The Illness and Death of Robert Louis Stevenson

"No appropriate laboratory or radiological tests were available during his life. It is fascinating to speculate about the cause of his death."

Prof Gordon Wright B.Sc, M.B. Ch.B. F.R.C.P.A. gwright@bond.edu.au

Robert Louis Stevenson was one of the three major Scottish Literary figures of the 18th and 19th centuries along with Scott and Burns. His short life, which was prolific and influential, featured constant travel to find environments beneficial to his health. He finally settled in Samoa where he died after a stroke at the age of 44.

Stevenson was born in Edinburgh into a wealthy upper middle-class family of engineers famous for their design and construction of lighthouses. He was an only child and sickly. He was described as having weak lungs from early infancy and by the age of two had his own nurse. Although he was a slow reader, he was noted to be bright and creative. As a child he won poetry competitions and at the age of 16 his historic novel “The Pentland Rising” was published by his father. He had remarkably little schooling – spending less than one year at Edinburgh Academy. Private tutors were hired, and he later attended Edinburgh University from the age of 16. The study of science and engineering did not capture his attention and disappointed his father. He wanted to be a writer. A compromise was reached with his father, and he studied law and qualified as an advocate.

All through this time, his health was poor and in addition to dyspnoea and cough he was noted to have pulmonary haemorrhages. A diagnosis of tuberculosis was made. The search for a climate that would improve his respiratory symptoms had begun.

Initially he travelled with his cousin to France, and he wrote two travel books which were well received. His health was remarkably good at this time and his life would change for ever. He met

Frances Osbourne, an American woman studying in France. The relationship was complicated because she had separated from her philandering husband, and she had two children. While it was clear that there was deep affection between them and she was a great champion of his work, they were cautious because Stevenson was to some extent dependant of financial support from his father. As a result, Frances returned to California. Stevenson’s health at this stage was poor but deterioration was minimal. Frances, or Fanny as she was usually called, cabled Stevenson about her dire circumstances resulting from her divorce and her deteriorating mental health. This encouraged the now impoverished Stevenson to travel second class on the “Devonia” from Port Glasgow to New York where he hoped to find a US publisher. Initially he was unsuccessful. His health was deteriorating, and he used his minimal resources to travel across America on a migrant train. He was near death when he was reunited with Fanny and took some time to recover. He suffered repeated pulmonary haemorrhage but recovered and following Frances’ divorce, they married. Stevenson eked out a living with some published articles and his parents accepted the situation and provided an annuity.

Stevenson, accompanied by his wife and twelveyear-old stepson, Lloyd, returned to Scotland in August 1880 and went on holiday with his parents (with whom there was a full reconciliation) to Strathpeffer, in the highlands. Thenceforward Stevenson's life was that of an invalid suffering from chronic lung disease and at risk from haemorrhages and prostrating coughs and fevers. Two winters were spent on medical advice, at Davos, a dismal health resort in the Swiss Alps.

In July 1884 Stevenson and his wife moved to Bournemouth, where Lloyd Osbourne was at school, and finally decided to settle there. Thomas Stevenson bought his daughter-in-law a house in nearby Alum Chine, which they renamed Skerryvore . For most of his years in Bournemouth, Stevenson lived the life of an invalid plagued by colds and haemorrhages—a life later remembered as that of 'the pallid brute that lived in Skerryvore like a weevil in a biscuit'. Bournemouth was seen as a health resort in the 19th century. A change of air was often prescribed for patients with consumption. It has been considered by some experts that this was the reason Stevenson persisted in living there despite his reported deterioration. It is notable that his most successful writing occurred during this period. It was the time his fortune was made, and his financial security was established. Treasure Island, The Strange Case of Dr Jekyll and Mr Hyde and Kidnapped were published between 1884 and 1887. Kidnapped was mostly written in his sick bed by Stevenson. The author’s health was so poor that a new change of air was needed.

