Harriet Reisen sent me a section from her book, Louisa May Alcott The Woman Behind Little Women that nicely summarizes Drs. Hirschhorn and Greaves’ article (see post):
Chapter 17: “The Cream of Things,” (page 271 in hardback)
“Louisa continued to believe Dr. Kane’s 1870 diagnosis, that mercury poisoning from calomel lay at the root of her ills. That diagnosis went unchallenged until 2001, when Drs. Norbert Hirschhorn and Ian Greaves, working with another colleague on a paper about the effects of Abraham Lincoln’s mercury-based “blue pills,” learned that Louisa Alcott was believed to have died of mercury poisoning. Could they confirm that diagnosis? Greaves and Hirschhorn set out to be Louisa’s doctors, compiling a medical history from her writings and reports by others. They noted her excellent health and exceptional vigor before contracting typhoid pneumonia, her treatment with mercury, her recovery, and the symptoms and debility that began about three and a half years later.
“Hirschhorn and Greaves classified Louisa’s symptoms as headaches (“neuralgia”), joint pain and swelling (“bunches on the leg”), and a welter of gastrointestinal ills: “loss of appetite, nausea, heartburn,” also “eructation” (belching) and stomach discomfort. Louisa’s intestinal problems overshadowed the others and pointed to gastro-esophageal reflux disease, or GERD. Louisa also complained of laryngitis and bronchitis; GERD is a known cause of those symptoms.
Hirschhorn and Greaves found that mercury poisoning was not a plausible explanation for Louisa’s symptoms. She did not have the trembling hands or “extreme sensitivity to slights, [and] irrational outbursts of rage” that were known effects of mercury poisoning. Louisa had a tem- per, but however quick and at times unkind, it always had a cause and a rational target.
“The pattern of Louisa’s poor health over many years also refuted the mercury poisoning thesis. Mercury causes symptoms only as long as it is taken, and Greaves and Hirschhorn found no evidence that Louisa took mercury after she left the Georgetown hospital. The medical profession knew that mercury was dangerous and ineffective. That knowledge had supported Lincoln’s decision to discontinue mercury when he became president. Dr. Kane had been correct about the danger of mercury, but his belief that it never left the body and that the painful “bunches” on Louisa’s leg were from dormant mercury was unfounded. Louisa’s body would have been free of mercury in a year after treatment, at most, Hirschhorn and Greaves maintain.
“What, then, was causing Louisa Alcott’s many distressing symptoms? Drs. Hirschhorn and Greaves looked at two theories. Either Louisa suffered from several seemingly unrelated chronic illnesses, or, more likely, all could be explained by one multisystemic disease. If so, which one? Without being able to conduct modern diagnostic tests, Greaves and Hirschhorn wrote, “we can only recall the old professor’s teaching: ‘Listen to the patient. She is telling you the diagnosis.’ ” Louisa was “telling” them that she had an autoimmune disease. Exposure to mercury had the potential to trigger an autoimmune response but would not cause the symptoms per se. An autoimmune disease such as syphilis or lupus, on the other hand, could attack Louisa in exactly the miserable ways she described. Discarding syphilis as less probable, the doctors posited lupus as the likely candidate.
“Without Louisa their theory could not be proved, and lupus can be difficult to diagnose in any case. But the doctors came very close to clinching the case when Dr. Hirschhorn found a visual clue that had been hiding in plain sight for over a century. As in the best detective fiction, the clue was in the portrait—the only painting of Louisa—by the acclaimed artist George Healy. Louisa had enjoyed sitting for Healy when she came to Rome in 1870 after a run of sunny days in northern Italy. She was less pleased with the portrait, which she described in Jo’s Boys as notable for the “curious effect of light upon the end of the nose and cheeks as red as the chair she sat in.” She hung it behind a door.
Harriet had also mentioned in a comment on the previous post that the article could possibly be obtained for free through your public library. It’s a surprisingly easy read considering that it’s for a medical journal. Check it out!
Louisa May Alcott is My Passion 
I find this fascinating – not only because of the revered patient but that medical science can diagnose someone so long after their death! Thanks for sharing the article!
Welcome Lisa! I look upon Louisa’s diagnosis rather like a Sherlock Holmes case – those doctors did a great job of detective work. 🙂
To me, this is one of the most fascinating parts of Harriet Reisen’s biography on LMA. I read it in October last year, and I remember that what I loved about the portrait painted in Rome was the fact that it proved that her hair, her “one beauty,” grew back after being shorn short. Before I read about it in LMA: Woman Behinf Little Women, I thought that due to calomel her hair had become thin and weak for good.
I love these detective like speculations on her illness, though, I think we have to come to terms with the fact that we will never know.
