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Jane Austen and "a society of sickness".

OVER HALF A CENTURY after Jane Austen's death in 1817, James Edward Austen-Leigh, her nephew and the author of her first biography, wrote: "She was always very careful not to meddle with matters which she did not thoroughly understand. She never touched upon politics, law, or medicine, subjects which some novel writers have ventured on rather too boldly, and have treated, perhaps, with more brilliancy than accuracy" (18). But now it seems that, being conscious of the Victorian social climate where modesty and self-effacement were required of women, Austen-Leigh intended to disguise his aunt's interest in "unwomanly" affairs. His comment is actively misleading, for, although Austen did not "meddle with" medicine, she certainly "touched upon" a variety of injuries, diseases, illnesses in both her letters and fiction.

On injuries and diseases which appear in Austen's fiction, excellent studies by John Wiltshire and Anita G. Gorman have been published. Thus, based upon her letters, this paper demonstrates that Austen has up-to-date medical knowledge, and examines the standard of medicine in her lifetime, and her view of health, which no doubt exerts a strong influence on medical events in her fiction. The paper considers what she knew about medicine to be important, and therefore depends heavily on medical books of her time and the works of modern medical historians.

In Austen's daily life, diseases and ailments were common and recurring. In her letters, Austen writes about the physical condition of people--her own, someone in her circle, or a casual acquaintance--in no fewer than 68 letters out of a total of 161. Claire Tomalin notes that Austen frequently had eye trouble (111). Certainly, what most often troubled the novelist physically was her bad eye condition and her family knew that. On 22 January 1799, she wrote, "'My eyes are pretty well, I thank you, if you please." Four months later, on 17 May, she again wrote, "I find no difficulty in doing my Eyes." But, in her middle age, her trouble became critical and prolonged: "I am pretty well in health and work a good deal in the Garden, but for these last 3 or 4 weeks have had weakness in my Eyes; it was well for you it did not come sooner, for I could not now make petticoats, Pockets & dressing Gowns for any Bride expectant--I can not wear my spectacles, and therefore can do hardly any work but knitting white yarn and platting white willow. I write & read without spectacles, and therefore do but little of either" (mid-July? 1814). It is unclear when she took to wearing glasses. However, it seems that in addition to daily chores, by extensive reading and writing (probably fine writing on tiny pieces of paper), she overworked her eyes.

Austen also wrote of her rheumatism, her bilious fever, cold, and slight pain. Rheumatism is a good place to start in that it still troubles us today. On 20 February 1817, she wrote to her niece Fanny Knight: "I am almost entirely cured of my rheumatism; just a little pain in my knee now & then, to make me remember what it was, & keep on flannel.--Aunt Cassandra nursed me so beautifully!" This letter shows that flannel was popularly used as a medical treatment. Further evidence is found in her letter dated on 19 June 1799, when she was visiting Bath: "my Uncle is still in his flannels, but is getting better again." Indeed, this treatment was considered effective. Samuel Solomon, one of the best-known quacks of the period, advised wearing a flannel waistcoat next to the skin in order to prevent a cold and cure affected lungs, weak bowels, rheumatism, scurvy, dropsy, and nervous complaints (26, 28).

When it comes to flannel, Janeites would call to mind the scene in Sense and Sensibility where Marianne Dashwood laughs at Brandon's flannel waistcoat: in her opinion, "a flannel waistcoat is invariably connected with aches, cramps, rheumatisms, and every species of ailment that can afflict the old and the feeble" (38). Eileen Sutherland points out that during the Napoleonic Wars, generals and soldiers wore flannel waistcoats for protection against the cold, and says that "Marianne displays her naivete and ignorance of the world, equating flannel waistcoats with 'aches, cramps, rheumatisms, and every species of ailment that can afflict the old and the feeble' [38]. She should have connected it with danger, endurance and courage, a kind of military uniform" (58). Marianne is certainly naive. Yet, at least she is likely to be familiar with flannel as a popular lay treatment, and her association was not uncommon; this might also have been Austen's joke at her uncle Mr. Leigh-Perrot's expense.