Now financially secure Stevenson and his family returned to the USA. They stayed in upstate New York where he wrote The Master of Ballantrae. In the cold snowy landscape near the Canadian border his health improved, and the family travelled in style to California. The California air kept his cough under control and soon the Pacific voyaging commenced. The family sailed to Hawaii where they lived in the small village of Waikiki for over a year and more writing continued. Restless for adventure they sailed to the Marquesas and Kiribati, then named the Gilbert Islands. All these experiences influenced his subsequent decisions and his writing. After visiting Tahiti, they settled in Samoa. During this period Stevenson was remarkably well, except for a pulmonary haemorrhage in Tahiti.

For the last four years of his life Stevenson made his home on his plantation of Vailima, beautifully situated 600 feet above sea-level, on the mountainside among thick woods, with fine views of the Pacific. His main absences were two brief visits to Sydney, in the spring of 1891 and again in 1893, and a visit to Honolulu in the autumn of 1893; he returned from all of these in worse health. They moved into the new house in April 1891. Stevenson gathered his family around him and lived in patriarchal style, like a clan chieftain.

Stevenson spent the morning of 3 December 1894 happily dictating Weir of Hermiston to his stepdaughter. At sunset he joined his wife on the verandah and collapsed while helping her to prepare a mayonnaise for dinner: two hours later, without regaining consciousness, he died of a cerebral haemorrhage. The following day forty Samoans cut a steep path up the mountainside, and he was buried (by his own wish) on the summit of Mount Vaea.

The certified cause of Stevenson’s death was cerebral haemorrhage. The details of Stevenson’s medical history have been well documented. There are pros and cons regarding the diagnosis of tuberculosis, and tuberculosis was supported by senior clinicians of the time. No appropriate laboratory or radiological tests were available during his life. It is fascinating to speculate about the cause of his death.

Using artificial intelligence (chat gpt) and inserting the clinical history the following information was provided:

There could be other possible diseases or conditions that could have contributed to the sudden death of the man based on the information provided. Some potential considerations could include:

Cardiovascular diseases: Conditions such as a heart attack (myocardial infarction), aortic dissection, or other cardiovascular abnormalities can lead to collapse and loss of consciousness.

Stroke: Apart from a cerebral haemorrhage, an ischemic stroke (blockage of blood flow to the brain) or other types of brain-related conditions could result in collapse and unconsciousness.

Pulmonary conditions: In addition to pulmonary tuberculosis, other respiratory conditions such as severe asthma exacerbation, pulmonary embolism, or severe chronic obstructive pulmonary disease (COPD) exacerbation could lead to collapse.

Neurological conditions: Certain neurological disorders, such as epileptic seizures or brain tumors, may cause sudden loss of consciousness and subsequent death.

Infectious diseases: Various severe infections, including sepsis or meningitis, can lead to rapid deterioration and loss of consciousness.

These are just a few examples of potential alternative diagnoses that could be considered. However, it's important to note that an accurate diagnosis would require a comprehensive evaluation of the man's medical history, physical examination, and possibly additional tests. Only a qualified healthcare professional, reviewing all relevant information, would be able to provide a definitive diagnosis.

I am not sure about Stevenson’s cause of death but from the history cerebral haemorrhage is a likely cause.

Consumption or tuberculosis was a destroyer of lives and livelihoods. Before 1850, it was responsible for one in four deaths worldwide. Until the 1870s it was the number one killer of Britons. Because consumption was so rampant, the medical and social perceptions of the disease influenced where and when consumptive patients went for the Change of Air if they were able to move about at all. Not at all surprisingly, consumptive patients dominated the travelling invalid scene; in 1850, an estimated 90% of travelling British invalids suffered from consumption. Because consumption had no cure, all its treatments were palliative; they involved making the patient as comfortable as possible in the right climate, so the body could, in the fulness of time, possibly heal itself.

Tuberculosis must be regarded as the most likely cause of Stevenson’s pulmonary disease. The most important differential diagnosis is bronchiectasis. The early onset of illness and stabilisation in middle age could fit with this diagnosis.