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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.

MRS CASSANDRA AUSTEN

In October 1798 Jane described how, after a journey, her mother ‘was a good deal indisposed from that particular kind of evacuation [presumably an emptying of the bowels] which had generally preceded her Illnesses’. Also, that she had ‘felt a heat in her throat as we travelled yesterday morning, which seemed to foretell more Bile’.
20

In December Jane stated that Mr John Lyford, surgeon of Winchester, had called the previous day, dined with the Austens and expressed the wish for ‘my mother to look yellow and to throw out a rash, but she will do neither’. The doctor appeared to have been looking for some tangible signs that would enable him to make the diagnosis, but he was unable to find them.
21

Later that month Jane reported to Cassandra:

My Mother continues hearty, her appetite & nights are very good, but her Bowels are still not entirely settled, & she sometimes complains of an Asthma, a Dropsy [oedema – accumulation of fluid, most commonly in the lower legs], Water in her Chest & a Liver Disorder.
22

In the case of Mrs Austen, the presence of bilious attacks and bowel disorder is in keeping with the symptoms of tuberculosis. However, the presence of oedema, the fact that her appetite was good, and the lack of mention of fever or night sweats suggests some other, unknown disease (though co-existing tuberculosis cannot be totally ruled out).

JAMES AUSTEN

A poem written by Jane’s eldest brother James, entitled ‘Lines written at Steventon in the Autumn of 1814’ when he was aged 49, reveals a man who considered himself to be ‘an invalid’ who lived in ‘sad seclusion’, and which speaks sorrowfully of ‘what remains/Of my allotted time …’
23
It is not known from what ailment James was suffering, or whether, prior to this time, he had been in the company of his brother Henry, who presumably was tubercular. Whatever it was that James was suffering from he, in his poem, ‘mocks the healing power/Of any medicine, but his native air’. James also was correct in believing that his life would not be a long one; he died in December 1819 aged 54.

CAROLINE AUSTEN

In 1815, the year after her father wrote the above poem alluding to the fact that he was far from well, his daughter Caroline, then aged 9, stated: ‘In the May of this year I had an illness such as was then called bilious fever. Soon after I recovered …’
24
This, as already mentioned, is a symptom typical of tuberculosis (but of course not diagnostic of that condition). If Caroline’s symptoms were the result of a tubercular infection, it may be assumed that she developed an immunity to that disease, for she lived to be 75.

 

How ironic it is that in the fourteenth letter of Jane’s
Love and
Freindship
– from her
Juvenilia
– Laura describes the terminal illness of her friend Sophia as follows:

Her disorder turned to a galloping Consumption and in a few Days carried her off. Amidst all my Lamentations for her (and violent you may suppose they were), I yet received some consolation in the reflection of my having paid every Attention to her that could be offered, in her illness.

As for Sophia, her last words to Laura were:

Beware of fainting fits … Though at the time they may be refreshing and agreable yet beleive me they will in the end, if too often repeated and at improper seasons, prove destructive to your Constitution … Run mad as often as you chuse, but do not faint.
25

Notes

1.­
Sir Zachary Cope, ‘Jane Austen’s Last Illness’ in the
British Medical
Journal
, 18 July 1964.

2.­
Encyclopaedia Britannica
, 1911.

3.­
Dr Tony Smith,
Complete Family Health Encyclopaedia
.

4.­
Letter from Jane Austen to Cassandra Austen, 17/18 November 1798.

5.­
Letter from Jane Austen to Cassandra Austen, 12/13 May 1801.

6.­
Letter from Jane Austen to Cassandra Austen, 21/22 May 1801.

7.­
Helen and Gavin Turner Lefroy (eds),
The Letters of Mrs Lefroy
(Winchester: Sarsen Press, 2007), p. 35.

8.­
Le Faye,
Jane Austen’s ‘Outlandish Cousin’
, p. 160.

9.­
Letter from Jane Austen to Cassandra Austen, 3 November 1813.

10.­
Letter from Jane Austen to Cassandra Austen, 6/7 November 1813.

11.­
Caroline Austen,
My Aunt Jane Austen
, p. 11.

12.­
Letter from Jane Austen to Cassandra Austen, 17 October 1815.

13.­
James E. Austen-Leigh,
A Memoir of Jane Austen
, p. 91.

14.­
A.H.A. Asbroek, et al., ‘Estimation of Serial Interval and Incubation Period of Tuberculosis using DNA Fingerprinting’, in
The
International Journal of Tuberculosis and Lung Disease
, Vol. 3, No. 5, May 1999. (Paris: International Union Against Tuberculosis and Lung Disease.)