Unlike rheumatism, the disease named "bilious fever" does not exist today. But this disease is suspected of having something to do with Austen's death (remember that Mrs. Tilney died of bilious fever). It meant an intermittent fever accompanied with a frequent and copious discharge of bile. The explanation provided in The Ladies' Friend, a family medical book from 1787, is relatively detailed:
 This disorder is epidemic in camps and marshy countries.--It
 begins with chilliness and lassitude, pains in the bones and head,
 and a disordered stomach--restlessness all night long, and too
 often the patient becomes delirious. In the morning imperfect
 sweats bring on a remission of all the symptoms. In the evening
 the paroxysm returns, but without any cold fit, and is generally
 worse than before. The second morning it remits: and these periods
 go on daily until it insensibly changes either into a continued,
 or intermitting state. (190)


On the other hand, Austen's description does not offer much to identify her symptoms:
 I have been suffering from a Bilious attack, attended with a good
 deal of fever.--A few days ago my complaint appeared removed,
 but I am ashamed to say that the shock of my Uncle's Will
 brought on a relapse, & I was so ill on friday [sic] & thought
 myself so likely to be worse that I could not but press for
 Cassandra's returning with Frank after the Funeral last night, which
 she of course did, & either her return, or having seen Mr Curtis, or
 my Disorder's chusing to go away, have made me better this morning.
 (6 April 1817)


From this letter, we know that "a good deal of fever" from which Austen suffered was an intermittent fever. Although it had occasional remissions, her disease was already over its middle stage.

Austen refers to a wide range of other diseases and symptoms. These include gout, asthma, dropsy, sore throat, putrid fever, nervous fever, typhus, lung inflammation, cough, chilliness, headache, and earache. Putrid fever and lung inflammation probably mean typhus and pneumonia, but nervous fever is unidentifiable. These diseases and symptoms very often afflicted her contemporaries--some appear in her fiction; to name a few, Harriet Smith's sore throat and Jane Fairfax's nervous fever. Nowadays their identification and cure are easy. But, as we see in Marianne's near death and Elizabeth's anxiety over Jane's fever, in the eighteenth century it was next to impossible to specify a disease and offer a proper treatment immediately. We should note that in those days there was no concept of the virus, bacillus, or microorganism, and the knowledge of chemical substances was very poor. To make this point clear, I would like to take gout as an example because Austen's brother Edward Knight and his mother-in-law Lady Bridges both suffered from it. Today we know that the cause of gout is an increase of uric acid, the result of too much protein. But in Austen's time little was known about uric acid even amongst medical professionals. It was generally accepted that gout was a disease peculiar to the well-off, an unpleasant result of their lifestyle. This assumption is not entirely wrong, but, clearly, the standard of medicine in Austen's time was not high.

To make matters worse, there were virtually no effective and safe treatments. In the light of modern treatment, applying flannel to rheumatism is primitive. Medicine, either bought at an apothecary's or prescribed by physicians, was no more effective than flannel. What medical professionals could do was likewise very limited. Austen reveals her dissatisfaction with a Bath apothecary:
 Edward has seen the Apothecary to whom Dr Millman recommended
 him, a sensible, intelligent Man, since I began this--& he
 attributes his present little feverish indisposition to his having
 ate something unsuited to his Stomach.--I do not understand that
 Mr Anderton suspects the Gout at all;--The occasional particular
 glow in the hands & feet, which we considered as a symptom of that
 Disorder, he only calls the effect of the Water in promoting a
 better circulation of the blood. (19 June 1799)


Probably due to the lingering influence of the humor theory, bloodletting, purging, and vomiting were still heavily relied on to handle many diseases; otherwise, practitioners turned to toxic chemicals such as mercury, quinine, and opium. The lay public including children took these powerful medicines for even minor ailments--as Austen wrote of her seven-year-old niece Harriet-Jane Austen: "Now, the reports from Keppel St are rather better; Little Harriet's headaches are abated, & Sir Ev:d is satisfied with the effect of the Mercury, & does not despair of a Cure" (23 March 1817). Austen's concerns and worries about the health of herself and others belong to an age when curing diseases was difficult, and typify, in the words of the medical historians Dorothy and Roy Porter, "a society of sickness" (3) in eighteenth-century England.

