What Killed Jane Austen?: And Other Medical Mysteries

by George Biro

  Evan Thomas recognised, however, that the medical establishment was powerful, so he arranged that his three sons had a formal medical training. The eldest, Hugh Owen Thomas, was to emerge as the greatest of all the Thomases.

  Hugh worked first with his father in the city of Liverpool and then as an osteopath in the dock area of the port. As time went on he became outspoken and a mite too forthright for the medical establishment. Although he obtained remarkable results in straightening and lengthening limbs, the medical establishment was very suspicious of the young upstart, for did he not fulfil one of the main criteria of a charlatan in that he was denigrating of others, especially doctors?

  What the surgeons either did not realise, or, more likely, chose to ignore, was that he was one of their own, having qualified at University College Hospital, London, in 1857. He never had access to any hospital beds, yet managed to leave the profession two legacies, one of which is used to this day—the famous Thomas Splint for fractured legs. The other is the rather gruesome Thomas Wrench for straightening bones, and long since abandoned.

  Hugh Owen Thomas died childless in 1891 aged 57, and although his funeral was attended by thousands, many in tears, it was not until years later that he was eventually recognised as the father of orthopaedic surgery, and one who had metamorphosed the treatment of diseases of the joints.

  Who can tell which of the eccentrics of today may not become pillars of the establishment tomorrow?

  (JL)

  4

  Famous Patients

  The mystery of Napoleon’s Final Waterloo

  The historian Hendrik van Loon described Napoleon Bonaparte as having an ego ‘so great that he needed an entire planet … for his ambitions’. But when he died in 1821, he was in exile on the British colony of St Helena, a small island 200 kilometres west of Africa.

  What killed him?

  Napoleon’s list of ailments reads like a hypochondriac’s wish-list: epilepsy, migraine, relapsing fever (probably malaria), probable bladder stones, skin problems, stomach ulcer, underactive thyroid gland, pneumonia, insomnia, piles and attempted suicide! Some biographies also list chest and thigh wounds, though Dr Richard Gordon says Napoleon’s only campaign wound was when his horse kicked him in the foot.

  The French still argue that Napoleon’s agonising piles were the sole reason for the delay that cost him victory at Waterloo in 1815. His opponent, the Duke of Wellington admitted: ‘It was the most desperate business I ever was in … and never was so near being beat.’

  Not only did the British win the battle, Napoleon threw himself at their mercy. But what to do with him?

  Napoleon himself hoped to settle near London. Metternich suggested exile in the north of Scotland. The Times wanted to hang him.

  Hanging might have been kinder than exile on the ‘living tomb’ of St Helena, where Napoleon lived out his remaining six years. Napoleon had 12 servants, 3 French officers and 3,000 British guards!

  He kept up a flood of petty rows with Sir Hudson Lowe, who arrived as governor of the island in 1816. Napoleon was convinced that Lowe meant to kill him.

  Napoleon became ill in 1817, with vomiting and diarrhoea. Dr Barry O’Meara, a naval surgeon, diagnosed tropical hepatitis (amoebic infection of the liver), which was common on the island. He wanted Napoleon moved, so in 1818 the authorities sacked him. The next doctor, John Stokoe, agreed with O’Meara, so they court-martialled him.

  Then, by request of Napoleon’s mother came a fellow Corsican, Dr Francesco Antommarchi. But the prisoner didn’t do well. He still had vomiting and diarrhoea, and he was very ill for six weeks with a cough and with pain in his abdomen and shoulder. He was given calomel (chloride of mercury), but without benefit.

  He was dizzy, so the doctor bled him.

  By early 1821, he could no longer take solids. Still Dr Antommarchi called it hepatitis. While he was still alive, no one seemed to consider that Napoleon might have cancer, though his father had died of stomach cancer.

  In March 1821, the vomiting was worse; by April it was black, suggesting internal bleeding. As he got worse they gave him more calomel.

  Finally, on 5 May 1821, Napoleon died. He was 51 years old.

