Illness features strongly in all the novels of Jane Austen. The topic is used to move plots along, shape characters and often to trigger comedy. But did it preoccupy her so much because – in her day, and in her own case – good health was often hard to hold onto? If Jane Austen had lived in this century, she probably wouldn’t have died so young. One suspected cause of her death, at the age of 41, was Addison’s Disease, a kidney problem where the adrenal glands don’t produce enough hormones. Symptoms include abdominal pain, loss of appetite, weight loss, exhaustion and darkened skin – all symptoms that the novelist wrote of in her letters to family members.

Nowadays, someone with this condition would be given the required hormones (cortisol and aldosterone) in tablet form to keep them well.

Other experts suggest that Jane Austen died of Hodgkin’s disease: a blood cancer. Treatment today would include chemotherapy and radiation – and most people now make a full recovery from it. She also suffered with conjunctivitis from her early 20s onwards. Nowadays, antibiotic eye drops would be prescribed, ending the discomfort that often impeded her ability to write.

NO ANAESTHETIC, OR ANTIBIOTICS

Think about what else was missing on the health front in her time. Anaesthetics – like ether and chloroform – were about 40 years away, so surgery or tooth extraction relied mainly (and unsuccessfully) on alcohol to mask the pain.

Joseph Lister (of Listerine fame) was yet to develop an antiseptic and Pasteur hadn’t yet developed pasteurisation or his important vaccines. And the origins of infection – that bacteria could be spread by water, food or air – weren’t fully understood either. It would also be 1928 – over 100 years later – before Sir Alexander Fleming would discover penicillin, the antibiotic that went on to revolutionise healthcare.

Medical devices, such as the stethoscope, had yet to come on stream too, and the smallpox vaccination of Edward Jenner hadn’t been discovered either – so no wonder health was a constant concern.

With poor (or no) sanitation common, venturing out, particularly in towns and cities or to visit the sick could be a dangerous move in Jane Austen’s day.

Old, very damp houses didn’t help on the health front either. Tuberculosis was rife, and people could easily die from colds and flu – something that seldom happens today.

Not having good health back then could, of course, have serious social consequences. If you couldn’t work, you had no income in an era devoid of welfare benefits. Even for women like Jane Austen, being frail could be a social disadvantage, a fact highlighted in her novel Sense and Sensibility when John Dashwood reminds Elinor that Marianne’s illness (after being jilted by Willoughby) will reduce her chances of a good marriage.

With many women dying in childbirth, too, in that era – including three of Jane Austen’s real-life sisters-in-law – a robust constitution was a necessity in prospective brides.

MEDICAL SUPPORT

As far as medical support went, this was very hit-or-miss in the late 1700s and early 1800s. While there were the three categories – physicians, surgeons and apothecaries – at that time none were well trained, regulated or trusted and there was always a strong element of unlicensed “snake oil” salesmen doing the rounds too. Surgeons were considered tradesmen, as their work was messy – tooth extractions, amputating limbs – and they worked with their hands. Physicians, although considered gentlemen and able to dine with the gentry (because they didn’t get their hands dirty), might never have had any real practical training before qualifying; and apothecaries (dispensers of drugs/remedies like laudanum) weren’t well-regulated either.

The main medical text book of the time, which Jane Austen would have been familiar with, was William Buchan’s Domestic Medicine. It focussed on the four humours – blood, phlegm, yellow bile and black bile – and keeping these balanced in the body. For Buchan, restoring the balance could mean blood-letting, starving and purging (vomiting) to relieve the body of symptoms like fever.

So while we, in this day and age, have a certain amount of emotional security around health issues – as in reasonable confidence that most illnesses can be cured/treated – that kind of emotional security wasn’t there in Jane Austen’s day. Illnesses of many sorts actually appear in all her novels. Who can forget how handy wet feet and catching cold were in orchestrating an opportunity for Mr Bingley to fall in love with Jane Bennet in Pride and Prejudice?

In the medical literature of the time, causes of illness were put down to “diseased parents” (now the genetic dimension); sedentary habits; individual intemperance (modern day “lifestyle”); climate; location; anger; wet feet and abrupt changes of temperature. It was believed then, too, that fevers could be triggered “by injury, bad air, violent emotion, irregular bowels and extremes of heat and cold.

WOMEN DIDN’T HAVE MUCH POWER

From reading her novels it’s obvious that a lot of psychological problems may have been manifesting themselves in physical symptoms too. Women didn’t have much power in those days, so was getting sick – or pretending to be sick, or having hypochondriac tendencies – the result of a general lack of say or power in society? Were the many headaches indicators of stress or social tension, for example?

When Mrs Bennet became frustrated, her “nerves” got the better of her and she took to the bed until circumstances suited her again.Given that women had little power, rights or options in Jane Austen’s day, maybe it wasn’t any surprise that they fainted, had hysterics or generally pleaded illness if it all got too much for them emotionally.

The very tight corsets may not have helped on the feeling-well front either, given that they could impede blood flow. Fainting was so common at the time that chaise longues – or fainting couches, with one end risen – were commonplace pieces of furniture.

Was Marianne Dashwood’s emotional pain simply expressing itself in physical illness? Or did her poor emotional state simply make her more vulnerable to infection? Whatever the case, Sense and Sensibility has a lot to say about illness and the complexity of it.leaving them to look after themselves, now could they? CL