Not only did Austen list the diseases which had been annoying her circle, she also recorded what treatments they were subject to. To understand the major treatments practiced in her time, it is worth discussing the treatments Edward and Lady Bridges had for their gout as they could afford to try whatever therapy they liked. Edward was keen to try a new treatment--electric cure. Once again, we have Austen's own observation: "He drinks at the Hetling Pump, is to bathe tomorrow, & try Electricity on Tuesday;--he proposed the latter himself to Dr Fellowes, who made no objection to it, but I fancy we are all unanimous in expecting no advantage from it" (2 June 1799). The origin of electric therapy was with a French scientist, P. J. C. Mauduyt, who began to investigate this method in Paris in 1778, almost at the same time as Anton Mesmer introduced animal magnetism. Though less popular than mesmerism, as a radical treatment, the electric cure drew the attention of both professional and amateur scientists in Europe. Its purpose was to activate the circulation of the fluid in the body, and this technique was believed to be effective for paralysis, epilepsy, and menstrual disorders (Sutton). Also in Britain, electric therapy became widely known in a very short time. In the 24th edition of Primitive Physic (1792), one of the best-known medical manuals written for a lay readership, the author John Wesley appreciates that the electric treatment is "far superior to all the other medicines" he has ever known (xvii), and advises it for both serious and slight cases, ranging from insanity to headache. (1) Edward could have known about electric cure from reading medical manuals, or through his Parisian cousin Eliza de Feuillide. In addition, his proposal of an electric therapy to Dr. Fellowes indicates that unlike today, in Austen's time, the power relation between wealthy patients and their doctors was definitely patient-oriented (Jewson 375-76; Porter 24-25). Some patients directed doctors to agree with their favorite treatment, just as Edward did. (2)

Alongside a new treatment, old-fashioned treatments were still in use. Austen observed that a Bath physician named Dr. Parry applied bloodletting to Lady Bridges: "His system is a Lowering one. He took twelve ounces of Blood from her when the Gout appeared, & forbids Wine &c.--Hitherto, the plan agrees with her" (7 November 1813). The case histories of Edward and Lady Bridges demonstrate that in Austen's time there was little progress in medicine, and that every treatment known either to doctors or patients was tried at random.

It is supposed that, like bloodletting, electric treatment was unpleasant despite its novelty. What was far more appealing to the public was hydrotherapy practiced as bathing and drinking water at watering places. The most popular destination was Bath, which plays a crucial part in Austen's life and fiction. Although its popularity declined with the emergence of coastal resorts, the history of Bath as a frequented spa is quite long and prominent, far surpassing other spa towns. In the early 1700s, Dr. Oliver, a local physician, claimed that Bath water could cure almost every disease, from leprosy to infertility. Another physician, Dr. Peirce, referred to a woman whose several troublesome symptoms were completely cured by the Bath waters (Neale 13, 15). In 1786, although in a soberer tone than those of Dr. Oliver and Dr. Peirce, James Makittrick Adair, a physician of the General Hospital at Bath, wrote of a female patient whose obstinate biliousness was successfully cured by Bath water (18-19, 118).

