What was ailing Louisa May Alcott?

Susan Cheever’s book has now led me through Louisa’s service in the Civil War and her battle with pneumonia and typhoid which resulted in high doses of calomel and subsequent mercury poisoning. Her service resulted in her finding her true voice as a writer, but at a terrible cost with regards to her health. She died all too soon at the age of 56.

In the course of my reading, Cheever (and Harriet Reisen too) noted a paper by two doctors who attempted to diagnose what ailed Louisa throughout the latter years of her life. Their names are Norbert Hirschhorn (also a poet) and Ian A. Greaves. Here is the enticing summary of their paper, as found on the Johns Hopkins Institute website:

Hirschhorn, Norbert.
Greaves, Ian, 1947-
Louisa May Alcott: Her Mysterious Illness
Perspectives in Biology and Medicine – Volume 50, Number 2, Spring 2007, pp. 243-259

The Johns Hopkins University Press

Louisa May Alcott (1832–1888), famous in her own time and immortalized in ours as a major figure of the “American Renaissance,” died at the age of 55 after intermittent suffering over 20 years. Her illnesses evoked intense interest in her time and in ours. Alcott tracked her signs and symptoms (in letters and journal entries), which included headaches and vertigo, rheumatism, musculo-skeletal pain, and skin rashes; in her final years she recorded severe dyspepsia with symptoms of obstruction, and headaches compatible with severe hypertension. Her death came suddenly with a stroke. Standard biographies propose that her illnesses were due to acute mercury poisoning from inorganic mercury medication she received for a bout of typhoid in 1863, a cause she herself believed. We have reviewed Alcott’s observations, as well as those of others, and have determined that acute mercury poisoning could not have caused her long-term complaints. We propose instead that Alcott suffered a multi-system disease, possibly originating from effects of mercury on the immune system. A portrait of Alcott raises the possibility that she had systemic lupus erythematosus (SLE).

Unable to resist, I purchased the article from the Johns Hopkins Institute journal called Perspectives so I could read more, and what a great read! Both Cheever and Reisen cite that it was the portrait of Louisa that hangs in Orchard House showing a possible “butterfly rash” that started the discussion: “But what attracted us to the possibility of SLE [aka Lupus] is an oil painting of LMA made by one of the 19th century’s most famous and realistic portraitists, George P.A. Healy, an Alcott family friend (De Mare 1954)” (“Louisa May Alcott Her Mysterious Illness”, Perspectives in Biology and Medicine – Volume 50, Number 2, Spring 2007, pp. 255, The Johns Hopkins University Press), If you have seen the portrait in person, do you agree she was showing a rash? I had assumed the painter was giving her face a little extra color and never thought of a rash (Cheever didn’t really see it either) but the article makes quite a compelling argument for it. Here’s a small picture of the portrait, taken from the the cover of Little Women Abroad, edited by Daniel Shealy: do you see a rash?

I could see right away why these two doctors researched her ailments because she kept such copious  notes in her journals. It’s irresistible to try and diagnose her illness from all the information she left us.  As they cited on page 254, “Listen to the patient. She is telling you the diagnosis.” There are just too many references to cite here but you can see them in the article or read The Journals of Louisa May Alcott to find out more.

This paper made me realize just how much Louisa really suffered. She had a multitude of ailments, some truly dreadful. Drs. Hirschhorn and Greaves organized her ailments into 3 categories: Headache, Musculo-Skeletal Pain and Gastrointestinal. Using her journal entries (most of which showed a woman who suffered much yet kept a stiff upper lip), they constructed a loose time line of when and where her various symptoms occurred and what eventually led to her death. It’s a long and complex road to the end and testifies yet again to her strength of will. Undoubtedly her family and her writing kept her alive; she felt needed and though it was often a burden (as seen in her journal entries), she soldiered on.

This article served to feed the flame of fascination and admiration for Louisa May Alcott all the more! I never guessed I would be exploring articles like this and reading through primary sources and archives in my quest to find out more. The more I read, the more I want to know. And the best news is, I’ve only scratched the surface!

Check out this article by Drs. Hirschhorn and Greaves – it’s a fine piece of detective work with some compelling conclusions. As they themselves said, they can’t truly diagnose such a complex illness as Lupus with total accuracy just by reading 19th century references by the patient. But I could feel the enjoyment these two men must have experienced in investigating it – it was palpable. And by the way, the periodical has many other interesting articles in it too!

APPENDUM 12/8/2011

I was pleased to receive letters from both Dr. Hirschhorn and Dr. Greaves regarding this post. Dr. Greaves added an interesting tidbit:

“Yes, there was a lot of enjoyment in trying to put together the fragments of her medical problems and seeing of there was a single coherent diagnosis. The recent experimental evidence in animals, whereby administration of mercury led to a lupus-like condition, is information not available to earlier authors on this subject, and helped persuade us that we were on the right track.

Pictures of her portrait that show the “rash” really do not do it justice — I think it is a more prominent feature when the original painting is viewed (as I had a chance to do this past summer).”

I will definitely have to study that picture more closely the next time I visit Orchard House!


If there had been online nursing classes back then, maybe more people
would have known what was ailing her.
However, there was of course less medical knowledge then than now.


Louisa creates the perfect man for Jo (and herself?)

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9 Replies to “What was ailing Louisa May Alcott?”

  1. Did you find the reading hard? I ask because if its heavy with medical lingo then I may want to stay away. However, the little piece you quoted doesnt indicate that.

  2. I don’t really see the rash either. I seem to remember reading somewhere (it might even be a line in Jo’s Boys or something) that LMA herself thought that the portrait was too red in the face. So even if there is a “rash,” it still might not fully represent how she actually looked.

    It’s interesting to speculate as to what her ailments really were, though of course we will never know for sure.

  3. I may try and give this article a go.

    Has anyone actually studied other mercy victims to see what their symptoms were?

  4. Readers interested in Greaves’ and Hirschhorn’s article without charge might first try logging into your local library network to access the various databases they subscribe to. I am usually able to access periodical articles this way.

    I’m sending an excerpt from my book about this to Susan. I hope she’ll print it and my thoughts about the question.

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