  Six British doctors helped Dr Antommarchi with the autopsy. Since they could not agree, they wrote four separate reports. At first Dr Antommarchi reported cancer, but later he said hepatitis had killed Napoleon and blamed the British for exposing him to the dangerous climate of St Helena.

  One of the British doctors also reported an enlarged liver consistent with hepatitis, but the governor pressured him into removing this from his report.

  So did the former emperor die a natural death? He himself wrote in his will: ‘I die before my time, murdered by the English … ’

  Over a century later, in the 1960s, there came to light several samples of hair said to belong to Napoleon. One sample reportedly showed that he had taken at least 40 doses of arsenic in his last few months of life.

  In 1982, other researchers found that the emerald greens in 19th-century wallpaper contained a copper—arsenic pigment which a fungus could convert into arsenic vapour. They found a scrap of Napoleon’s wallpaper which contained enough arsenic to make him ill, but not to kill him.

  Some Frenchmen believe that he died of arsenic given over a long time, followed by cyanide. Others believe the confessions of Count de Montholon, aide-de-camp to Napoleon, who allegedly laced Napoleon’s wine with daily doses of arsenic. Why? Because he believed that his wife was Napoleon’s mistress.

  So what or who killed Napoleon? Cancer? Hepatitis? The English? The wallpaper? Or the jealous husband?

  (GB)

  What killed Jane Austen?

  Like its houses and its chairs and its coffee pots, social intercourse in 18th-century England has managed to convey to us a society which was at once both sensible and elegant. It seemed to manifest good manners, piety, and cultivated discernment—at least it did if you were of ‘the gentry’, which was the case with one of the greatest writers in the English language. Indeed, the lifestyle of the era provided the ideal ambience in which the genius of Jane Austen could flourish.

  She was born in 1775, the daughter of a clergyman, and the seventh of eight children in a closely knit family. She lead a life of middle-class gentility and ease spent entirely in the quiet of rural southern England. Austen’s characters and their backgrounds were drawn from her own circle, and they never strayed from the world in which she moved.

  Furthermore, she was much too well-bred to let her own name grace the title page of her novels, and all her books were styled as being written ‘By a Lady’, as indeed they were. And yet her towering reputation is based on only six works of fiction published over a seven-year period. The first, Sense and Sensibility, appeared in 1811; the last, Northanger Abbey and Persuasion, were published posthumously in 1817 (dated 1818). They have never been out of print and have flourished even more since the mid-1980s.

  Jane Austen was of a caring disposition and was the wit of the family. She never married, and it appears the creative impulse, then customarily fulfilled by the task of being wife and mother, was in her fulfilled through her art. She said her books were her children.

  The author took considerable pains to conceal from friends and visitors the nature of her life’s work and wrote on small pieces of paper, the more easily to slip under a blotter or into a drawer if chanced upon.

  She led a sheltered life at home, interspersed with occasional visits to Bath to take the waters, or to London, or to the not too distant houses of her elder brothers.

  It all sounds like a rural idyll, and so it was, until June 1816 when, at the age of 40, she had an attack of nausea and vomiting and low backache. It could have been something or nothing, but, in the light of subsequent events, was probably significant.

  In July she was depressed and felt weak. This was put down to her dissatisfaction with the book Persuasion, which she had just completed. It may well have been, but two months later it
was noted she tired more easily than had usually been the case, had uncharacteristic mood swings and further back pains. However, everything subsided and life progressed in its customary leisurely.

  In December she declined an invitation to dinner using as an excuse that ‘the walk is beyond my strength (though I am otherwise very well)’.

  The following month she wrote to a friend that she was stronger but felt ‘bile’ was at the bottom of her general malaise. This may indicate a recurrence of her gastric upsets of nausea and vomiting.

  All pretty vague so far, but then in March 1817 Jane wrote a letter to her favourite niece, Fanny, and in it gave the clue which could lead us to the likely diagnosis. She wrote: ‘I certainly have not been well for many weeks … I have a good deal of fever at times, but am considerably better now and recovering my looks a little, which have been … black and white and every wrong colour … Sickness is a dangerous indulgence at my time of life.’

