Predicting the due date of a pregnancy is a matter of guesswork, even in these modern times. Babies are notorious for following their own schedule rather than the convenience of their mother, midwife, or obstetrician. Nevertheless, it is rare for a pregnancy to extend much beyond 40 weeks, and it is almost as dangerous for a baby to arrive in the 43rd week as the 36th.
When I was edging toward my 42nd week of pregnancy with my second daughter, my midwife began issuing warnings that intervention would be necessary should my stubborn wee infant refuse to emerge within a reasonable time frame. Thankfully, the baby was simply waiting for the full moon on May Day to make her appearance, and she burst into the world without undue biomedical harrying. Jane Austen’s mother, Cassandra, was less fortunate than I.
Jane Austen was born on 16 December 1775, a full month after her parents had expected her. This would put her into the dangerous zone of a 43rd or 44th week gestation, which is given the benign name of a “postdate pregnancy,” but is actually a cause for serious concern. As Annette Upfal explains in her article for the Journal of Medical Humanities:
There is a heightened risk of birth injury or death, and over 20% of postdate infants show signs of wasting of tissues – a medical condition known as post-maturity, which in severe cases can be fatal … If a pregnancy is prolonged, the placenta begins to degenerate and the fetus may receive inadequate nutrients from the mother.
Being born postdate can cause serious problems for the baby, including listlessness, irritability, inadequate feeding, failure to thrive, and a lifelong immune insufficiency as a result of in utero malnutrition. In plain English, a person born postdate may never develop a fully adequate immune system, and be susceptible to infections and chronic illnesses his or her entire life.
Although Jane Austen is usually thought of as robust (barring an almost fatal case of typhoid fever when she went away to school) right up until the 18 months prior to her death, a trawl through her surviving letters and other resources reveals she was incredibly vulnerable to contagious diseases a healthy adult would normally be able to fight off.
For example, she was plagued with chronic conjunctivitis. Conjunctivitis, more colloquially known as pink-eye or red-eye, is an eye infection that can be caused virally or (in worse cases) by bacteria. In either case, with no treatment a person’s body usually fights off the viral or bacterial invader within 3 to 6 weeks. In contrast, Austen’s “sore eyes” persisted for months and became an acute case. For years she had to deal with intermittent return of the illness, and by the latter years of her life the “reoccurrences would be more frequent and disabling”.
Austen also caught whooping cough in 1806, when she was 30 years old. Whooping cough is incredibly rare in patients over 10 years of age, and when an adult infection (known as catarrhal) does occur it is typically mild and of short duration. In contrast, Jane Austen’s illness became serious enough for her sister, Cassandra, to have sent out letters among family and friends to apprise them of the trouble, as evidenced by the need for letters written “to inquire particularly” about Austen’s condition.
In the late summer or early autumn of 1808 Austen once more contracted an infection – this time in her ears. Interestingly, the same bacteria that commonly cause pink-eye — Staphylococcus aureus, Streptococcus pneumonia, or Haemophilus – are also the bacteria that commonly cause ear infections. It is spread either through internal sinus drainage from the diseased eye into the ear canal, or when the patient rubs their itchy, swollen eyes and then touches their ear. The bacterial infection causes painful inflammation in the ear canal, and can even lead to hearing loss in some cases. A joint case of ear and eye infection is most common in infants and young children, who don’t have fully developed immune systems yet. It is rare for healthy adults to develop this issue. Yet it happened to the supposedly healthy Jane Austen.
Moreover, the 33-years-old Austen’s ear and eye infections lingered beyond any reasonable expectation. They also worsened, and became enough of a health problem that her family and friends were sending her ‘receipts’ of home-made remedies for treatment in an attempt to alleviate her condition. Happily, the family apothecary, Mr John Lyford (not the surgeon Dr. Giles Lyford who would attend her final illness in Winchester), was able to effect a cure by advising her to apply cotton soaked with “the oil of sweet almonds” to her. Upfal believes this to indicate that Jane Austen was suffering from otitis externa, and infection of the outer ear, but I think it to be more likely that it was her inner ear canal that was infected. Sweet almond oil, either undiluted or mixed with olive oil, is an antibacterial agent that has been used for medical treatment for thousands of years. Sweet almond oil seeping from a wad of cotton at the opening of the ear canal would have coated the inner ear and killed the bacteria causing the infection.
In 1813 Jane Austen began to experience terrible pains in her face, which Upfal attributes to postherpetic neuralgia but from the symptoms recorded I think the pains were most likely the result of trigeminal neuralgia. Trigeminal neuralgia causes, “ sudden attacks of severe sharp shooting facial pain that last from a few seconds to about two minutes … similar to an electric shock. The attacks can be so severe that you’re unable to do anything during them … The pain can be in the teeth, lower jaw, upper jaw, cheek and, less commonly, in the forehead or the eye … After the main severe pain has subsided, you may experience a slight ache or burning feeling … [or] a constant throbbing, aching or burning sensation between attacks.”
