Fourth in a series of posts celebrating 200 years of Jane Austen’s Mansfield Park. For more details, open Your Invitation to Mansfield Park.

Tom Bertram predicts the death of Dr. Grant in the third chapter of Mansfield Park. His death would be convenient in that it would allow Edmund Bertram to become the clergyman at Mansfield, but how does Tom know that this “hearty man of forty-five” won’t live long – and how does Jane Austen know? Dr. Cheryl Kinney, who is one of the “Best Doctors in America” (she’s made the list annually since 2001) and a Board Member of the Jane Austen Society of North America, answers this question in today’s guest post.

Dr. Kinney is a gynecologist in Dallas, Texas, and she was one of the coordinators of the 2011 JASNA AGM in Fort Worth, “200 Years of Sense and Sensibility.” In addition to her private practice, she has volunteered with Project Access, providing care to uninsured and financially marginalized women throughout the Dallas area. She’s been named by the Consumers’ Research Council as one of “America’s Top Obstetricians and Gynecologists” yearly since 2002, and has been named a “Texas Super Doctor” by her peers for the last ten years. Cheryl has lectured extensively to various groups in the Dallas/Fort Worth area on issues relating to gynaecology, including menopause, sexual dysfunction, endometriosis, and pelvic surgery, and she has also lectured all over the United States, Canada, and England on women’s health in the novels of Jane Austen and other 18th and 19th century British authors. It’s my pleasure to introduce her post on Dr. Grant and the risk factors for sudden death.

Tom listened with some shame and some sorrow; but escaping as quickly as possible, could soon with cheerful selfishness reflect, firstly, that he had not been half so much in debt as some of his friends; secondly, that his father had made a most tiresome piece of work of it; and, thirdly, that the future incumbent, whoever he might be, would, in all probability, die very soon.

On Mr. Norris’s death the presentation became the right of a Dr. Grant, who came consequently to reside at Mansfield; and on proving to be a hearty man of forty-five, seemed likely to disappoint Mr. Bertram’s calculations. But “no, he was a short-necked, apoplectic sort of fellow, and, plied well with good things, would soon pop off.”

– From Mansfield Park, Chapter 3 (Cambridge: Cambridge UP, 2005)

In Jane Austen’s time sickness and suffering were part of everyday life and because Austen wrote about everyday life, illness and injury permeate her novels. Perhaps better than anyone, she made use of these bodily events to develop her characters and drive her plots. In Chapter 3 of Mansfield Park, Austen uses Mr. Norris’ death to not only move Mrs. Norris to Mansfield proper, but to move the Grants into Mansfield Parsonage, to position the Crawfords to their advantage, and to disclose Tom’s culpability (and lack of remorse) in robbing Edmund of a portion of his living.

But to regard Jane Austen’s use of illness, injury, and death as mere plot mechanics is to deny the extraordinary precision with which she constructed her stories. She brilliantly used fictive ills metaphorically to expose strengths and weaknesses of human nature, as well as thematically to reinforce the maxim that permeates all of her novels: if we do not behave ourselves properly, something bad is bound to happen. Allowing her to accomplish these artistic goals was a remarkable understanding of the human body.

When Tom Bertram is confronted with his responsibility in the loss of the parsonage living for Edmund, he responds that Dr. Grant “plied well with good things, would soon pop off.” Despite being “a hearty man of forty-five,” Dr. Grant does indeed die a sudden death from gluttony.

Today, we are all aware of the association between a high fat diet and heart attack and stroke. In Regency England, however, most doctors had no idea what caused sudden death. Review of the medical literature from 1708 until 1919 reveals suspected etiologies that included cold weather, a thick neck, tight clothing, constipation, long stooping, warm baths, debauchery and “the venereal act.” A high fat diet was rarely included on the list of possible causes.