  Over the next two months she wrote to a friend recounting details of recurrent vomiting attacks, concluding: ‘my chief sufferings were from feverish nights, weakness and languor’.

  We know the slightly built Austen was bright-eyed and had an olive complexion, certainly not ‘black and white and every wrong colour’. But a visitor in May later wrote that the author was looking very pale and spoke in a weak, low voice.

  The family became concerned and moved her to Winchester to be nearer expert medical help. It was to be of no avail. Over a six-week period she became progressively weaker and had a number of fainting fits, until on 18 July 1817, after several hours of unconsciousness, Jane Austen died in the arms of her only sister, Cassandra.

  So what did she have?

  The story is one of unimpaired intellect but increasing languor, intermittent backache, fainting attacks, gastrointestinal disturbances, and fever, especially at night. Added to all that, and crucially, is a darkening of the face. The delicacy of the era regrettably precludes us from knowing about skin changes elsewhere, especially the vagina or in the mouth, or where pressure was applied to the skin (at the waist, for instance).

  A number of conditions come to mind, but probably only one fits the whole scenario.

  The lassitude could have been due to a rare neuromuscular condition, myasthenia gravis, but there seems to have been no speech or swallowing problems. Maybe the heart could be implicated in the form of bacterial endocarditis, an infection on the valves of the heart, but fainting crises are not known with this. Perhaps cancer of the stomach with resulting anaemia from the slight but persistent blood loss characteristic of the condition. Yet the digestive problems did not seem either very great or progressive.

  Skin discolouration occurs in a number of general diseases: the rare so-called ‘bronzed diabetes’ or haemochromatosis, but the other symptoms do not fit; chronic inorganic arsenic poisoning with its raindrop pigmentation and abdominal symptoms, or indeed poisoning from any of the heavy metals, lead especially, and which could be ingested from medication or water pipes. But the other history is inappropriate, and no other family members were affected.

  Pellagra, an ailment caused by a deficiency of the vitamin niacin, could be a long shot with its diarrhoea, dermatitis and dementia; but her diet was good and she was certainly not demented.

  No! None of these seem right. From the records and the fact she was a country person with ready access to probably tubercular-contaminated milk, the most likely diagnosis is Addison’s Disease due to tuberculosis of the hormone-producing adrenal gland.

  Thomas Addison only graduated two years before the death of Miss Austen, and it was not until 1848 that he first described the disease which bears his name. Its best known feature is the skin discolouration, which Addison described as ‘smoky or various tints of deep amber or chestnut brown’.

  With the medical knowledge of his era, Addison was unaware that the blood pressure is lowered in this malady, for he had no means of measuring it.

  Until the mid-20th century tuberculosis was the prime cause of Addison’s Disease. Now it is likely to be due to an auto-immune reaction, as was the case in that other famous sufferer, John F. Kennedy.

  Only one aspect does not completely fit. It is said that tubercular patients are commonly more sexually charged than the general run of the population, possibly due to the persistent low-grade fever. No hint of sexual impropriety in Miss Austen has come down to us.

  Due to an overall lack of surviving correspondence, Jane Austen’s biographers have an incomplete picture of what her day-to-day life was really like, either in sickness or in health. But we all know from her books that she was a consummate writer whose genius was tempered with gentle humour and a subtle insight into the moral nature of humankind.

  It is better we remember her thus, rather than someone suffering from an uncommon and debilitating medical disorder.

  (JL)

  A medical history of Oscar Wilde

  Oscar Wilde was born in 1854, the second of three children of Sir William and Lady Jane Wilde of Dublin. Sir William was an ophthalmic surgeon, editor of the Dublin Journal of Medical Science, a writer on Irish superstitions and defendant in an alleged rape-under-anaesthetic case. He lost, but only a farthing in damages was awarded against him.

  Lady Wilde was a noted poet, and wrote a book on ancient cures and charms of Ireland. So Oscar was well-connected, medically.

  The first serious illness of the author was in 1877 while he was at Oxford. He contracted what he called ‘a positive sin’, a Victorian euphemism for syphilis.

