Hektoen International

A Journal of Medical Humanities

Robert Louis Stevenson and hereditary hemorrhagic telangiectasia

Sally Metzler
Chicago, Illinois, USA


Painting of the Stevenson House
Fig. 1: Edward Joseph F. Timmons, Stevenson House, ca. 1940, oil on canvas, Collection of the Union League Club Chicago.

Famed Scottish author Robert Louis Stevenson (1850-1894) traveled to Monterey, California, in 1879 and lived for three months on the second floor of a white adobe boarding house called the French Hotel. Located on 530 Houston Street, the edifice is now known as the Stevenson House and serves as a major tourist site and memorial to this famous author’s brief but important sojourn (fig 1).1 Stevenson’s journey to Monterey began three years earlier in France, followed by an Atlantic crossing to New York, and ended after a grueling traverse of 6,000 miles to reach the west coast. Why would Stevenson, who suffered ill health most of his life, embark on such a trip? The simple answer was love. He traveled to claim the hand of Mrs. Fanny De Grift Osbourne, an American from Oakland California. Eleven years his senior, Fanny was staying at an artist’s colony in Grez France, recovering from the loss of a child and sorting out an unhappy marriage. Stevenson was also in Grez, and one summer evening attended a dinner party at which Fanny was also present. He was captivated by her beauty, wit, and charm. The unlikely couple fell in love. Fanny returned to California, but Stevenson could not get her out of his mind.

Resolute to reunite with her, he undertook a trip that nearly killed him. Once in Monterey, he spent a good amount of his days convalescing. While waiting for Fanny to sort out her affairs and finalize her divorce, he managed to pen several important works. Though fraught with anxiety and illness, he completed The Old Pacific Capital, a description of Monterey, and the Amateur Immigrant, an account of his cross-country journey to California.

His tribulations bore fruit, as less than a year after arriving in Monterey, on May 19, 1880, he and Fanny were married in a private ceremony across from the San Francisco Bay. The occasion was bittersweet, as Stevenson described himself at the time as a “. . . a mere complication of cough and bones, much fitter for an emblem of mortality than a bridegroom.”2 Though he recovered, “. . . forever after that shattering year in California, he was an invalid.”3

Photograph of Robert Louis Stevenson
Fig. 2: Photograph of Robert Louis Stevenson

In view of the near constant ill health Scottish author Robert Louis Stevenson endured throughout his short life of forty-four years, it is astounding he produced so many masterpieces of literature. Perhaps, in a twist of fate, his afflictions turned him inward and sparked his bouts of creativity. Certainly his lack of stamina since childhood and oft-invalid existence forced him to forgo the active pursuits which would traditionally distract one from writing. He wrote of his grueling illness: “For fourteen years I have not had a real day of health.”4 Undaunted, he persevered and wrote assiduously throughout his bouts of sickness: “I have written in hemorrhages . . . written torn by coughing . . . few are the days when I am not in some physical distress.”5 These passages and others lead to the query under what affliction did Stevenson suffer? Tuberculosis has been intimated as the culprit, especially based on reports of his respiratory distress and his own account of spitting blood. He in fact referred to his pulmonary hemorrhages as “my old friend Bluidy Jack.”6

From the diary his mother kept, it is clear Stevenson was sickly even as a child. She diligently noted a running list of his ailments: croup, scarlet fever, chicken pox, mumps, gastric fever . . . the maladies continue. By the age of twenty-nine, Stevenson had apparently experienced episodes of pulmonary bleeding. Undaunted, he traveled and wrote throughout his relatively brief life, “. . . when I spit blood I write verses.”7

Much of the time he was under the care of physicians, searching for a cure to his disease. At one point he was attended by the late Sir Andrew Clark, a prominent doctor of tuberculosis. But to his distress, no one seemed able to pinpoint the nature of his distress and deliver him from his infirmities. So if not tuberculosis, what might have been his illness? Past biographers have mentioned fibronous bronchitis, thyroid abnormality, bronchiectasis, or even a lung stone.8 Thanks to the inventive research by two genetic scientists, Alan E. Guttmacher and J.R. Callahan, the culprit may have been hereditary hemorrhagic telangiectasia (also known as Osler-Weber-Rendu Syndrome9), which Stevenson putatively inherited from his mother Margaret, who also suffered from pulmonary ailments.10 But as scientists did not begin in earnest to identify the syndrome until around 1890, and Stevenson died in 1894, hereditary hemorrhagic telangiectasia (HHT) would not have been in the vocabulary of diagnosticians. The important word in this discussion is Stevenson MAY have been born with HHT. The scientists concluded there is no solid evidence concerning the cause of Stevenson’s maladies without affirmation of his hair or tissues and evidence of the HHT mutation. In addition, such study of his relatives would also prove helpful.11 They mention the apparent absence of the skin lesions known as telangiectases on Stevenson, though introduce the caveat that perhaps the telangiectase went unreported or undetected in photographs.12 However, what may have been overlooked before is that one biographer indeed mentioned “skin eruptions” witnessed on the hands of Stevenson by a landlord in Monterey: “ . . . Miss Rosanna Leese, who had always feared the skin eruption on his hands, upped her price . . .”13

