User:Simmaren/Sandbox/Jane Austen/Final Illness Notes

This page contains notes on the question of Jane Austen's final illness. '''This is not an article. '''

Sources are keyed to the bibliography in the main article: Jane Austen

Honan

 * Austen's final illness is mentioned or discussed on pages 374, 378, 379, 385-392, 394-398, 400-405 (death). Honan deals with the nature of her illness on 391-392, although he describes her symptoms in other places. He notes the symptoms consistent with a diagnosis of Addison's disease, and points out that the destruction of the adrenal glands that causes the symptoms of Addison's disease can be a result of tuberculosis, cancer of the stomach or bowels, or an autoimmune reaction. Honan cites Zachary Cope's 1964 article but is not dogmatic - he points out that Cope called his work a "surmise" and cites apparently unpublished work by pathologist Dr. P. N. Cowen, who argued that if the changes in Austen's skin color are ignored, the rest of her symptoms were consistent with a diagnosis of cancer or tuberculosis per se without adrenal involvement. Honan's descriptions of Austen's symptoms and decline are quite moving.

Tomalin

 * Tomalin mentions or discusses Austen's final illness on pages 254-255 and 258-269 (death). Tomalin discusses the nature of the illness in Appendix i, "A Note on Jane Austen's Last Illness" (282-283), apparently written based in part on a consultation with a Dr. Eric Beck. Tomalin points out that at this distance in time, any diagnosis must be tentative. She mentions Cope's 1964 article ("a carefully argued case"), briefly describes Addison's disease, and argues that "it has other features which do not seem to fit what we know of Jane Austen's case." Tomalin mentions the absence of a "tanned, healthy appearance," postural hypotension  (faintness upon getting up) and a steady progression of the disease as  characteristic of Addison's disease but apparently absent in Jane Austen's case. She also mentions that Austen's recurrent fevers were not characteristic of Addison's disease.


 * Tomalin suggests that a lymphoma such as Hodgkin's disease may be a better fit with the known symptoms - "recurrent fevers and progressive weakening, leading to death." Tomalin suggests that Jane Austen's and Fanny Austen's reports of Jane's experience of severe facial pain over seven weeks in 1813 could have been an early symptom of a lymphoma.

Le Faye, A Family Record

 * Le Faye deals with Austen's final illness on pages 235-236, 238-240, 242-243 and 245-254 (death). Le Faye gives an explanation of Addison's disease (236) and clearly comes down on the side of Addison's disease: "in recent years medical opinion has put forward the theory, based on Jane's own description of her symptoms, that early in 1816 she fell victim to the then unrecognized Addison's Disease." Le Faye cites the 1964 Cope article and the Encyclopedia Britannica.

Wiltshire, Jane Austen and the Body

 * Wiltshire's focus in this work is not Jane Austen's own health but rather her treatment of health and medicine in her novels. Nevertheless, he does discuss Austen's final illness (199-201) and its effects (or lack of effect) on her last work. On his last page, Wiltshire mentions one of Austen's late letters "describing the symptoms of her illness so clearly that modern doctors feel reasonably confident about making a retrospective diagnosis of Addison's disease". (221)

Smithers, "Medicine"

 * This is a brief (three page) article mainly on medicine as portrayed in Austen's novels. Smithers does discuss Austen's final illness, however. (305-306. "The well-known surgeon Sir Zachary Cope attributed it to Addison's disease, a failure of adrenal glands, making a likely guess on slender evidence. Responding in a letter, Dr. F. A. Bevan suggested that she might have had Hodgkin's disease, and the increasing fatigue, bouts of fever, and remissions during te course of a steady decline over a few months would fit his speculation well enough, although we hear nothing about lymph-node swelling." (305) Smithers notes that Cope relied heavily on Austen's description of the discoloration of her skin as evidence for the brown pigmentation of Addison's disease.

Fergus, A Literary Life

 * This is a literary biography of Jane Austen. Austen's final illness is discussed on pages 166, 169-170. "Symptoms of Addison's disease, probably the condition that killed her, may have shown themselves early in 1816." (163) Fergus cites only the Cope article.

Medical commentators and their qualifications
(Simmaren, I've added this so you have the various references in one place for convenience. Pointillist (talk) 01:56, 16 March 2008 (UTC))

Sir Vincent Zachary Cope
Source for statements by Honan et al.
 * Author of article "Jane Austen's Last Illness" in British Medical Journal (18 July 1964, p182ff, http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1816080&blobtype=pdf).
 * Curriculum Vitae at http://www.aim25.ac.uk/cgi-bin/search2?coll_id=3291&inst_id=8.
 * Additional biographical material is available in volume 6, page 84 of Plarr's Lives of the [Royal College of Surgeons] Fellows (source: http://livesonline.rcseng.ac.uk/lives_index.pdf) but this is not yet available online.
 * Author of "The Royal College of Surgeons of England: A history" (see http://www.rcseng.ac.uk/library/helpsupport/faqs.html/?searchterm=Zachary%20Cope).

Dr F A Bevan

 * Author of letter "Jane Austen's Last Illness" in British Medical Journal proposing Hodgkin's lymphoma as more likely diagnosis (8 August 1964, p384, http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1816385&blobtype=pdf).
 * Apparently in 1953 a general practitioner (source: "Marital Tensions: Clinical Studies Towards a Psychological Theory of Interaction" (1967) by Henry V. Dicks, page 18 and footnote on page 27, http://books.google.co.uk/books?id=mHA9AAAAIAAJ&printsec=frontcover&dq=Marital+Tensions:+Clinical+Studies+Towards+a+Psychological+Theory+of+Interaction&source=gbs_summary_r)

Dr Eric Beck
Consulted by Tomalin for her Appendix I.
 * Former chief examiner of the Royal College of Physicians (see http://www.rsmpress.co.uk/bkdias.htm).
 * Author of "Tutorials in Differential Diagnosis" (4th Edition, July 2003; ISBN 0443061572, see http://www.amazon.co.uk/Tutorials-Differential-Diagnosis-Beck/dp/0443061572).
 * Chairman of the Royal College of Physicians committee "Practical Assessment of Clinical Examination Skills" (see http://www.rcplondon.ac.uk/pubs/exam_mrcp_pacebooklet.htm).

Professor Ian Frazer
Consulted by Upfal for her paper "...New evidence points to a fatal Hodgkin’s disease and excludes the widely accepted Addison’s" (J Med Ethics; Medical Humanities 2005;31:3-11 (2005), http://mh.bmj.com/cgi/reprint/31/1/3).
 * Founder of University of Queensland’s Centre for Immunology and Cancer Research
 * Australian of the Year 2006 for his development of Human Papilloma virus vaccine, to prevent and treat cervical cancer (http://www.australianoftheyear.gov.au/pages/page58.asp)
 * Curriculum vitae at http://www.acrf.com.au/page/bio_prof_ian_frazer.html