George Dunea, MD
Hektoen Institute, Chicago, Illinois, United States

Jane Austen

Jane Austen
Courtesy of the University of Texas Libraries, University of Texas at Austin

Jane Austen began working on Sanditon in January of 1817, completing only 2,600 words before she died six months later—probably from adrenal failure (Addison's disease) caused by tuberculosis. The fragment was published in part in 1870, then in its entirety in 1925. Several authors since then have completed the story, including one anonymous author around 1975. In that particular version, published as a Signet paperback edition, Jane Austen’s part consists of a mere 71 pages, or a little over 10 chapters.

In an apology published at the end of the book, the anonymous author explains how she guessed Jane Austen’s intentions towards the plot. She reminds us that, at least as expressed in her novels, Jane Austen’s range of interests were limited, with no mention of the Napoleonic wars or other political events of the period. Instead, in five of her six major completed books, we find a heroine, lovely and intelligent, living quietly in the country until a rich bachelor arrives on the scene. Then, after a series of intrigues and setbacks, they get together, marry, and presumably live happily ever after. Much of this is foreshadowed in the famous first sentence of Pride and prejudice: “It is a truth universally acknowledged that a single man in possession of a good fortune must be in want of a wife.”

Jane Austen's beginning of Sanditon, though devoid of universally applicable wisdom, is worth reproducing here to show how well she crafted her sentences, packaging an abundance into one opening paragraph:

A gentleman and the lady travelling from Tunbridge towards that part of the coast that lies between Hastings in Eastbourne, being induced by business to quit the high road and attempt a very rough lane, were overturned in toiling up its long ascent, half rock, half sand.

The gentleman, a Mr. Parker, is traveling to recruit a physician for Sanditon, a small seaside village that, in partnership with the wealthy Lady Denham, he hopes to develop into a fashionable vacation resort—an activity that constitutes his only hobby and obsession. He thinks that “the advantage of a medical man would very materially promote the rise and prosperity of the place, would in fact tend to bring a prodigious influx”—for nothing else was wanting.

Whether he will succeed is not the purpose of this article. Relevant, however, are the attitudes of some of the main protagonists towards doctors and illness, as described by Jane Austen with her trenchant, ironic wit in the fragment that, alas, she did not live to complete. First there is Lady Denham. She is twice widowed, very rich, very stingy, and of the opinion that the fewer servants one has the better life is. Mixed about the potential influx of tourists, she worries that tourists who scatter their money freely will raise the price of bread and meat, but also wonders if among the tourists there may not be a few consumptives who may want her asses’ milk—which is presumably effective when combined with fresh air.

To Mr. Parker, she wonders what on earth one could achieve by having a doctor at Sanditon, other than to “encourage the servants and the poor to fancy themselves ill.” She herself has lived 70 years without ever seeing the face of a doctor, let alone taking physic. And she verily believes that her poor husband would still be alive had he never seen one. “Ten fees, one after another, did the man take who sent him out of the world. I beseech you, Mr. Parker, no doctors here.”

In sharp contrast to Lady Denham's unfavorable opinion of the healing profession stand those of Mr. Parker and his three siblings. Mr. Parker, true to his obsession, is convinced that nobody could be in the state of “secure and permanent health without spending at least six weeks by the sea every year.” He regards sea air and sea bathing together as distinctly infallible, effective in curing every disorder of the stomach, the lungs, or the blood. He finds them “anti-spasmodic, anti-pulmonary, anti-septic, anti-bilious, and anti-rheumatic,” and proclaims, “Nobody could catch cold by the sea; nobody wanted appetite by the sea; nobody wanted spirits; nobody wanted strength.” Sea air was healing, softening, relaxing—fortifying and bracing—evidently designed by nature for the cure.

Mr. Parker has three siblings, charitable and amiable, “full of imagination and quick feelings,” but with “an unfortunate turn for medicine, especially quack medicine,” with “an early tendency at various times to various disorders.” Always in hand are phials of salt from which they would take two or three drops at a time with “a great many odd faces and contortions.” Charlotte, a guest of the Parkers and the main heroine, however, sees no signs of illness in any of them and would have undertaken their cure by putting out the fire, opening the windows, and throwing out all the drops and salts.

Diana, the younger sister, fancies herself rheumatic, nervous, and possibly bilious despite improving with wine in moderation, so that she is at her best in the evening. She avoids dry toast because toast without butter would damage the very delicate coats of her stomach. Indeed she thinks that toast can irritate these coats by acting just like a nutmeg grinder. Diana is subject to “attacks” of spasmodic bile, hardly able to crawl from bed to sofa when these come on. She has consulted physician after physician in vain, is now entirely done with their whole tribe, and worries that in her present state sea air would be the death of her. As for treating Mr. Parker's sprained ankle, which was acquired during the aforementioned carriage accident, she recommends rubbing, for there is “nothing as judicious as friction,” though the rubbing may have to be continued for six hours at a time without interruption.

Also suffering from diseased nerves is the elder sister, Susan, who endures such severe headaches that even six leeches a day for 10 days brought no relief. Convinced that “the evil lay in her gums” she had three teeth extracted and is now decidedly better, though her nerves are still so deranged she speaks only in whispers, fainting twice one morning on hearing her younger brother, Arthur, suppress a cough. This brother, chubby and overweight, never works and is so languid that his sisters worry about his liver. Yet he is tall and stout, “broad made and lusty, with not the least look of an invalid other than a sodden complexion.”

From this description of hypochondria or somatization in the 19th century, one is left wondering how these supposed invalids would have fared nowadays. How many CT scans and endoscopies would they have had, wandering from doctor to doctor, from hospital to hospital, from emergency room to emergency room in a system where things are “free”? Would they be taking tranquilizers and antidepressants, carrying with them long lists of their medical prescriptions—Lipitor, niacin, folic acid, resveretrol, atenolol, Valium, Zocor, Reglan, Diovan, Metamucil, Colace, lactulose, vitamin B, C, and E, and now, of course, calcium and vitamin D? Would they also practice yoga and submit to professional counseling? Of one thing I am certain: they would be fussy eaters, avoiding nuts, spices, and fried food, and, at best, eating only organic produce—but carefully and in moderation, to avoid damaging the delicate linings of their sensitive stomachs.

 


GEORGE DUNEA, MD, FACP, FRCP, FASN is the president and CEO of the Hektoen Institute of Medicine. He is also a professor of medicine at University of Illinois at Chicago, the medical director of Chicago Dialysis Center, and founding chairman emeritus, Division of Nephrology, Stroger Hospital of Cook County.