The famous American author Mark Twain (Samuel Clemens) lived from 1835 to 1910. In spite of being a life-long serious cigar smoker, he was quite healthy until late in life, when he developed heart trouble. However, illness, particularly infectious diseases, changed Twain’s life and shaped his writing. Let me tell you how.

I love this time period in the history of medicine, because it was during this time that the Germ Theory evolved. The understanding of disease changed from the miasma (bad air) and humoral theories to the knowledge that microscopic germs caused illnesses. It was still prior to the antibiotic period, however, and infectious diseases were rampant and feared.

Twain often told the story of his childhood measles. He was twelve, and his father had just died of pneumonia. Measles swept through the Midwest US, including Hannibal, Missouri. Everyone was terrified, including the Clemens household. Children died daily. Finally, Clemens decided he couldn’t stand the suspense anymore, and just wanted to get it over with. He snuck into a neighbor’s house and got into bed with a playmate who was sick with measles. Of course he got sick, was deathly ill for two weeks and finally recovered. “This was a turning point in my life…For when I got well my mother closed my school career and apprenticed me to a printer….I…began to add one link after another to the chain which was to lead me into the literary profession. I can say with truth that the reason I am in the literary profession is because I had the measles when I was twelve years old. “

Twain’s beloved wife Olivia had her own health issues. She apparently had a bad fall on ice when she was sixteen, with a resultant back injury. She was partially paralyzed and spent two years receiving therapy at the Swedish Movement Cure in Manhattan; those treatments included bed rest and an immobilizing back brace. Interestingly, a faith healer later was able to “raise her from her bed”. However, for the rest of her life she suffered from depression, insomnia, fatigue, weakness and malaise. Many scholars of the Twain family believe she may have actually had Pott’s Disease (tuberculosis of the spine) or severe scoliosis. Others cite neurasthenia as her diagnosis.

Neurasthenia, the great catch-all diagnosis of the 1800s, was felt to be exhaustion of the central nervous system’s energy reserves, caused by the frantic pace of life. Symptoms included lassitude, depression, high blood pressure, lethargy, anxiety, palpitations, headache. It was particularly common in American women, and in Europe it was called “The American disease”. The reformer Jane Addams, writer Walt Whitman, and even president Teddy Roosevelt were among the neurasthenia sufferers. Commonly treated with trips to a spa, electroshock therapy and various tonics and nerve pills, it was an accepted chronic illness of that time. Sounds a lot like chronic fatigue, long-Covid and dysautonomia, doesn’t it?

Nevertheless, Olivia was able to run a household and raise four children. Sadly, illness dogged her; she caught typhoid while pregnant and her first baby was born prematurely. The baby, Langdon, was always sickly, and died at 19 months of diphtheria. Three daughters were born after that: Susy, Clara and Jean.

The youngest, Jean, was healthy until she was fifteen; she then developed epilepsy. Twain always blamed it on a head injury a few years earlier. Because of Olivia’s poor health and Jean’s intractable epilepsy, the family spent most of ten years (1891-1901), and much of Twain’s fortune in Europe, seeking health cures. Twain was a fan of homeopathic and alternative treatments. Particularly popular at that time were European baths, for hydrotherapy. Hydrotherapy, or water cure, was a staple of the late-Victorian health reform movement and consisted of bathing in cold or hot water, drinking various mineral waters, steam baths, wraps in wet sheets, and sitz baths.  The Clemens family visited spas in France, Germany, Italy and Austria. Jean’s epilepsy was treated by specialists in Vienna without benefit. They moved to London and then Belgravia. Jean then spent a summer at a lakeside sanatorium in Sweden. Finally, Twain decided she could get the same care in the US, and they returned home.

Epilepsy was poorly understood in the 19^th century. Treatments, other than hydrotherapy, included borax, cannabis, as well as bland diet and seclusion. People with uncontrolled seizures were sometimes committed to asylums. Potassium bromide was used as treatment during Jean’s lifetime; we don’t know if she took it. It wasn’t until 1912 (too late for Jean) that phenobarbital was developed. There was a strong stigma against people with epilepsy. Nonetheless, the Clemens tried to include Jean in their daily activities.

During the time most of the family was in Europe, older daughter Suzy was bored and at loose ends. She returned home, and while her loved ones were still in Europe, she died of spinal meningitis in 1896. Mark Twain was brokenhearted and depressed; his writing took a darker turn after Suzy’s death.

Twain’s wife Olivia, died in 1904 and Twain had difficulty caring for Jean without Olivia’s help. By 1906 Jean’s behavior had become erratic, and she spent three years in Katonah, New York, in an epileptic colony. The family was torn apart by this decision. She begged to come home and finally in 1909, she was allowed to return home. Only nine months later, she was found dead in the bathtub, presumably after a seizure. 

So, Mark Twain, 73 years old, had buried three of his four children and his wife. He was a broken man, deep in depression, and died four months later.

His early writing, such as Tom Sawyer, Huck Finn, the Prince and The Pauper, were lighthearted. Later writing, like Letters from the Earth, and The Mysterious Stranger, were dark and anti-religious. Perhaps a lifetime of dealing with chronic illnesses in loved ones had changed his outlook.