  Due to the coy attitudes of the era, apart from that comment, diagnosis is based on circumstantial evidence only. For instance, we know he was given mercury, the contemporary treatment for luetic (syphilitic) disease, and statements by close friends at his death and a doctor’s certificate at that time seem to indicate the pathology. Furthermore, he broke off a promising liaison with a young lady following advice that he should not marry until two years after the primary episode. There seems to have been no obvious signs of infection (such as skin lesions) during his life, and the diagnosis remains conjectural.

  The only obvious effect of the mercury was that it turned his slightly protrusive teeth black, and thereafter he usually covered his mouth while talking.

  If the diagnosis of syphilis was genuine, there was certainly no long-term effect on his mental capacity. He took the university by storm, turning Victorian Oxford into Periclean Athens with his repartee and well-honed English. He was awarded a rare double first in Greats (Roman and Greek history, literature and philosophy) at his graduation from Magdalen College, he won the prestigious Newdigate Prize for poetry, and all his life was renowned for the brilliance of his wit.

  In the early 1880s Wilde easily established himself in the social and artistic circles of London by his flamboyant presence. The publication of his poems in 1881 was followed by a lecture tour of America. He hardly endeared himself when on arrival in New York he announced: ‘I have nothing to declare but my genius.’

  But America left one legacy: he contracted malaria, which he described as an ‘aesthetic disease’. He must have had repeated bouts, as quinine was found in his effects when he was arrested 13 years later.

  Wilde married Constance Lloyd in 1884, and by 1886 they had two children, Cyril and Vyvyan. That year he met Robert Ross, ‘with the face of Puck’, and they became lovers.

  He had no intention of giving up his wife, but had to find an excuse to live apart sexually. It is conjectured by his well-regarded biographer, Richard Ellmann, that he told her about the syphilis and that celibacy was necessary. In any event, she suspected nothing, and sexual intercourse ceased.

  In 1891 he formed an intimate friendship with Lord Alfred Douglas. This infuriated Douglas’s father, the Marquess of Queensberry, who left an open card at the Albemarle Club, which said: ‘To Oscar Wilde posing as a Somdomite’(sic).

  In February 1895 Wilde sued the Marquess of Queensberry for libel, failed, and in April was arraigned for sodo
my. He was tried twice, the first trial being aborted by a hung jury, despite the joyous evidence of blackmailing boys.

  At the second trial in May he was found guilty and given two years’ hard labour; a crushing blow for such a sensitive man.

  At Pentonville Prison he was declared medically fit, so spent six hours a day on the demoralising treadmill, where he peddled mindlessly for 20 minutes then rested for five minutes, slept on bare boards and for the first three months had no communication with anyone on the outside.

  The result was that he lost weight, became withdrawn and depressed, and suffered from insomnia. After some weeks, diarrhoea set in. As the prison lavatories could only be used during the hour of exercise, a tin bowl in his cell was his toilet. He was later to write that warders vomited at the indescribable sight that greeted them in the morning.

  The prisoner fainted in chapel, and in the fall injured his ear so badly he spent two months in the infirmary. He was troubled by pain in the ear for the rest of his life.

  Wilde was transferred to Reading Gaol. When discharged in May 1897 he was bankrupt, a social pariah and a broken man.

  He went to live in France. There a persisted rash developed, possibly a vitamin deficiency—though he put it down to eating mussels—and he went to Rome to be blessed by the Pope. It did not help therapeutically, but of the event Wilde wrote mockingly to a friend: ‘My walking stick shows signs of budding!’

  Wilde deteriorated physically, and by September 1900 he had become bedridden. The skin rash was florid and his ear so painful that, according to a surviving bill, his doctor visited 68 times between September and December.

  On 10 October, in his beggarly room, his ear was operated on, either to puncture the eardrum to let accumulated fluid escape or for removal of polyps. It was during one of the daily post-operative dressings he made his famous remark: ‘I am dying beyond my means … My wallpaper and I are fighting a duel to the death. One or other of us has to go.’