer, K.G. White,  suggested in 2009 that tuberculosis, or consumption, was much more widespread in Austen’s day than Addison’s, and is another possible cause of her death. It may have been a secondary infection on top of a lymphoma. 

Lupus (an autoimmune disease)

An even more recent theory claims that all Austen’s symptoms were consistent with systemic lupus erythematosus. Joint pain, skin discoloration, fever, fatigue, and fluctuating symptoms that come and go are all consistent with lupus. See “Black and White and Every Wrong Colour.” 

Accidental Arsenic Poisoning

The British Library suggests that Austen may have died of accidental arsenic poisoning, from arsenic in medications or the water supply. They tested three pairs of spectacles from Austen’s writing desk, which are believed to be hers. Based on the prescription strengths, the researchers speculate that she may have gotten cataracts due to arsenic poisoning. Arsenic could also have caused her facial discoloration. See Dr. Sandra Tuppen’s article  and “Jane Austen Poisoned.”

Breast Cancer

Another possibility is breast cancer, which Carol Shields suggests in Jane Austen: A Life (NY: Penguin, 2001), 173-174. Austen’s Aunt Philadelphia (her father’s sister) apparently died from breast cancer, and estrogen fluctuations might have caused Austen’s fevers. 

Typhus

Another theory is that she died of a recurrence of the typhus which almost killed her as a child, while she was in Southampton. See Linda Robinson Walker, “Jane Austen’s Death: The Long Reach of Typhus?”

Overdose?

Helena Kelly, in Jane Austen: The Secret Radical, thinks that whatever Austen was sick with, “a dose of opiates strong enough to knock her out completely for nine hours has to have at least hastened her death” (282). The laudanum Dr. Lyford gave her may have been too high a dose, which caused her to eventually stop breathing.

In the end, we don’t really know what took Jane Austen away—to heaven, as her sister Cassandra strongly believed. We know she left this world before she could finish all the works we wish she might have done. But we’re thankful for those works she did complete and the legacy she left to us all.

What’s your favorite theory about what happened to our beloved Jane? Can you add any information about the possible diagnoses above?

Jane’s obituary in the Salisbury and Winchester Journal says, “Her manners were gentle, her affections ardent, her candour was not to be surpassed, and she lived and died as became a humble Christian.” (Candour at this time meant that she thought the best of people, as Jane Bennet did.) (Quoted in Claire Tomalin, Jane Austen: A Life.)

For spiritual and religious aspects of death in Austen’s novels and in her experience, see my article in Persuasions On-Line, “Preparation for Death and Second Chances in Austen’s Novels.” 

You can connect with Brenda S. Cox, the author of this article, at Faith, Science, Joy, and Jane Austen or on Facebook.