What was unique about Bath water was its temperature. In 1760, Dr. Richard Russell from Brighton analyzed mineral waters from British inland spas. He said that thanks to its heating and drying effects, Bath water was effective in dissolving tumors and ulcers and in preventing obesity. Among the representative diseases curable by the water, he identified poor appetite, indigestion, nervous distempers, jaundice, biliousness, bladder diseases, rheumatism, gout, skin diseases (193-94, 196-200). Of these diseases, Bath water was believed to be effective especially for gout. In the entry on gout in Domestic Medicine, the best-selling medical manual throughout the eighteenth century, William Buchan advises, "Such as can afford to go to Bath, will find great benefit from bathing and drinking the water. It both promotes digestion, and invigorates the habit" (362). (3) In addition to Edward and Lady Bridges, in Austen's novels, Mr. Allen and Dr. Grant both visit Bath to be cured.

The historian J. H. Plumb mentions that in the eighteenth century, holidays functioned as an index of wealth, and that the purpose of going to spas was mainly amusement (265, 284). From Austen's adulthood onwards, apart from medical purposes, watering places began to be visited for pleasure, and travel was an important activity in spending spare time in the upper middle classes. As was often the case with the well-to-do in provincial towns, the Knights and the Bridges went to Bath for having its water and pleasure. In 1799, the Bath apothecary Mr. Anderton recommended the water to Edward, expecting "a better circulation of the blood" (19 June 1799). Fourteen years later, Austen again wrote, "Lady B. drinks at the Cross Bath, her son at the Hot, and Louisa is going to Bathe" (16 September 1813). Together with his mother and brother-in-law, Mr. Bridges suffered from gout. On the other hand, from Austen's letters, we cannot know whether she drank and bathed in Bath water. Instead, while staying in Lyme Regis, she wrote that she enjoyed sea bathing: "I continue quite well, in proof of which I have bathed again this morning"; "The Bathing was so delightful this morning & Molly so pressing with me to enjoy myself that I believe I staid in rather too long, as since the middle of the day I have felt unreasonably tired. I shall be more careful another time, & shall not bathe tomorrow, as I had before intended" (14 September 1804). It seems that Austen loved a holiday in the seaside far better than staying in Bath.

As represented in the contrast between Austen's love for Lyme Regis and dislike of Bath, her attitude toward resorts and clientele flocking there is distinctively different, depending on who goes where for what. First, she liked quiet and inexpensive places like Lyme Regis but disliked an expensive, crowded, and ostentatiously fashionable place like Weymouth and Bath: "Weymouth is altogether a shocking place I perceive, without recommendation of any kind, & worthy only of being frequented by the inhabitants of Gloucester.--I am really very glad that we did not go there, & that Henry & Eliza saw nothing in it to make them feel differently" (14 September 1804). Second, although unwilling, she was relatively patient with attending her family members' holidaying. Yet, she occasionally disparaged strangers' craze for resorts: "I am sorry Sweden is so poor & my riddle so bad.--The idea of a fashionable Bathing place in Mecklenburg!--How can people pretend to be fashionable or to bathe out of England!" (25 September 1813); "Ed: Hussey is warned out of Pett, & talks of fixing at Ramsgate.--Bad Taste!--He is very fond of the Sea however;--some Taste in that--& some Judgement too in fixing on Ramsgate, as being by the Sea" (14 October 1813). Third, she accepted sensible people's medicinal visits, writing to her nephew James Edward, "Your Mother must get well first, & you must go to Oxford & not be elected; after that, a little change of scene may be good for you, & Your Physicians I hope will order you to the Sea, or to a house by the side of a very considerable pond" (9 July 1816). However, she was harsh about visits by hypochondriacs: "They have been all the summer at Ramsgate, for her health, she is 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" (25 September 1813). David Selwyn suggests that travel to watering places gave the bourgeois in the eighteenth century and Regency a good opportunity to "indulge the twin preoccupations of illness and amusement" (23). As we see in her love for Lyme Regis and sea bathing, Austen found charm and pleasure in holidaying. Nevertheless, she was aware that the fashion of spas and resorts was inseparably linked with the idleness and indulgence of the rich, especially hypochondriacs. As is obvious in her observation, they loved thinking themselves ill and worrying over imaginary diseases. Watering places offered them opportunities for doing so outside the home--what Austen detested above all.

