Jane Austen died in 1817 after an unidentified illness. Now it’s ‘one of literature’s great mysteries’
For decades, people have paused outside of No. 8 College Street next to the campus of Winchester College in England.
The only detail of the painted brick building’s façade that gives away its significance is an oval plaque above the doorway with the words, “In this house Jane Austen lived her last days and died 18th July 1817.” But for Janeites, devoted fans of the beloved author and her works, the spot represents what’s perhaps the most enigmatic chapter of Austen’s too-short life.
The novelist and her sister, Cassandra Austen, lived on the first floor of the building for eight weeks while Jane sought treatment for a nearly yearlong, unidentified illness. After appearing to improve in fits and starts, the author died at just 41 years old without ever having received a clear diagnosis that’s known today. As the 250th anniversary of her birth approaches on December 16, scholars are still debating the cause of her demise, trying to piece together a picture of her health based on descriptions of symptoms in Austen’s own words.
“There is, as of yet, no clear answer about what caused Jane Austen’s death at age 41,” said Devoney Looser, a regents professor of English at Arizona State University. “Our armchair diagnoses are drawn from the brief descriptions of her symptoms found in surviving letters.”
With little biological evidence available to study, Austen’s correspondence and novels have provided researchers with a rich road map to discovering clues from her final days, bringing previously unknown aspects of her condition to light — and unearthing potential new interpretations of her later works such as “Persuasion” in the process.
A 1964 paper by Zachary Cope — the first article to offer a potential cause of death for Austen — concluded the author died from Addison’s disease, a rare chronic condition in which the body’s adrenal glands don’t sufficiently produce certain hormones. Later hypotheses suggested that she had succumbed to stomach cancer, tuberculosis or Hodgkin’s lymphoma, respectively.
While starkly different conditions, these potential diagnoses share symptoms such as fatigue, weight loss and poor appetite, as well as the potential for intermittent fevers, chills or night sweats, said Dr. Dacia Boyce, internal medicine physician at the Carl R. Darnall Army Medical Center in Fort Hood, Texas.
“Addison’s disease remains the most popular answer, perhaps because that theory has been so often repeated,” said Looser, author of “Wild for Austen: A Rebellious, Subversive, and Untamed Jane.” “Another theory, advanced more recently, is that Austen may have died of a slow-growing cancer, such as lymphoma.”
But none seemed to fully explain her condition, leaving room for more theories to enter the fray.
The late neuro-opthalmologist Dr. Michael D. Sanders had read Cope’s analysis and was more than a casual fan of Austen when he began his own research into her mysterious decline. Sanders resided for 20-plus years near Jane Austen’s House — a museum that preserves the cottage in the county of Hampshire where the author once lived and wrote her novels.
He joined the London-based Jane Austen Society, an organization dedicated to the study of her life and works, in the 1970s, purchasing a lifetime membership for 10 pounds. Upon retirement in 2020 from the medical eye unit at St. Thomas’ Hospital in London within commuting distance of Hampshire, consultant emeritus Sanders was eager to dig deeper into the circumstances surrounding Austen’s death.
He and his colleague Dr. Elizabeth Graham, another consultant emeritus at St. Thomas’ who specialized in medical ophthalmology, had run the hospital’s medical eye unit for years. The duo encountered many young patients with lymphoma, lupus and tuberculosis during that time.
“Michael loved Jane Austen, so he’d often thought about it and why she died,” Graham, who’s now a trustee at Retina UK, said. “I think he was quite taken by the fact that she had all these joint problems, and they’d slightly been passed over. Some probably thought all women of a certain age get pain in their joints from time to time and get a bit tired.”
Sanders and Graham reviewed every letter of Austen’s to make a comprehensive list of her symptoms. The duo even sought the input of Austen scholar Deirdre Le Faye, long considered the preeminent expert on the author, before she died in August 2020. Their work, published in the journal Lupus in January 2021 before Sanders’ death in July 2022, creates a comprehensive timeline for the decline in Austen’s health, which appears to have begun in the spring of 1816.