In light of the failed attempts by the many doctors to cure Stevenson over the course of his life, it is somewhat surprising to learn of his estimation of the medical profession. His dedication in Underwood (1887) irrefutably asserts his feelings:

There are men and classes of men who stand above the common here: the soldier, the sailor, and the shepherd not infrequently, the artist rarely, rarlier the clergyman, the physician almost as a rule; he is the flower (such as it is) of our civilization; and when the stage of man is done with, and only remembered to be marvelled at in history, he will be thought to have shared as little as any in the defects of the period, and most notably exhibited the virtues of the race. Generosity he has such as is possible in those who practice an art . . . discretion tested by a hundred secrets; tact; tired in a thousand embarrassments, and what are most important, Heraclean cheerfulness and courage. So it is that he brings air and cheer into the sick room, and often enough, though not so often as he wishes, brings healing.14

In 1890, Stevenson purchased an estate in Vailima, a village near Apia, the capital of Samoa. He lived there with his mother, his beloved Fanny, her two adult children and son-in-law. As his health continued to decline, he developed strong relationships with local physicians, on whom he lavished praise, in particular for a naval surgeon who attended to the Samoan people of Apia, and to Stevenson. He commended the surgeon Donald Templeton Hoskyn, Surgeon of H.M.S. Curacoa, and expressed gratitude for his medical friends as follows:

. . . Your rare skill enabled you to save the lives of many whose loss we should otherwise be mourning. Your devotion to duty kept you late and early at the call of all. In every part of your conduct in this place we recognized the inspiriting picture of a man who loves his profession, and exults in its exercise . . .15

Unfortunately, the good doctor naval surgeon Donald Templeton Hoskyn could not save Stevenson. He died of a cerebral hemorrhage shortly after his eloquent speech. The local townspeople, who revered Stevenson for his writing and active support of the community, were devastated. His wife Fanny received hundreds of condolence letters worldwide. The Samoans carried his coffin up a steep hill to lay him to rest on his requested burial site of Mount Vaea. His tomb is inscribed with a requiem he composed:

Under the wide and starry sky,
Dig the grave and let me lie.
Glad did I live and gladly die . . .



  1. For years, artists and writers have been drawn to the majestic beautify of the Monterey coastline, so Stevenson’s choice was not unusual. Painters relished the opportunity to capture on canvas the Pacific Ocean, as well as the historic charm of the one-time capital of California under Mexican jurisdiction, such as in the example by Edward Joseph Finley Timmons, who painted the Stevenson House in the early twentieth century. The painting is part of the collection of the Union League Club Chicago (UL1966.1). See ulcc.emuseum.com for more information on the painting and artist.
  2. Nellie Van de Grift Sanchez, The Life of Mrs. Robert Louis Stevenson, London, 1920 (accessed as EBook #24332, Project Gutenberg).
  3. Anne Roller Issler, “Robert Louis Stevenson in Monterey,” Pacific Historical Review, Vol. 34, No. 3 (Aug., 1965), pp. 305-321; see p. 321
  4. Guttmacher, Alan E; Callahan J.R., “Did Robert Louis Stevenson have hereditary hemorrhagic telangiectasia?” American Journal of Medical Genetics, 2000 Mar 6;91(1):62-65; See p. 62.
  5. Guttmacher, Alan E; Callahan J.R., p. 62.
  6. [6] Guttmacher, Alan E; Callahan J.R., p. 62.
  7. Guttmacher, Alan E; Callahan J.R., p. 62.
  8. Guttmacher, Alan E; Callahan J.R., p. 63-64
  9. The disease carries the names of Sir William Osler, Frederick Parkes Weber andHenri Jules Louis Marie Rendu.
  10. Guttmacher, Alan E; Callahan J.R., “Did Robert Louis Stevenson have hereditary hemorrhagic telangiectasia?” American Journal of Medical Genetics, 2000 Mar 6;91(1):62-65.
  11. Guttmacher, Alan E; Callahan J.R., p. 64-65.
  12. Guttmacher, Alan E; Callahan J.R., p. 64.
  13. Anne Roller Issler, “Robert Louis Stevenson in Monterey,”Pacific Historical Review, Vol. 34, No. 3 (Aug., 1965), pp. 305-321; see p. 311.
  14. “Robert Louis Stevenson,” The British Medical Journal, vol. 2, no. 1773, Dec. 22, 1894, p. 1448.
  15. “Robert Louis Stevenson,” The British Medical Journal, vol. 2, no. 1773, Dec. 22, 1894, p. 1448



SALLY METZLER, PhD, is the director of the art collection at the Union League Club in Chicago.


Highlighted in Frontispiece Volume 12, Issue 3 – Summer 2020

Spring 2020 |  Sections  |  Literary Essays

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