Austen's disapproval and criticism of hypochondria were undoubtedly gained from her experience of attending Mrs. Austen, who is known to have been hypochondriac. Austen was a dutiful daughter, but, still, she was sometimes sick of Mrs. Austen's stream of complaints. Just after her twenty-third birthday, she wrote: "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, Water in her Chest & a Liver Disorder" (18 December 1798). Ten years later, Mrs. Austen's hypochondria remained unchanged: "For a day or two last week, my Mother was very poorly with a return of one of her old complaints--but it did not last long, & seems to have left nothing bad behind it.--She began to talk of a serious Illness, her two last having been preceded by the same symptoms" (17 January 1809). Toward Mrs. Austen, Austen's hatred is "regulated," to quote the title of D. W. Harding's famous article, but toward a stranger, her tone is fairly sharp: "Lady W. has taken to her old tricks of ill health again & is sent for a couple of Months among her friends. Perhaps she may make them sick" (9 February 1813). Austen's dissatisfaction and frustration in getting along with hypochondriacs may be echoed in the relationship between Elizabeth and Mrs. Bennet, between Emma and Mr. Woodhouse, and between Anne Elliot and Mary Musgrove.

As a result of her antipathy to hypochondriacs, it seems that Austen determined to keep herself fit based upon what was cheaply available to her (e.g., moderation and exercise), and she refused to complain of her illnesses. Like Elizabeth Bennet, Austen was an excellent walker and enjoyed long walks: "We took a very charming walk from 6 to 8 up Beacon Hill, & across some fields to the Village of Charlcombe" (2 June 1799); "We afterwards walked together for an hour on the Cobb" (14 September 1804). David Waldron Smithers observes that including her father's death, Austen's tone in describing medical events is generally calm (305). However, quite unusually for her, when describing her bilious fever, Austen loses her self-control. She considered it a shame, and made an excuse that her fever was not from her weakness, largely due to her uncle Mr. Leigh-Perrot's will, which left everything to Mrs. Leigh-Perrot as long as she lived, with the reversion of a large sum to Austen's brother James and his heirs; the Austen sisters were given only 1,000 [pounds sterling], respectively. We have Austen's self-defense: "I am ashamed to say that the shock of my Uncle's Will brought on a relapse.... I am the only one of the Legatees who has been so silly, but a weak Body must excuse weak Nerves" (6 April 1817). Yet, she recovered from the shock relatively soon. Two months before her death, in spite of being certain that she was to die before long, she made a joke: "Mr Lyford says he will cure me, & if he fails I shall draw up a Memorial & lay it before the Dean & Chapter, & have no doubt of redress from that Pious, Learned & disinterested Body" (27 May 1817). This is indicative of Austen's fortitude and resilience.

The letters I have examined so far are only a part of the evidence regarding medical events scattered through Austen's letters, but they offer valuable records of an age when the techniques of diagnosing and curing diseases were undeveloped, and people desperately searched for ways to preserve health, regardless of their efficacy. Nevertheless, suffering from "weak nerves," to quote Austen, became fashionable and was deemed an index of high social standing. As is evident in her sharp tone in writing of hypochondriacs, Austen was critical of such an inconsistent and odd view of health. She was sure that falling ill was greatly associated with weakness in an individual's integrity and morality. Thus, she did not want to be ill and did not want her illness to be known. She was quite familiar with popularly practiced treatments, but she did not blindly follow new and fashionable ones. Her regimen was simple and inexpensive, easily practicable at home and requiring no special equipment. Her statement on 23 March 1817 that "Sickness is a dangerous Indulgence at my time of Life" encapsulates her belief that in circumstances where little could be expected of medicine, she could fight against diseases by virtue of a strong mind rather than a medical intervention. This belief is a considerable influence on the interrelation between the temper and the state of health of her characters.

WORKS CITED

Adair, James Makittrick. Medical Cautions. Bath, 1786.

