What Illness Made Anne de Bourgh Sickly?
Diane Morris | Thursday, March 23rd, 2017 | Anne de Bourgh, Medicine | 20 Comments
I keep track of the questions that bring readers and other curious parties to my website. A surprising number of people are interested in Anne de Bourgh’s inheritance, a scheme which I outlined in a 2014 blog post. A 2015 blog post considered Anne’s arranged marriage to her cousin Fitzwilliam Darcy. With this blog post I address one of the first questions I asked when writing Anne’s story for my novel Rosings Park: What sort of illness made Anne “sickly and cross”?
What We Know about Anne from Pride and Prejudice
Miss Elizabeth Bennet had no very good opinion of Miss Anne de Bourgh, the heiress of Rosings Park. Here is what she tells Maria, Mrs. Collins’s sister, when the two of them are observing Anne and her companion, Mrs. Jenkinson, talking with Charlotte Collins out on the drive:
“I like her appearance,” said Elizabeth, struck with other ideas. “She looks sickly and cross. Yes, she will do for him very well. She will make him a very proper wife.”1
Miscellaneous pollen that might contribute to rhinitis (Image obtained from the Dartmouth College Electron Microscope Facility) (Source: Wikimedia Commons)
So here we have it: Anne de Bourgh’s character is forever fixed as sickly. But why is she sickly? What physical problems might beset her? Answering these questions proved a challenge. I read snippets of medical books published between 1795 and 1830 looking for a likely culprit. My thinking went like this: the illness must be fairly serious, perhaps one that nearly killed her. But so many illnesses were deadly then, the illness could not be too deadly. It should have lingering aftereffects—symptoms that would come and go. Perhaps infectious rhinitis would do, but I found no evidence that doctors recognized rhinitis back then. (Dr. Buchan’s popular treatise, Domestic Medicine, does not mention rhinitis.2) I must search for something suitable, but where to start? Ah, I should examine the reports of diseases in London, where Anne was residing when she became ill.
The Backstory to Anne’s Illness
In thinking about Anne’s illness, I had to work backwards from Jane Austen’s novel Pride and Prejudice (P&P), which was published in 1813. In my novel, titled Rosings Park, Anne is twenty-six years old. The action in Rosings Park is built around the action in Pride and Prejudice and begins in March, when Miss Elizabeth Bennet, along with Sir William Lucas and his daughter Maria, arrive in Hunsford, Kent, to visit Sir William’s newly married daughter, Charlotte Collins. Rosings Park is the de Bourgh’s estate situated near Hunsford, you may recall.
In my second novel—Cousin Anne—Miss de Bourgh is seventeen. Cousin Anne is a prequel to Pride and Prejudice. Its story, set in London, includes many familiar characters: Mr. Darcy, Colonel Fitzwilliam, Mr. Wickham, and, of course, Anne’s mother, Lady Catherine. Cousin Anne also brings to life several other characters: Anne’s father, Sir Lewis de Bourgh, and Darcy’s parents. I knew when I sat down to write this prequel that Anne would suffer a serious illness. But what sort of illness?
Diseases Reported by the Public Dispensary
Diseases in Eastern London, Nov/Dec 1803 (screen shot)2
I began by browsing for information about diseases in London. I found, for instance, this list of acute, chronic, puerperal and infant diseases in an eastern district of London between November 20, 1803 and December 20, 1803.
Among the acute diseases, note that ten individuals were diagnosed with “pneumonia,” a category divided into two parts: Pneumonia and Peripneumonia Notha. Five persons had dysentery, five had smallpox (Variolae) and four presented with acute rheumatism. The leading chronic cases included tussis (cough) and tussis cum dyspnoea (a cough plus other symptoms, such as a hard and fast pulse, side stitches, and bleeding).3 There were increased cases of coughs and catarrhs (common colds), as was expected during the autumn months. More worrisome was the increase in smallpox cases, for which the mortality remained “very considerable.”
