The final years of Jane Austen were overshadowed by a mysterious illness that has long since been a subject of speculation and debate. Her health began to decline in early 1816, when she was around forty years old. Her letters from that period make occasional references to fatigue and bouts of illness, but she tended to downplay the severity of her condition.

Over the following months, her illness worsened, marked by extreme fatigue, back pain, and a noticeable change in her appearance. She lost weight, became pale, and was unable to walk without difficulty. Still, she continued to work on her writing, revising Persuasion and beginning Sanditon, which she failed to finish.

Over the years, various theories have been proposed to explain her symptoms. Addison’s disease from adrenal insufficiency has long been the prevailing theory, its symptoms of fatigue, muscle weakness, weight loss, and skin darkening corresponding with some of the signs Austen reportedly exhibited in her final months. Another theory suggests that Austen may have suffered from Hodgkin’s lymphoma, and some medical historians argue that Austen’s symptoms—particularly her swelling and fatigue—fit the profile of this disease; the disease would likely have caused more severe symptoms toward the end of her life than what was documented. Some biographers suggest that tuberculosis, a common and often fatal disease in Austen’s time, could have been the cause, but the absence of cough and other respiratory symptoms make this unlikely. In 1964, Dr. Zachary Cope proposed that Austen may have suffered from Brill-Zinsser disease, a reactivation of epidemic typhus that could account for some aspects of Austen’s decline, particularly her fatigue and intermittent improvement followed by a final decline.

By the spring of 1817, Austen’s condition had worsened significantly, and she made the decision to move with her sister Cassandra to Winchester in hopes of receiving better medical care. Her brother Henry arranged for her to be treated by a respected local doctor, Giles Lyford. Lyford, who was renowned for his medical expertise, treated Austen with care and attention, but he quickly realized that her illness was beyond his ability to cure.

During this period, Austen’s writing productivity slowed, but she remained mentally sharp and deeply concerned with the fate of her unfinished works. In a poignant letter to a friend, she wrote, “I must keep writing as long as I can.” Despite her failing health, she maintained her characteristic wit and humor in her letters, even joking about her condition at times. Her final months were marked by a gradual physical decline. She became bedridden, experiencing increasing weakness and discomfort, though she remained conscious and lucid. Her family, especially her sister Cassandra, provided her with constant care and support. She maintained a sense of peace and composure during her last days, facing her illness with courage and resignation. She died on July 18, 1817, in Winchester and was buried in Winchester Cathedral. It was not until after her death that her reputation began to grow. Her brother Henry, in the posthumous publication of Persuasion and Northanger Abbey, revealed her identity as the author of her novels, which had previously been published anonymously. The exact cause of her death remains a mystery, but her existing body of work remains a testament to her enduring talent.

Addendum: A sensitive soul in Sense and Sensibility

Sense and Sensibility was Jane Austen’s first novel, published anonymously in 1811 during momentous events that she totally ignored: the war with Napoleon, the illness of King George III, and the regency of George IV. Her story about the love travails of teenage girls was in some respects not too different from her later novels. Two girls, Elinor and Marianne, having to move from their deceased father’s estate to a less elegant residence in Devonshire, experience the pangs of young love. Elinor endures them with equanimity, but Marianne has a more difficult time. She falls in love with a neighboring young man who is in financial straits and will abandon her to marry a London heiress.

In her novel the word sensible is not used in the way it is understood in modern English (denoting good judgment) but in the French meaning of sensitive. Thus when Jean-Jacques Rousseau writes about the misfortune of being born with a sensible soul (“quel malheur d’avoir une âme sensible”) he meant what in English would be a sensitive soul, which is what Marianne is suffering from.

In the last chapters of the book, Marianne develops a severe illness. Before the advent of germ theory, patients either recovered from severe diseases by going through a crisis (as Marianne does) or died if their organs underwent “putrefaction.” This term signified what all severe infectious diseases could turn into, regardless of whether they were typhoid, typhus, plague, or severe pneumonia.

Lumped together as “putrid fevers”, these diseases were feared by patients and physicians alike. They were characterized by high temperature, deteriorating mental state, sometimes foul-smelling bodily emissions, and eventual death. Treatment was by bloodletting to remove the products of putrefaction and by using compounds such as vinegar or other acidic substances to counteract the process. There was extensive literature about putrid diseases, how they were promoted by close contact, poor sanitation, and particularly on long term sea voyages or during widespread epidemics on land. With the arrival of the germ theory of Lous Pasteur and Robert Koch, the concept of putrid diseases vanished into thin air, leaving fans of Jane Austen to speculate from what disease Marianne had suffered and mercifully recovered.