15.­
Letter from Jane Austen to Cassandra Austen, 24/25 December 1798.

16.­
Letter from Jane Austen to Cassandra Austen, 2 June 1799.

17.­
Letter from Jane Austen to Cassandra Austen, 11 June 1799.

18.­
Letter from Jane Austen to Cassandra Austen, 19 June 1799.

19.­
Ibid
.

20.­
Letter from Jane Austen to Cassandra Austen, 27/28 October 1798.

21.­
Letter from Jane Austen to Cassandra Austen, 1/2 December 1798.

22.­
Letter from Jane Austen to Cassandra Austen, 18/19 December 1798.

23.­
David Selwyn (ed),
The Complete Poems of James Austen
by James Austen, July 1814.

24.­
Deirdre Le Faye,
Reminiscences of Jane Austen’s Niece Caroline Austen
(The Jane Austen Society, 2004), p. 45.

25.­
Jane Austen,
Love & Freindship and Other Writings
(London: Phoenix, 1998), p. 90.

Jane’s last (and unfinished) novel
Sanditon
was written between 27 January and 18 March 1817, by which time her health had deteriorated alarmingly. (It was not published until 1925). At that time, there was a school of thought, which Jane was aware of, to the effect that sea water and sea air had curative or restorative properties. It is no coincidence, therefore, that the book’s setting is the fictitious town of Sanditon, described as ‘a young and rising bathing-place, which everybody has heard of’. By contrast, the story also implies that the medical profession is, as often as not, ineffectual when it comes to the treatment of disease. In fact, the novel begins with an immediate attack on that profession.

Mr Parker and his wife are travelling along the coast road near Tonbridge in Kent, when their coach overturns in a rough lane, in the course of which Mr Parker sprains his ankle. The accident has been seen by local man Mr Heywood who, when asked if there is a surgeon nearby replies: ‘The surgeon sir! I’m afraid you’ll find no surgeon at hand here, but I dare say we shall do very well without him’.

When Lady Denham of Sanditon hears that Parker has requested a doctor, she is equally scathing about the medical profession:

Going after a doctor! – Why, what should we do with a doctor here? It would be only encouraging our servants and the poor
to fancy themselves ill, if there was a doctor at hand – Oh! pray, let us have none of the tribe at Sanditon. We go on very well as we are. Here have I lived seventy good years in the world and never took physic above twice – and never saw the face of a doctor in all my life, on my own account. – And I verily believe if my poor dear [late husband] Sir Harry had never seen one neither, he would have been alive now. – Ten fees, one after another, did the man take who sent him out of the world. – I beseech you Mr Parker, no doctors here.

Parker, who owns land and property in the parish of Sanditon, declares that he is enthusiastic about popularising the resort with a view to its future development and expansion. He relishes the prospect of changing it from ‘a quiet village of no pretentions’ to ‘a profitable speculation’. (This was the second reason, apart from his sprained ankle, why Parker had attempted to locate a surgeon, for if he could establish such a person in Sanditon, then ‘the advantage of [having] a medical man at hand would very materially promote the rise and prosperity of the place’).

It was Parker’s view that:

No person could be really well, no person could be really in a state of secure and permanent health without spending at least six weeks by the sea every year. – The sea air and sea bathing together were nearly infallible, one or other of them being a match for every disorder, of the stomach, the lungs or the blood; they were anti-spasmodic, anti-pulmonary, anti-sceptic, anti-bilious and anti-rheumatic.

Heywood, however, takes the opposite view, saying that if the moneyed classes were to be attracted to Sanditon, this would be ‘sure to raise the price of provisions and make the poor
good for nothing [i.e. purposeless]’. In fact, he thought that the coastline was already ‘too full of them [such resorts] altogether’.

The story so far shows that the author was aware that the traditional ways of life, particularly those of the country, were fast disappearing. For example, it was said of Heywood, who was a traditionalist, that:

Excepting two journeys to London in the year, to receive his dividends, [he] went no farther than his feet or his well-tried old horse could carry him, and Mrs Heywood’s adventurings were only now or then to visit her neighbours, in the old coach which had been new when they were married and fresh lined on their eldest son’s coming of age ten years ago.

In contrast the new world, as epitomised by Parker, was one where commerce and trade were all important.

