Has the mystery of Jane Austen's death finally been solved?

Between 1811 and December 1815, Jane Austen published four of her six novels. By the end of 1816, she had completed another. Yet by July 18 1817 (205 years ago today), she was dead.

None of her doctors seemed to know why she died, and the cause of her death has remained a mystery despite repeated attempts to solve it. How could a woman who had been healthy and energetic in her late-30s succumb so quickly by the age of 41?

Had she suffered from tuberculosis, the century’s great killer, it would certainly have been recognised and diagnosed at the time. And Addison’s disease, suggested as the cause in 1964 by the eminent surgeon Sir Zachary Cope, does not fit the facts provided by the letters from Jane to her sister, Cassandra, and other family members.

Nor does lymphoma, advanced as a candidate by Claire Tomalin in her excellent biography Jane Austen: A Life (1997) and by Mariella Frostrup in her recent Channel 4 series, Britain’s Novel Landscapes. Other reasons given for her early death, such as cancer of the stomach, have satisfied few.

But now, at last, the puzzle may have been solved. Writing in the medical journal Lupus, retired surgeon Michael Sanders, together with his former colleague Elizabeth Graham, has offered an alternative diagnosis that appears to fit the available facts. Although Cassandra burnt much of her correspondence with her sister, enough evidence remains in the surviving letters to suggest that the cause of death was systemic lupus erythematosus, or SLE.

The symptoms of lupus, an autoimmune disease, can include severe arthritis, rashes, fevers and chronic fatigue. Jane describes all of these in letters she wrote in the last 11 months of her life. From August 1816, she complained of rheumatism, specifically backache and pain in her knee.

In December 1816, she told her nephew, James Austen-Leigh, that she found walking out to dinner beyond her strength. And in March 1817, writing to her niece, Fanny Knight, she described her face as, “black and white and every wrong colour”, evidence of the butterfly rash commonly associated with the onset of SLE.

In the same letter she wrote, “I have had a good deal of fever of late and indifferent nights.” By April, she was confined to bed.

“Sickness is a dangerous indulgence at my time of life,” she wrote – and so it proved. The immediate cause of her death at the age of 41, at 8 College Street, Winchester, where she had moved to be closer to her specialist, Mr Lyford, may well have been failure of the heart or kidneys, but either of these could have been as the result of SLE.

Cope’s suggestion of Addison’s disease, a condition in which the body does not produce enough of the hormone cortisol, was based in large part on Jane’s letter to Knight about her skin discolouration, which he argued was evidence of the characteristic permanent brownish appearance seen in patients with Addison’s. That and Jane’s anaemia and progressive weakness.

But in his paper, Sanders, who has spent much of his life in Chawton, the village in Hampshire where Jane lived with her mother, sister and family friend Martha Lloyd from 1809 to May 1817, points out the key flaw in this diagnosis.

“In the 19th century, Addison’s disease was frequently due to tuberculosis and both adrenal glands had to be involved. Jane had no chest or orthopaedic problems to suggest TB,” he and Graham write.

As for the suggestion of lymphoma, they say, “there are no specific features to favour Hodgkin’s or B-cell lymphoma and there is no mention of enlarged lymph glands” – a cardinal feature of these conditions.

Austen’s readers across the English-speaking world mourn her early death because it has deprived them of a flowering, not a declining, genius. Her last completed novel, Persuasion (recently turned into a Netflix film starring Dakota Johnson), describes the early autumn of life as touchingly as the earlier Pride and Prejudice describes its spring. The fact that she decided to rewrite the last chapter shows, perhaps, that she recognised how her ill health was undermining her powers.

Given what might have been, it is all the more important for her admirers to know how she died. They may even derive some small comfort from the view of Sanders and Graham that, if she had suffered the same symptoms today, she may still not have survived. Of the 2,740 cases of SLE recorded in the UK between 1999 and 2012, 75 per cent were women, and the mortality rate was approximately 10 per cent.

Even in the era of modern medicine, lupus remains a leading – and poorly understood – cause of death in women in their 30s and 40s.