Although Hippocrates stated that very fat persons were apt to die earlier than those who were slender, it wasn’t until 1850, when Sir Richard Quain described the possible association between deposition of fat around the heart and sudden death, that high fat diets were seriously implicated. Quain’s fatty heart became a commonplace diagnosis in Victorian England – in George Eliot’s Middlemarch, young Dr. Lydgate diagnoses fatty degeneration of the heart in a patient who becomes short of breath – and firmly established Dr. Quain’s reputation as the leading authority on heart disease.

Dr. Quain’s paper is still consider a major milestone in the study of heart and blood vessel pathology, but is recognized as having a serious error in that it failed to identify the essential causes of the condition. In the entire paper (seventy-five pages) there is only one paragraph that remarks on the part a high fat diet might play on the formation of the disorder. The paragraph ends with the disclaimer “Beyond these general principles I fear we cannot go, and even to these there are exceptions.”

It would not be until the next century that the association between diet and sudden death was firmly and scientifically established. Jane Austen, without formal medical training, required no such length of time to come to the correct medical conclusion – that people who must have their “palate consulted in everything” (Chapter 11) and who indulge in “three great institutionary dinners in one week” (Chapter 48) would be at risk to suffer apoplexy and death.

In the ending paragraphs of the novel, Jane Austen uses Dr. Grant’s death to expose Sir Thomas’ and Edmund’s hypocritical defense of the clergy with their stance on multiple incumbencies. The death also reveals that both Fanny and Edmund could fall prey to the very mercenary motives that they found so reprehensible in Mary Crawford: a larger income and a bigger house – “. . . the acquisition of Mansfield living, by the death of Dr. Grant, occurred just after they had been married long enough to begin to want an increase of income, and feel their distance from the paternal abode an inconvenience.” There is the genius of Jane Austen.

It is a testament to her greatness that Jane Austen was able to accomplish so many artistic and thematic goals while remaining faithful to the properties of an actual disease process that would not be clearly understood until the next century.

References:

Barie, E (1912) Traie Pratique des Maladies du Coeur et de l’Aorte, 3rd edition, p. 1125, Paris, Vigot frères.

Bedford, E (1972) The story of fatty heart: A disease of Victorian times, British Heart Journal, 34: 23-28.

Buchan, W (1772) Domestic Medicine: or, a Treatise on the Prevention and Cure of Disease by Regimen and Simple Medicines, London.

Cheyne, J (1812) Causes of Apoplexy and Lethargy: with observations upon the comatose disease, London, Thomas Underwood.

Corvisart, J (1806) Essai sur les Maladies et les Lesions Organiques du Coeur et des Gros Vaisseaux, Paris, Migneret.

Fothergill, J (1879) The Heart and its Diseases, 2nd edition, London, Lewis.

Hayden, T (1875) The Diseases of the Heart and Aorta, Dublin, Fannin & Company.

Herrick, J (1919) Thrombosis of the coronary arteries, Journal of the American Medical Association, 72: 387.

Ljunggren B, Fodstad H (1991) History of stroke, Neurosurgery, 28: 482.

Morgan, A. (1968) Some forms of undiagnosed coronary disease in nineteenth-century England, Medical History, 12: 344-356.

Paget, J (1847) Lectures on nutrition, hypertrophy, and atrophy, London Medical Gazette, 5: 227.

Porter, R and D (1988) In Sickness and in Health: The British Experience 1650-1850, London, Fourth Estate.

Pound P, Bury M, Ebrahim S (1997) From apoplexy to stroke, Age and Aging, 26: 331-337.

Quain, R (1850) Fatty diseases of the heart, Medico-Chirurgical Transactions, 33: 121-196.

Robinson, N (1732), A Discourse upon the Nature and Cause of Sudden Death, London, T. Warner.

Sprengell, C (1708) The Aphorisms of Hippocrates and the Sentences of Celsus, London, R. Botwick.

To read more about all the posts in this series, visit An Invitation to Mansfield Park.