Parker was anxious that Mr and Mrs Heywood should visit Sanditon, but he could not prevail upon them to do so. However, they did agree that their eldest daughter, Miss Charlotte Heywood, might accompany the Parkers back to Sanditon.

Parker has two sisters, Susan and Diana, and a brother Arthur. In reference to his sisters, Parker declares:

They have wretched health … and are subject to a variety of very serious disorders. Indeed, I do not believe they know what a day’s health is.

On the other hand, he also admits that ‘there is a good deal of imagination’ in them. Likewise, Parker’s youngest brother Arthur, who lives with the sisters, was ‘almost as great an invalid as themselves’.

When Diana writes to her brother Parker, the latter imagines what his other brother Sidney would say if he could see her letter:

I know he would be offering odds, that either Susan, Diana or Arthur would appear by this letter to have been at the point of death within the last month.

Sure enough, in the letter, Diana refers to having had ‘a more severe attack than usual of my old grievance, spasmodic bile and hardly able to crawl from my bed to the sofa’. And in a swipe at the medical profession, she declares:

We have entirely done with the whole medical tribe. We have consulted physician after physician in vain, till we are quite convinced that they can do nothing for us and that we must trust to our own knowledge of our own wretched constitutions for any relief.

Here, Jane is living vicariously through Diana, whose symptoms of biliousness, together with weakness which obliges her to lie on the sofa, are identical to her own. However, whereas Diana is neurotic and complaining, Jane by contrast, is courageous and stoical.

Diana’s sister Susan is, according to the former, in an equally unfortunate predicament:

She has been suffering much from the headache … and the proposed remedy of six leeches a day for ten days together relieved her so little that we thought it right to change our measures.

It is then decided that the ‘evil lay in her [Susan’s] gum’, and accordingly it was arranged that she should have three teeth
extracted. This made her ‘decidedly better’ but on the other hand her nerves were still ‘a good deal deranged’.

Despite their tendency to hypochondria, Parker took a charitable view of his sisters, and in spite of all their sufferings he declared them to be much ‘occupied in promoting the good of others!’ (This is Jane, as usual, seeing some good in everybody).

Arthur and his sisters duly arrive in Sanditon, take lodgings in the town and are introduced to Charlotte Heywood, who is sceptical about their alleged sufferings. In regard to Diana, for instance,

[she] could perceive no symptoms of illness which she [Charlotte], in the boldness of her own good health, would not have undertaken to cure, by putting out the fire, opening the window, and disposing of the drops and the salts [with which she plied herself] …

As for Diana’s brother Arthur, it was Charlotte’s opinion that his ‘enjoyments in invalidism were very different from his sister’s’, and also that he was inclined to use his alleged illnesses to his advantage, being ‘determined on having no disorders but such as called for warm rooms and good nourishment’.

Towards the end of
Sanditon
a Miss Lambe appears, who is sick and ‘under the constant care of an experienced physician’. Perhaps, had Jane Austen been able to complete the story, there would have been friction between this lady, who appears to have had a serious health complaint, and Susan, Diana and Arthur Parker, who undoubtedly did not.

 

As regards the obvious hostility shown towards the medical profession in the novel
Sanditon
, it should be remembered that its author Jane was in poor and rapidly deteriorating health herself when she wrote it. Her doctors were unable to cure her, and it is only natural that she should have lashed out at their perceived ignorance and incompetence. On the other hand, to be fair to the doctors, Jane was suffering coincidentally from not one, but two diseases. The first was Addison’s disease, which was unknown to them at the time. The second (as has been demonstrated beyond reasonable doubt) was tuberculosis, for which, in those days, there was no known cure.

Likewise, a person such as Jane who was genuinely sick – and she must have felt dreadfully unwell as the combined effects of these two diseases gradually overcame her – would not take kindly to those who feign or exaggerate their illnesses. Therefore, not only did she portray her characters Susan, Diana and Arthur as figures of fun, she also shows a thinly disguised contempt for them as she scorns their constant whinging and play-acting. The message of Sanditon is this: if you are ill, then try to bear your illness bravely, which, by all accounts, is what Jane herself did.

 

In early 1817, Edward’s daughter Fanny consulted Jane, once again, over her (Fanny’s) love life. Should she have accepted Mr John Plumptre, who was now courting another lady? Was she, at the age of only 24, in imminent danger of being left on the shelf? She goes on to ask Jane her opinion of another suitor, Mr Wildman. (Fanny eventually married Sir Edward Knatchbull, Bt, in 1820).

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