Austen, Jane. Jane Austen's Letters. Ed. Deirdre Le Faye. 1995. 3rd ed. Oxford: OUP, 1997.

--. Sense and Sensibility. Ed. R. W. Chapman. 3rd ed. Oxford: OUP, 1933.

Austen-Leigh, James Edward. A Memoir of Jane Austen. 2nd ed. 1871. Ed. Kathryn Sutherland. Oxford: OUP, 2002.

Buchan, William. Domestic Medicine. 18th ed. London, 1803.

Freeman, S. The Ladies' Friend; And Family Physical Library. 5th ed. London, 1787.

Jewson, N. D. "Medical Knowledge and the Patronage System in 18th Century England." Sociology 8 (1974): 369-85.

McKendrick, Neil, John Brewer and J. H. Plumb. The Birth of a Consumer Society: The Commercialization of Eighteenth-Century England. London: Europa, 1982.

Neale, R. S. Bath 1680-1850: A Social History or a Valley of Pleasure, Yet a Sink of Iniquity. London: Routledge, 1981.

Porter, Dorothy, and Roy Porter. Patient's Progress: Doctors and Doctoring in Eighteenth-Century England. Stanford: Stanford UP, 1989.

Porter, Roy. Disease, Medicine and Society in England, 1550-1860. 2nd ed. 1993. Cambridge: CUP, 1995.

Russell, Richard. A Dissertation on the Use of Sea Water in the Diseases of the Glands. 4th ed. London, 1760.

Selwyn, David. Jane Austen and Leisure. London: Hambledon, 1999.

Smithers, David Waldron. "Medicine." The Jane Austen Handbook with a Dictionary of Jane Austen's Life and Works. Ed. J. David Grey. London: Athlone, 1986. 304-06.

Solomon, Samuel. A Guide to Health. 18th ed. London, [18187].

Sutherland, Eileen. "That Infamous Flannel Waistcoat." Persuasions 18 (1996): 58.

Sutton, Geoffrey. "Electric Medicine and Mesmerism." ISIS 72 (1981): 375-92.

Tomalin, Claire. Jane Austen: A Life. 1997. Harmondsworth: Penguin, 1998.

Wesley, John. Primitive Physic. 24th ed. London, 1792.

NOTES

I owe a great deal of thanks to Brian Southam for his helpful suggestions.

(1.) John Wesley (1703-91) was one of the founders of Methodism, not a medical professional, but he had a great interest in medicine. In 1746 he opened a dispensary in Bristol, and his practice remarkably succeeded. Primitive Physic was originally published in 1747 and printed in twenty-three editions by the time of Wesley's death. On Wesley's medical career and Primitive Physic, see G. S. Rousseau, "John Wesley's Primitive Physic (1747)," Harvard Library Bulletin 16 (1968): 242-44, 251-53.

(2.) Porter introduces the case where Dr. Johnson insisted on bloodletting against his physician's advice.

(3.) William Buchan (1729-1805) was born in Scotland and took the degree of MD in the University of Edinburgh. He worked for the Foundling Hospital in Yorkshire, practiced in Sheffield, and later in London. Domestic Medicine was originally published in 1769 and printed in nineteen editions in Britain by the time of Buchan's death. In America, since its first publication in 1771, Domestic Medicine was a long seller, too. On Buchan and Domestic Medicine, see C. J. Lawrence, "William Buchan: Medicine Laid Open," Medical History 19 (1975): 20-35; Charles E. Rosenberg, "Medical Text and Social Context: Explaining William Buchan's Domestic Medicine," Bulletin of the History of Medicine 57 (1983): 22-42.

Akiko Takei is Associate Professor at Yamaguchi University, Japan. Her research interests are eighteenth--and nineteenth-century British novels and history. Her articles have been published in Eighteenth-Century Fiction and Dickensian.
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Title Annotation:AGM 2005: Milwaukee
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Publication:Persuasions: The Jane Austen Journal
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Date:Jan 1, 2005
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