Charlotte Brontë – A Medical Casebook by Dr. Michael O’Dowd is an eye-opening book about medical knowledge in the Brontë household with a big focus on the exact cause of Charlotte’s death in 1855.
I have already mentioned this book in my last blog post on Ireland when I met the author in Connemara, Ireland. I have now finished the book and thought it appropriate to do a full review. It is not a novel; it is a book based on facts and historical evidence.
I must admit that when I first saw the title of the book – Charlotte Brontë – A Medical Casebook – I was afraid that it would be a purely medical book that would go beyond my comprehension as I am not medically trained at all.
But, having read Michael’s other fascinating book on Charlotte and Arthur’s honeymoon in Ireland (for which I wrote an extensive review in December 2021 and which I absolutely loved – the best and I think the only non-fiction book on the honeymoon), I was intrigued to start reading his new book. I was told that I did not have to read the various chapters in the right order and could dip in and out of the book as I wished. But I did start the book as one should: from page one up to the end.
The book is divided into seven themed sections. Part 1 to Part 4 are the more general sections, containing the following themes:
1 – medical record keeping and the evolution of medical casebooks
2 – the past comes to life: Charlotte’s letters and her friendship with Elizabeth Gaskell who was her first biographer (The Life of Charlotte Brontë)
3 – the domestic medicine manuals (from early times up to the time of the Brontës) which were so important to both Patrick and Charlotte Brontë for their understanding of medicine
4 – Charlotte and her actual knowledge of medicine
In Part 5 to Part 7, the author moves to the actual final illness and death of Charlotte Brontë:
5 – phthisis (otherwise known as consumption or tuberculosis): I learned that there are different types of tuberculosis affecting different organs and parts of the body; this chapter also deals with the treatment of consumption at the time; it also shows how it affected the Brontë family. Many Brontë siblings died of consumption and “phthisis of three months duration” was officially recorded on Charlotte’s death certificate as the cause of death.
6 – historical facts about pregnancy up to the Victorian era: signs, diagnosis, and the important question: was Charlotte pregnant during her final illness?
7 – alternative theories for Charlotte’s final illness and death.
As you can see from the themes presented in this book, it is mainly about Charlotte Brontë's final illness and death, the cause of which was officially certified as "phthisis." In many Brontë biographies, however, the idea has been launched that she died of complications of early pregnancy.
In his book, Michael O’Dowd (a retired consultant obstetrician, gynaecologist and esteemed medical historian) explains clearly why this theory of death in pregnancy is most likely not possible. His research is very thorough and extensive, and is based on real evidence and historical medical facts and documents of the time.
Based on this extensive research, he presents some alternative theories for Charlotte’s final illness and death before arriving at a conclusion. His book is very convincing as he explains Charlotte’s thorough knowledge of medicine, the various types of phthisis/consumption/tuberculosis, the word "sickness" used in Charlotte's letters in the context of the time, Charlotte's symptoms as described by herself in her letters and in the letters of her husband Arthur and her father Patrick (who were present throughout her illness), the diagnosis of pregnancy in the 19th century, and what Charlotte’s symptoms could have meant. One of his main arguments is that phthisis is an illness, pregnancy is not; and Charlotte’s condition was described (also by her doctors) as "symptomatic," which in medical terms refers to a disease or an illness: pregnancy is neither of these.
The book contains a lot of medical information of the time, but this is presented in such a way that it is understandable for persons who do not possess any medical knowledge, and the alternative theories that the author presents are very convincing. It is a very fascinating book to read presenting an alternative medical assessment by an expert in this field about Charlotte Brontë's final illness and death. Dr. O’Dowd questions the accepted narrative that Charlotte died from hyperemesis gravidarum (excessive morning sickness) which was mooted 53 years ago by Professor Philip Rhodes. Dr. O’Dowd presents us with an alternative and credible diagnosis.
I have read many biographies on Charlotte Brontë over the years and I have never questioned what they claimed to be the cause of her untimely death. I have always thought that Charlotte died of hyperemesis gravidarum, but then I came across Michael’s book. In the meantime, I have met Michael in Ireland (and discussed his book) and also heard him speak at the inaugural Brontë Birthplace Zoom talk. His medical and historical evidence is really clear. It has convinced me that death in pregnancy might not be the cause of Charlotte’s death. It is more likely that she died of consumption.
I can only hope that more and more Brontë enthusiasts will make the effort to read Michael’s book and draw their own conclusions about Charlotte’s death based on the factual evidence presented, instead of accepting blindly what other biographers say. It is rare indeed to have the expert opinion about Charlotte’s final illness and death, not only from a consultant obstetrician and gynaecologist with an additional doctorate in medicine and a PhD in medical history, but also from a Brontë devotee with a particular interest in Charlotte Brontë herself. A book from a medical expert writing with real knowledge about Charlotte’s final illness and death and reassessing the cause of her death by closely scrutinising the primary sources is long overdue!
This book is worthwhile reading and I can certainly recommend it. And if you have the opportunity to hear Michael speak (on Zoom or in person), you should take it. He is a charming person and a very good speaker!
Marina Saegerman
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