The table provides a good example of how hard it can be to understand how diseases were classified in the early 1800s. The disease Peripneumonia Notha was not described in the 1803 journal from which the table was taken, but I stumbled across a summary of diseases for April and May of 1812 that mentioned Peripneumonia Notha. Dr. Fothergill described this condition as “an urgent and dangerous disease” and lamented the use of the term because its meaning—”bastard pneumonia”—was barbarous. Interestingly, Google Translate converts the Latin to English in this manner: “counterfeit pneumonia,” which doesn’t sound quite so disreputable.
Reports of Diseases at the Public Dispensary in London
Diseases Observed by the Public Dispensary, London, 1804 (screen shot)3
The Public Dispensary in London also reported diseases. The table at right shows the acute and chronic diseases listed by the Dispensary for the months of September through November, 1804. Among acute diseases, catarrhs or colds led the list with 40 cases, followed by Synochus (a type of fever), pneumonia, cholera, typhus, and scarlatina. (Today the word “scarlatina” is synonymous with “scarlet fever,” but in Jane Austen’s day, scarlatina was considered a less severe form of scarlet fever.5) Acute rheumatism affected two individuals. Thirty people were ill with asthenia or general weakness.
Organizing My Thoughts on Anne’s Illness
My first thought was this: how lucky I am to live in the 21st-century! I am not likely to contract typhus or cholera—both caused by bacteria—because I live in the US where public sanitation is very good. I was inoculated against smallpox and had rubeola (measles) and pertussis (whooping cough) as a child. But what about Anne? After studying the list of common diseases in London during the early 1800s, I became interested in rheumatism. Had I found a likely cause of Anne de Bourgh’s sickliness?
Sources:
1Austen, Jane. Pride and Prejudice. London: Penguin Books, p. 156 (chapter 28).
2Buchan, William. Domestic Medicine. (Boston, 1811).
3Anon. Medical and Physical Journal, vol XI (January-June), 1804, p. 83 (PDF p. 106).
4Dr. Fothergill’s table. The Monthly Magazine, vol. XXXIII, 1812, p. 499 (PDF p. 510).
5Clark, John. Observations on Fevers, Especially Those of the Continued Type; and on the Scarlet Fever Attended with Ulcerated Sore-Throat. (London, 1792), pp. 354-355 (PDF pp. 387-388).
Great post! Amazing to think that a baby could die from teething problems, fever from having worms, or one i’m sure you know – rollover. This is when the baby was smothered by it’s parent when they rolled over them in bed. It seems to be more prevalent in historical accounts concerning the alcoholism of the destitute – drunk parent smothers baby. Even more amazing is the anti vax movement…my grandparents lived through scarlet fever, diphtheria, and sicknesses no longer in the lives of most people under 50 years old. We are extremely lucky!
Just lovely to hear from you, Julie. I couldn’t agree with you more: we are incredibly lucky here in the US. I myself had strept throat and scarlet fever as a teenager. Without penicillin (two double-doses) I probably would not be here today. So glad you enjoyed the post. Kind regards.
Oh! One other comment! Concerning your posts on Fanny Burney and her mastectomy – read the letters between John and Abigail Adams regarding their daughter Nabby’s mastectomy. She traveled from the fort in Albany to Philadelphia in a carriage/wagon. The trip took 2 weeks, through wilderness and over rutted roads. Then like Fanny, the surgery was performed without drugs.
Thanks, Julie, for telling me about Nabby’s mastectomy. I was not aware of it. Did she, like Fanny Burney, live another two+ decades afterward? Are the Adams’s letters available online? When I read surgical case histories from the early 1800s I marvel that anybody survived. If the surgery itself didn’t kill you, the recovery might! Thanks for visiting my blog. It’s a lot of work to put the posts together, but doing so helps in finding background information for my stories. Best wishes.
Correction: Nabby’s surgery took place in the Adams’ home in Quincy. Nabby had surgery in October and passed away in August, possibly due to the delay in having the surgery. It had spread to her lymph nodes, some of which were ripped out during the mastectomy. I originally read about this in “The Adam’s Women: Abigail and Louisa, Their Sisters and Daughters” by Paul C. Nagel. However; there is a pretty concise essay written about Nabby from “Bathsheba’s Breast: Woman, Cancer and History” by James S. Olson on the Sam Houston State University website. Enjoyed your response!!!