But the most specific symptoms show up in Austen’s correspondence at the end of August 1816, 11 months before her death.
Austen’s most common complaint was rheumatism, or pain in her back and knee. She also experienced bouts of fatigue, fevers and a discoloring skin rash on her face, with Austen writing she was “black and white and every wrong colour.”
Her symptoms appeared to resolve periodically, and Austen wrote that she felt “tolerably well” and more active. But her issues always returned.
“Sickness is a dangerous indulgence at my time of life,” Austen wrote in a March 1817 letter.
In May 1817, she was referred by her doctor to Giles King Lyford, surgeon at the County Hospital on Parchment Street in Winchester, and she and Cassandra made the 15-mile journey. She wrote from 8 College Street to one of her nephews, James Edward Austen-Leigh, “I continue to get better.” Austen would have been well-positioned in London and Winchester to receive qualified care, according to Graham.
“There’s no evidence that she saw what we would call quacks,” Graham said. “She saw good physicians.”
Much is known about Austen’s final days spent at 8 College Street. “Thanks to surviving letters, we actually know more about how she felt during the months leading up to her death than we do about many other periods of time in her life,” said Austen scholar Juliette Wells, a professor of literary studies at Goucher College in Baltimore.
Austen’s health deteriorated in June and July of 1817 and she experienced a weak pulse, spending much of her time sleeping.
On July 15, Austen dictated verses describing horse races at Winchester to Cassandra that would be the author’s final poem, “Venta.” Just hours later, Austen rapidly declined. She had a seizure and fell unconscious on July 17. Some of her last words to Cassandra were that she wanted nothing but death, and “God grant me patience, pray for me, oh, pray for me!”
She died in her sleep at 4:30 a.m. the following day, her head resting on a pillow on Cassandra’s lap.
“I have lost a treasure, such a sister, such a friend as never can have been surpassed,” Cassandra wrote in a letter to her niece, Fanny Knight. “She was the sun of my life, the gilder of every pleasure, the soother of every sorrow; I had not a thought concealed from her, and it is as if I had lost a part of myself.”
No direct evidence of medical documents linked to Austen exists, but Graham is sure that such records were kept at the time. She said she is not aware of an official death certificate for Austen, and as far as treatments the author received, there is only mention in the letters of “applications” but nothing more specific. Therefore, what doctors at the time believed was the cause of Austen’s illness and demise remains an open question.
“Nobody said what she died of,” Graham said. “Cassandra didn’t say what she died of. They just said she fell asleep.”
When Sanders and Graham reviewed Austen’s symptoms, they didn’t directly identify evidence for Addison’s, tuberculosis or lymphoma. In Addison’s, patients experience permanent discoloration that results in the tanning of the skin across their bodies. But Austen’s multicolored rash affected only her face, and it was transient, Sanders and Graham wrote in their paper.
Given that tuberculosis accounted for at least 20% of deaths in the 17th, 18th and 19th centuries in Europe, it’s highly likely that her doctors would have been familiar with diagnosing the disease in their patients, Graham said. Austen also didn’t appear to have the chest or orthopedic complaints typically connected to tuberculosis.
Lymphoma seemed unlikely because there is no mention of Austen having enlarged lymph glands, and patients with lymphoma don’t have arthritis or skin lesions, the researchers noted in their paper.
Sanders and Graham kept coming back to Austen’s joint pain, her most frequent complaint, as well as her several periods of spontaneous remission — something lymphoma patients wouldn’t have experienced without treatment, which didn’t exist in Austen’s time because lymphoma had not yet been identified.
“The fact that she had a rash and that she had an illness that basically killed her in a year, I think people got very wound up with that and therefore didn’t put into it the facts of the joint pains,” Graham said. “And it was the fact that she had this disease that waxed and waned, fluctuated with high fevers and a skin rash, and at times, would feel really well, because in lymphoma, you wouldn’t get better.”
