When I was 12 and laughed my way through my first reading of “Pride and Prejudice,” I didn’t really consider the fact that its author, Jane Austen, had died young.
After all, she was 41 at her death in 1817. Middle-aged to a 12-year-old.
Now, of course, I realize that Austen died in the prime of her life — and at the peak of her writing skills. Her last fully completed novel, “Persuasion,” which was published posthumously, has a undercurrent of loss, regret and, at times, despair that makes it, in my unscholared opinion, the most interesting of her books.
Like so many of Austen’s fans, I’ve always wondered what great novels we’ll never read because of her early death. (A large number of Austen’s personal letters were also lost to us, sadly, when her beloved but rather prim sister, Cassandra, set them aflame in her fireplace.)
I never questioned what caused Austen’s death, however, until I read Claire Tomalin’s terrific 1997 biography, “Jane Austen: A Life.” I had always accepted (without really thinking about it) that Austen had died of Addison’s disease, a once-fatal (but now completely treatable) disorder in which the adrenal glands produce insufficient amounts of cortisol and other hormones.
Addison’s disease has been the generally assumed cause of Austen’s death since first proposed in 1964 by Zachary Cope, a British surgeon. Cope also suggested that Austen’s illness was triggered by tuberculosis (TB), once the most common cause of Addison’s.
Symptoms of Addison’s disease occur slowly and, according to the Mayo Clinic, include muscle weakness, fatigue, weight loss, decreased appetite, fainting (from low blood pressure), and darkening of the skin (hyperpigmentation). Near the end, as the adrenal glands fail, the symptoms may include lower back and abdominal pain, severe vomiting and diarrhea, and, eventually, loss of consciousness.
Austen had many of these symptoms.
Tomalin, however, argues equally convincingly that Austen’s reported deathbed symptoms are more in line with a diagnosis of lymphoma (cancer of the lymphatic system).
So I read with interest an article published Monday in the journal Medical Humanities that resurrects the question of what killed Jane Austen. The author of the article, Katherine White, who has Addison’s herself, argues for a third possibility: run-of-the-mill (at the time) bovine tuberculosis, probably from drinking infected, unpasteurized cow’s milk.
White uses a variation of Sherlock Holmes’ famous “the dog that didn’t bark” reasoning to come to her conclusion:
[W]e should assess the cause of Jane Austen’s demise, not only on the evidence of her reported symptoms, but also on the evidence of what she did not have. … [V]omitting did not feature in Jane Austen’s final 48 hours. Her family did not report an emaciated appearance and took comfort in the fact that she did not suffer greatly during her final illness. Austen herself reported that she had a clear head and scarcely any pain. [Indeed, two days before she died, Austen’s mind and humor were so intact that she was able to dictate 24 lines of comic verse to Cassandra from her sick bed.] Therefore, we can conclude that it is most likely she did not die from Addison’s.
As for Tomalin’s theory:
While lymphoma would be one possible cause of the exhaustion, recurrent fever, bilious attacks [nausea and vomiting] and rheumatic pains described by Austen, disseminated tuberculosis affecting the joints and liver — probably of bovine origin — would offer a simpler explanation of her symptoms.
White acknowledges that Addison’s disease cannot be entirely ruled out. And I, for one, am not 100 percent convinced by all of her pro-TB arguments, particularly her suggestion that the “black and white and every wrong color” description of Austen’s skin near the end of her life simply refers to dark circles under the novelist’s eyes. That finding too easily brushes aside (I think) the fact that pigmentation changes often occur with late-stage Addison’s disease.
But I want to believe White’s conclusion. Death from TB would have been much less painful than one from Addison’s disease.
Cassandra did write that Austen slept peacefully during her last 48 hours. For that, we can be thankful. But I will always grieve the novels she never got to write — or, to put it, frankly, more selfishly, we never got to read.