So Nabby underwent surgery at home, just like Fanny Burney. In terms of survival, the thinking back then was that a patient’s constitution had much to do with their survival, a notion that is not out of place today. Of course, Regency surgeons and doctors had no knowledge of the germ theory of disease. It would be comical, if it weren’t so sad, that their ideas about the causes of contagious disease were primitive: bad air, bad food or a “poison” that defiled the animal spirits. The thing that impresses me about these medical practitioners is that they were asking the right questions. Kind regards.
Bathsheba’s Breast Women, Cancer, and History by Olson, James S. [Johns Hopkins University Press,2005] [Paperback] Paperback – 1994
The Adams Women: Abigail and Louisa Adams, Their Sisters and Daughters Paperback – March 5, 1999
by Paul C. Nagel
Thanks for the new resources, Julie. I’ve made a note of them. It would do me good to read more U.S.-based books that describe what was going on over here during Jane Austen’s day. I occasionally read an early 19th-century book on surgery or disease by an American author (usually published in Philadelphia), but I should read farther afield. Best wishes.
Hey! I just wanted to know, do you have some medical education? Because I was also very interested concerning her illness and my thoughts went to a completely different direction. I thought she was having some gene mutation, as it was very common to have kids with e.g. Cousins which multiplies (factor 2) the risk of having a handicapped baby. We get some more information about her appearance, they say her face nor her body looks very similar to her mother. I don’t know any childhood infection that could cause such a change of facial characteristics.
Hi, Mary. You raise an interesting issue about Anne. With so much being understood today about genetics it is not surprising that you are wondering why Anne might differ in looks (and possibly character) from her mother. We have no reason to believe that Anne’s parents — Sir Lewis de Bourgh and Catherine Fitzwilliam de Bourgh — were cousins, but many such marriages did take place during that time, which makes the genetic issue a consideration. It all seems like a lottery! For example, I am the spitting image of my mother and of her mother (my grandmother), but I have a dear friend who really doesn’t look like either of her parents (she wasn’t adopted). I have tended to regard Anne’s physical appearance as being partly the result of having a sickly childhood, a situation that makes her thin, small, and not very robust. But the issue you raise is equally valid. FYI: I have a graduate degree in nutrition and worked with physicians in many different settings during my career … until I took up historical fiction! Many thanks for contacting me. I will give your idea some thought! Kind regards.
I always thought her illness was a little more subtle, something along the lines of anemia complicated by continual misdiagnosis, unorthodox treatments, and an overbearing mother. I don’t know why but that’s the first thought that popped into my head. Then again, I also always believed Mrs Bennet suffered from a severe anxiety disorder brought on by a more severe end of postpartum depression after giving birth to Elizabeth. So what do I know? Your thoughts are a logical conclusion, and make sense.
LaNale, I can embrace your first impressions of Anne de Bourgh’s illness wholeheartedly. She could have suffered from any number of things, including anemia and strange treatments or a low-grade infection or pneumonia. And you’re right: anyone might grow disagreeable if forced to live with the likes of Lady Catherine! Of course, no one knows what disease Jane Austen had in mind when she described Anne as sickly and cross. After reading some Regency-era medical texts I leaned toward giving her a rheumatic affection that arose from having strept throat and scarlet fever as a child. But your arguments in favor of an alternative view are perfectly feasible. Many thanks for contacting me. Kind regards.
The answer may well be endometriosis. The diagnosis is ‘new’ but the disease is old. The Endometriosis patient is often thin, sickly and anxious. Jane Austen must have known women suffering this condition. It would be logical to write one in.