Both researchers had spent years working with Dr. Graham Hughes, a rheumatologist and expert on lupus who opened Europe’s first lupus clinic at St. Thomas’ Hospital, making them familiar with the symptoms. Hughes is also the founder and editor of Lupus, which published the study.
Sanders and Graham hypothesized that Austen had systemic lupus erythematosus, a condition commonly associated with joint problems, facial skin changes, fever and fatigue. The autoimmune disease, first described more than a decade after Austen died, occurs often in young women and can be fatal in their 30s and 40s. Patients with systemic lupus erythematosus, or SLE, also experience flares of exacerbated symptoms, according to the study. Modern treatments are helping patients with lupus manage their symptoms, which can vary greatly from patient to patient and impact multiple organs and bodily systems.
The researchers wondered whether they could study a sample of Austen’s hair. A lock, which the author bequeathed to her niece Fanny Knight, is on display at Jane Austen’s House. The museum is also home to two other known hair samples associated with Austen.
Ultimately, Sanders and Graham decided not to pursue requesting a sample.
“DNA examination is not usually fruitful without the follicle,” Graham said. “It would tell whether she had a genetic type that might support lupus, but it wouldn’t tell whether she had lupus.”
So far, the hair samples have only undergone scant examination. An electron microscope study from 1972 took place because the Jane Austen Society had concerns the locks might be showing signs of deterioration. There was evidence of bleaching due to light exposure, with some hairs appearing a light straw color, while their underside was brown.
The authors of the 1972 study were only able to use a few hair fibers because the Jane Austen Society wished to keep the majority of the sample intact. The analysis concluded only that within the last few years of her life, Austen did little to tend to her hair, with minimal brushing, combing and handling.
Recently, hair sample analysis has offered insights into the health and death of other historical figures, including composer Ludwig van Beethoven.
Before Beethoven died on March 26, 1827, it was his wish that his ailments be studied and shared so “as far as possible at least the world will be reconciled to me after my death.” Scientists studying DNA from his remaining locks of hair showed in 2023 that the composer had pronounced genetic risk factors for liver disease and a hepatitis B infection before his death. Beethoven’s genome has been made publicly available, and a 2024 study revealed that the composer experienced lead poisoning, as well as elevated levels of arsenic and mercury.
“The Beethoven genome team was fortunate, for our findings uncovered three critical causes for his death,” said William Meredith, Beethoven scholar and study coauthor of the 2023 genomic analysis and 2024 study. “Without physical evidence, as in Austen’s case, the most brilliant analysis that rests on letters and descriptions of symptoms has to remain speculative.”
Currently, however, there are no research projects analyzing Austen’s hair sample and no plans to do so.
All three of the locks of hair associated with the celebrated author held at Jane Austen’s House have already been studied, said Lizzie Dunford, director of Jane Austen’s House. The University of Surrey tested the samples in 2015, revealing two of the three had been contaminated, most likely through storage in metal lockets, Dunford said. The third showed normal levels of most elements, she added.
“Based on this research, we understand that further analysis of the hair samples would not resolve any questions around the potential causes of Austen’s death, which might have to remain one of literature’s great mysteries,” Dunford said.
Debate about the author’s puzzling malady continues among Austen scholars, with some leaning toward lymphoma and others supporting the more recent lupus hypothesis. Part of the trouble with diagnosing Austen based on her words is an age-old issue that physicians still struggle with today.
“Doctors are translators if they’re doing their job right,” Boyce, the Fort Hood-based internist, said. “The patient says the rash is black and white, but really it’s just a bruise, or it’s completely different from the way that they might describe it. Austen is this really accurate writer. But is what she describes exactly how you would approach it as a physician 200 years later?”