Hi. I wanted to comment about the effect of mercury on the human body. I was not aware of LMA’s health problems, but having read your blog about her health issues, I felt compelled to comment. I suffer from mercury toxicity/poisoning health problems. There is a lot of misinformation out there, especially amongst doctors, of the seriousness of mercury and how insidious it can be. The laundry list of potential symptoms is vast and unforunately, even the most educated of doctors is often wrong about this. A person does not have to suffer from hand trembling or outbursts of anger to be mercury toxic. It would be a rare occasion that a person would exhibit every possible symptom. Each person is different and therefore each person will present with some, but not usually all potential symptoms. Unfortunately, most doctors think that people who do not work around metals cannot have a toxicity problem and most believe the connection between amalgam fillings and toxicity is a misnomer. I can attest to the fact that they couldn’t be more wrong. That being said, mercury is also being found in rampant amounts in drinking water (tap water), fish, and of course in the air we breathe. We live in a very toxic world.
I have been sick for over 14 years. I had 1 amalgam filling and that is all it took. The autoimmune damage that the mercury caused led to a host of other problems. The mercury weakens the immune system and makes it ripe for other issues to become rampant such as candida, parasites and other conditions such as lyme disease, lupus, MS, Parkinson’s, Alzheimer’s, Autism, and so on. I have many of these conditions. I had my amalgam out, but unfortunately, my dentist was not trained in the proper extraction method that is necessary to safely remove the mercury from the body. The statement made that a person will not stay toxic with mercury if they are not still injesting it, simply is not true. The body cannot assimilate mercury and therefore it settles in different parts of the body, such as organs, muscles, joints and so forth, causing continous damage. Mercury is the hardest metal to get rid of from the body. I have been trying for years.
I’m not saying these doctors are wrong, simply that their “conclusions” are not altogether correct. But sadly that is what I have come across only too often in the medical community. I wanted to correct a few things in case you have any readers who may be going through the same thing, and erroneously and prematurely rule out mercury as a potential cause of their health issues, due to the possible lack of hand trembling and anger outbursts. Thank you.
Kirstin, thank you for your comments. I am not at all trained in the medical field so I can’t comment on mercury per se. Certainly however, you have suffered from it for many years, just like Louisa did. If mercury stays in your body permanently, is it always toxic or does it lose its toxicity and what you’re left with is the autoimmune problems?
All you had was the one filling in your tooth and it created all this suffering in your life. People in the 19th century were dosed with calomel l like it was water! There are charming aspects to life in the 19th century but I sure am glad I live with 21st century medicine, as imperfect as it is.
I hope that someday you find some relief. Thank you for offering your point of view on this difficult subject.
Calomel is so insoluble that nearly all of it is excreted. It can still be toxic, but it requires a lot to be taken over a period of time.
It was reported that they doused her a LOT. That probably explains why.
I agree with Kirstin regarding the symptoms of mercury toxicity. I’ve been living with it for 9 years myself. If you’re interested in the subject, Dr. Andrew Hall Cutler, PhD, a biochemist who studied at Princeton has written some of the most in-depth material on chronic, low-dose mercury poisoning. Also Dr. Boyd Haley, PhD, the former chairman of the Chemistry Department at the University of Kentucky was one of the world’s leading mercury researchers. My illness also presented as an autoimmune disorder until I had a urine porphyrin test and then had my hair tested for mineral derangement. My symptoms were very similar to LMA’s, but Kirstin is right that mercury poisoning can manifest in over 200 different ways. Most doctors haven’t the faintest idea how to test for mercury as the ones who are the most toxic tend to show the lowest levels of mercury excretion in hair, blood, urine, and fecal tests because their tissues are holding onto the heavy metals instead of excreting them. Anyway, I love your blog. The doctors specifically said, ‘Listen to the patient. She is telling you the diagnosis.’ Well, she already told us the diagnosis was mercury poisoning, so thank you for defending her.
Hi Anne, thank you for all that great information. I’m sorry you’re stricken with the same disease, I hope you find the right doctor who can better help you. I’m so glad you’re enjoying the blog. Are you the Anne I met at Orchard House today, by any chance?
I am very surprised that after reading several posts here for this page about Louisa that the author is this page is quoting Susan Cheever about Louisa Alcott. It really does perplex me since her book was nothing more than a sordid tale of Cheever’s imagination. Had you been quoting Eden’s Outcasts I would see it differently. Cheever really invented so much of the data she purports as true in American Bloomsbury and frankly it was rather an offensive read. I find it strange you would be quote her when their are so many other great sources to take from about Alcott.
I actually quote Cheever very little, you must have come across the posts that did quote her. I quote extensively from Eden’s Outcasts, especially with regards to Bronson Alcott. I also quote from other biographers such as Madeleine Stern and Harriet Reisen. I’ve read 9 or 10 biographies and each one has a slightly different take.
I did a review of Cheever’s book and cited the fact that it had many errors, some quite obvious. The main thing about it is that it added nothing to the story, there was nothing original in the book and it was rather derivative. It is not a biography that I normally refer to.