Jane Austen must have been in agony.
Trigeminal neuralgia seems to be caused most often by an enlarged blood vessel (usually the superior cerebellar artery) putting pressure on the trigeminal nerve (the 5th and largest cranial nerve) close to the nerve’s connection with the pons, the descending section of the brainstem, but that pressure can also be created by a cyst or tumor.
One of the ailments most often given as the reason for Austen’s early death is Hodgkin’s disease, also known as Hodgkin’s lymphoma. Upfal supports this hypothesis, and I half-way agree with her. I believe Austen was suffering from non-Hodgkin’s lymphoma, which is any blood cancer — includes all types of lymphoma – that isn’t Hodgkin’s lymphoma.
The reason I believe Austen have been suffering from non-Hodgkin’s lymphoma (NHL) is directly connected to her neuralgia. One of the not-uncommon symptoms of NHL is trigeminal neuralgia, caused by the swelling of the lymph nodes or tumors in the cranial region. Common symptoms of NHL also include the intermittent low-grade fever, weight loss, itchiness, and fatigue that were Austen’s most common complaints in the last year of her life. Furthermore, NHL can have periods where the patient feels just fine, before the tiredness kicks in again. This is especially true of ‘indolent’ or slow-growing lymphomas. It can also cause the skin discoloration, the “black and white, and every wrong colour” that Austen lamented. Moreover, one of the most common risk factors for NHL is poor immune function, which Upfal argues (in my opinion, persuasively) that Austen experienced as a result of her postdate birth.
First, there is the determination of Austen herself not to be a “poor honey”, a silly female hypochondriac determined to secure attention for herself by her ailments. Austen could not stand that sort of thing. She complained to her brother Frank Austen in 1813 that Mrs. Edward Bridges was “a poor Honey – the sort of woman who gives me the idea of being determined never to be well — & who likes her spasms & nervousness & the consequence they give her, better than anything else.”
In her letters, Austen often turns any report of her illness into a joke, or minimizes the effects of her sickness and assures her correspondent that she is doing very well NOW, thank you very much. She frequently implies that any poor health was merely playacting on her part, such as when she tells her sister that, “It was absolutely necessary that I should have the little fever and indisposition which I had; it has been all the fashion this week in Lyme”. Her complaints are also seldom admitted to be serious, as when she downplayed the onset of her whooping cough as “a cold”. The health of other people was a much-mentioned topic in her letters, but her own health was ignored for the most part.
This pattern continued to the very end. A little more than a year before her death she assured a niece that she had “got tolerably well again, quite equal to walking about and enjoying the air,” joking that “Sickness is a dangerous indulgence at my time of life,” and cheerfully reporting “the advantage of agreeable companions” was the only medicine she needed. Only a few weeks before she died she wrote to one her nephews that, “I am gaining strength very fast. I am now out of bed from 9 in the morning to 10 at night: upon the sopha, ’tis true, but I eat my meals with aunt Cass in a rational way, and can employ myself, and walk from one room to another.”
Austen’s persistent negation of her own illness has created a belief in her good health that is more accepted than proven.
In addition, there are the “missing” letters; correspondence destroyed by her family after her death. In those letters Austen could have vociferously complained about dismal health and we would have no inkling of it. She could have likewise admitted to debauchery, cannibalism, and necromancy and we’d be none the wiser. Anything that would contradict the ‘ideal’ Jane Austen, the beloved sibling and aunt who had nothing more important in her world than her domestic concerns, was carefully eradicated by relatives eager to preserve her reputation in the Victorian era. Creating the idea that Jane Austen had fortitude in the face of illness, as well as a near-implacable refusal to acknowledge bodily functions below the neck, would have been the goal of her preservationists, and any letter indicating differently would have gone onto the fireplace grate.
We lost a tremendous amount of information about Jane Austen’s personality, life, and writing thanks to the destruction of her letters, and (alas!) we’ve also lost most of the clues that might have helped us unravel the mystery of her tragically precipitous death. A death that may have occurred so early because her birth was so late.
Meet the Author: Kyra Cornelius Kramer is a freelance academic with BS degrees in both biology and anthropology from the University of Kentucky, as well as a MA in medical anthropology from Southern Methodist University. She has written essays on the agency of the Female Gothic heroine and women’s bodies as feminist texts in the works of Jennifer Crusie. She has also co-authored two works; one with Dr. Laura Vivanco on the way in which the bodies of romance heroes and heroines act as the sites of reinforcement of, and resistance to, enculturated sexualities and gender ideologies, and another with Dr. Catrina Banks Whitley on Henry VIII.
Ms. Kramer lives in Bloomington, IN with her husband, three young daughters, assorted pets, and occasionally her mother, who journeys northward from Kentucky in order to care for her grandchildren while her daughter feverishly types away on the computer.