Everyone interviewed for this story agreed on one thing: The cause of Austen’s death will likely remain a mystery.
“We clearly just don’t have enough information to finally decide,” said Richard Foster, fellows’ librarian and keeper of collections at Winchester College.
Still, the efforts to analyze her illness offer new windows into the author’s life and literature. Health is at the forefront of Austen’s final works, with illness and injury prevalent in “Persuasion” and the seeking of cures in “Sanditon,” Boyce said. Also a Janeite, Boyce explored medical themes in Austen’s final works in the 2020 edition of the Jane Austen Society of North America’s journal, Persuasions.
Boyce believes those later writings show how Austen regarded illness in her time while she herself was ill.
“As a physician, it’s really interesting to see what people look to for cures,” Boyce said.
Seeking sea air, sea bathing or frequenting mineral spas was popular in Austen’s time, as people sought cures for illnesses that had yet to be named, Boyce added.
Mentions of illness are common across Austen’s novels. Her characters have nervous complaints, headaches, fevers and even health anxiety that leads to hypochondria, as in the case of Mr. Woodhouse, father of the titular character in “Emma.” Plot lines in her earlier writings almost always have a positive outcome, infusing them with a lightness that notably changes in the final works.
“Things start to shift towards ‘Persuasion,’ where the happy endings become a little less happy and the suspicion towards life becomes a little higher,” said Dr. Jaime Konerman-Sease, a clinical ethics assistant professor at the University of Minnesota Center for Bioethics, who wrote her dissertation on Austen.
Austen started writing “Sanditon” in January of 1817 when she temporarily recovered, but had to set it aside again in March of that year. The novel — a satirical take on a fictional seaside resort hoping to attract England’s invalids — was never finished.
Austen likely didn’t realize she was dying in early 1817, but her clever, cutting tone in “Sanditon” shows resilience, Arizona State’s Looser said.
“Many of us would be very tempted to withdraw into ourselves in self-pity and pain,” Looser said. “It’s incredible that she could draw these very funny characters that are almost making fun of her own condition in a way.”
Austen explored the question of strength and weakness across her works, Looser noted. Of all Austen’s novels, “Mansfield Park” is often lowest on the list of favorites among fans because the heroine, Fanny Price, is described as weak, frail and shy, rather than confident and feisty like the heroines Emma Woodhouse in “Emma” or Elizabeth Bennet from “Pride and Prejudice.”
When Konerman-Sease revisited “Mansfield Park” in graduate school to complete her reading of Austen’s books, she didn’t expect it to help her learn how to navigate life with a chronic illness. Konerman-Sease had begun experiencing chronic fatigue symptoms as an undergraduate student in 2013. She worked closely with her primary care physician but never received a formal diagnosis.
In 2017, she turned to Austen while bedbound. “A 200-year-old book met me where I was,” she said.
Over the course of “Mansfield Park,” Fanny Price learns to advocate for and stand up for herself in a world that moves so much faster than she does — a world where people are more interested in having fun than considering what the person next to them might need, Konerman-Sease said.
Konerman-Sease managed her own illness by not only focusing on sleep, diet and exercise, but also reflecting on how she interacted with others as a friend, partner and family member, something Fanny Price prizes.
Konerman-Sease didn’t want her experiences with illness, pain and frustration to shape her interactions with others — a sentiment Austen seemed to share.
When Foster read over Austen’s final letters as he prepared to welcome visitors to 8 College Street for a few weeks last summer, he was struck by her tone of cheerfulness and optimism “under what were obviously pretty horrible circumstances.”
“I think it reinforces the idea that, in some ways, the thing that mattered most to her was familial relationships,” Foster said. “She was with people that she loved when she died. There’s some sense she gets a chance to say goodbye.”
That ability to connect, through pain and across time, still resonates today. “I think for a lot of people, she’s much more than simply an author that they enjoy and admire,” Foster said. “But sort of a companion to life.”
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