Thanks, John, for the interesting suggestion. I had not thought of it, despite having two friends who have struggled with it for years. I vow to explore the Regency-era medical journals to see what I can find out about it. There is the tiniest chance that I may write a fourth book in my series Surgeon’s Duty, which is now a trilogy due to be published next year, or I may write a third book in the Anne de Bourgh series. A case of a lady with endometriosis might fit a new story very well. Best wishes to you in these strange times. Diane
If you watch the BBC 1995 version of P&P it is obvious – she has arsenic poisoning because Lady Catherine had the house painted green…
What an interesting theory, Jean! After I read your comment I went to PubMed Central to find articles on arsenic poisoning. Today the main causes are natural sources of contaminated water, smelting, and other industrial processes. But I found an article published in 1860 that describes several arsenic sources common then: children’s bon-bons, women’s robes tinted with arsenic, and paper hangings used in homes that were colored green by arsenite of copper. (The 1860 paper can be found here: https://bit.ly/32pwp8r) You have inspired me to carry out a more thorough search. I see a blog in my future on this topic. I’ll let you know what I find, but there will be a bit of a wait … I have only two chapters left to write and then my trilogy on bodysnatchers and the rise of the pure surgeon during Jane Austen’s day is finished (except for extensive editing and finding a cover designer). Many thanks for sharing your idea! Best wishes, Diane
I’m guessing it’s some type of congenital heart disease, such as vsd
Yours is an interesting diagnosis, Liz, and not one I had considered because I know very little about it. Your comment sent me off and running. I read various general descriptions of VSD (ventricular septal defect) and its diagnosis, manifestations, and treatments. As I understand it, VSD is characterized by a hole between the heart’s right and left ventricle chambers. Today an infant suspected of having VSD is monitored closely. In most cases, the hole closes naturally and all is well. In other cases, it does not close and surgery is required to close it. Infants suspected of having VSD are often followed for 2 or 3 years. Could Anne de Bourgh have had VSD? It’s possible she did, but to have survived until adulthood, the hole must have healed spontaneously. Otherwise, I believe she would have died as an infant, mainly because so very little was known about heart function in the Regency era and her family doctor would not have understood why her health was poorly. It was not until the 1840’s that doctors and surgeons began to get a handle on various heart-related diseases like aneurisms and diseases of the veins and arteries. Still, I added notes to my “medical” spreadsheet about this condition. Maybe in a future novel I’ll use VSD or something like it. Best wishes, Diane
Thalassemia is an inherited blood disorder that causes your body to have less hemoglobin than normal. It is brought on by consanguinity, cousins marrying cousins. Annes’s father need not have been a cousin to Lady Catherine, but prior generations may likely included consanguineous marriages. Symptoms of Thalassemia include fatigue, weakness, paleness, and slow growth
Your question, Janine, prompted me to do some research on PubMed Central, where I read 10 or 12 articles. Thalassemia is an inherited blood condition that affects hemoglobin metabolism. People with this condition have severe, chronic anemia and need regular blood transfusions from childhood to prevent complications resulting from high levels of iron in the blood. Without transfusions the condition is fatal, with many infants dying in utero or shortly after birth. Historically, the gene that causes this condition has been found in populations living around the Mediterranean Sea and also in the Middle East, the Far East (including China), India, and Africa. Many of these cultures have a tradition of sons and daughters marrying within their family, which might place their offspring at risk. So is it likely that Mr. Darcy and Anne de Bourgh’s families were carriers of the gene? Based on my reading I would say that it’s possible but not likely. I came to this conclusion after learning that the gene is distributed worldwide, except in people originating from northern Europe (which includes England) and North America. Thus, the United Kingdom (UK) would not naturally be a region where many people would carry the gene, which I believe would have been true during the Regency era. Most UK cases of thalassemia reported today occur in populations that migrated there. Thus, about 1,000 people in England are affected by thalassemia, with 20 to 25 babies born with the condition each year. This is a very small number of affected cases in a population of 68 million in the UK (57 million in England alone). Still, the seriousness of the condition has spurred the development of prevention programs to educate couples planning to marry about their risk of having a baby with thalassemia. If you’d like copies of the articles I read please let me know and I’ll email them to you. Thanks for stirring the little gray cells with your question! Best wishes, Diane