Robert Burns only lived to the age of 37. The cause of his death remains uncertain, but alcohol abuse has been suggested as a contributing factor for almost two hundred years. There are some clues as to what might have befallen him, and what did not.
There is no doubt that Robert Burns passed away July 21, 1796, in the Scottish town of Dumfries. The image above portrays the room where he died. The events leading to his final illness probably began several years before.
The 2008 book “Robert Burns the Patriot Bard” by Patrick Scott Hogg claims that Burns had a serious illness in the autumn of 1791. It was so bad that the doctor came to visit him 5 times in 8 days. The symptoms were said to include painful joints and fever. The physician prescribed emetics and laxatives, and Burns recovered. While there are numerous potential causes for those symptoms, one that stands out is rheumatic fever. It is a condition which follows a common Streptococcal infection. The body’s natural defensive antibodies are believed to attack not only the Strep germs, but parts of the body itself. They can cause inflammation and damage to the joints and the heart valves among other tissues. The disease is prone to recur with repeated Strep infections.
Four years later, in the autumn of 1795, Burns had a very difficult time. One of his darling daughters, Elizabeth Riddell Burns, died at age two. The poet was unable to visit her in her final illness and this guilt added to his grief. He wrote to his long-time correspondent Mrs. Francis Dunlop,
“I have lately drunk deep of the cup of affliction. The autumn robbed me of my only daughter1 and darling child, and that at a distance too, and so rapidly, as to put it out of my power to pay the last duties to her.”
Robert Burns also had a tooth extracted in 1795. It would have likely been done for an abscess. It’s a minor problem today, but was a much more serious issue then. Dental infections could be dangerous in the pre-antibiotic area. There was also one additional risk. Dental manipulation can introduce live bacteria into the blood. While the germs are easily cleared away by an intact immune system, the bacteria can persist if the host immunity is weakened for any reason, or there is a particular anatomical abnormality. An abnormal heart valve is one site that can be colonized by circulating bacteria. Rheumatic fever can damage heart valves. Hence, Burns may have been vulnerable to this complication2.
It was recorded that there was also a food shortage in the area that year. Given that he was not a wealthy man, Burns might have had trouble keeping food on the table. This may have weakened his ability to resist infections.
The diagnosis of acute rheumatic fever is hinted at by Burns’ letter to Mrs. Dunlop
“I had scarcely begun to recover from that shock, when I became myself the victim of a most severe rheumatic fever, and long the die spun doubtful; until after many weeks of a sick bed, it seems to have turned up life, and I am beginning to crawl across my room”.
It is noted that the poet was indeed extremely ill. He was bedridden for weeks and was barely able to crawl about his room as he rallied.
Robert Chambers was a Scottish author and geologist. He wrote a biography of Burns in 1834 which was largely taken from the writings of Dr. James Currie, who will be described later. Chambers wrote of an extraordinary incident that supposedly took place in January 1796.
“… Burns tarried to a late hour at a jovial party in the Globe Tavern. Before returning home, he unluckily remained for some time in the open air, and, overpowered by the effects of the liquor he had drunk, fell asleep. … a fatal chill penetrated his bones; he reached home with the seeds of a rheumatic fever already in possession of his weakened frame”
While the Globe Tavern was very close to Burns’ home, this still seems highly unlikely expedition for a man so ill. Moreover, the poet was in financial distress because his wages were reduced by his long absence from work. It does not add up that he would be out carousing when he was sick and broke.
Dr. William Maxwell3 (1760 — 1834) was a good friend of Robert Burns and he took an active role in trying to treat him.
Maxwell described Burns as suffering from “Flying Gout”4. This is not currently recognized as a diagnosis5. What Maxwell may have been decribing was what would be called “migratory arthritis” today. It is a cardinal symptom of rheumatic fever.
One approach that was popular at the time was the use of medical bathing. Also called balneology, or hydrotherapy, it claimed that exposure to mineral waters might treat certain diseases. In the 16th and 17th centuries mineral springs became popular among royalty and the well to do. People would “take the waters” for relaxation. Shortly after, physicians began to set up shop at the spas. They began recommending specific water treatments including baths, steam, douches and drinking6.
The book “Dissertation on the Use of Seawater in Diseases of the Glands” published in 1750 by Dr. Richard Russell, was a popular reference for decades. It may well have influenced Dr. Maxwell, who recommended that Robert Burns try the springs at Brow.
This well was a few miles Southeast of Dumfries, near an arm of the Irish Sea called the Solway Firth. On July 4 of 1796 Burns travelled to the Brow Well to drink the iron containing spring water and wade in the cold waters of the Solway Firth. He wrote in a letter to his colleague Alexander Cunningham
“Alas! My friend, I fear the voice of the Bard will soon be heard among you no more! For these eight or ten months I have been ailing, sometimes bed-fast & sometimes not; but these last three months I have been tortured with an excruciating rheumatism which has reduced me to nearly the last stage. You actually would not know me if you saw me. Pale, emaciated, & so feeble as occasionally to need help from my chair — my spirits fled! Fled! — but I can no more on the subject — only the medical folks tell me that my last & only chance is bathing & country quarters & riding.”
After a few days at the Brow Well Burns was so weak he did not have the strength to ride a horse. He had to borrow a carriage to get home.
Allan Cunningham (1784-1842) was a man of letters and music. His father was a friend of Burns and he was a friend of Sir Walter Scott. He wrote 3 books about Burns and the following are selections of his description of the final days.
“Though Burns now knew he was dying, his good humour was unruffled, and his wit never forsook him. When he looked up and saw Dr. Maxwell at his bed-side, - "Alas!" he said, "what has brought you here? I am but a poor crow and not worth plucking."
“His household presented a melancholy spectacle: the Poet dying; his wife in hourly expectation of being confined: four helpless children wandering from room to room, gazing on their miserable parents and but too little of food or cordial kind to pacify the whole or soothe the sick”.
“A tremor … pervaded his frame; his tongue, though often refreshed, became parched; and his mind, when not roused by conversation, sunk into delirium. On the second and third day after his return from the Brow, the fever increased and his strength diminished.”
In a lucid moment, Burns made a gift to Maxwell of his pistols.
“On the fourth day, when his attendant, James Maclure held a cordial to his lips, he swallowed it eagerly - rose almost wholly up - spread out his hands - sprang forward nigh the whole length of the bed - fell on his face and expired.”
Burns had a large funeral complete with military honours on July 26. Of the family, only his brother Gilbert attended. Dr. Maxwell was busy delivering Jean Armour of another child. She honoured the physician by naming her son Maxwell.
The poet was buried originally in a corner of the St. Michael's Churchyard cemetery. The remains were moved to a mausoleum in 1815. Along the way a lock of the poet’s hair was collected.
Dr. James Currie (1756-1805) was Burns’ first biographer. He was well known for his stance to abolish slavery in the British Empire and his efforts to improve conditions for the poor. Like Maxwell, he was a proponent of hydropathy. He also published the first scientific study with the thermometer in the English language.
Currie was also a staunch proponent of temperance. This orientation is clear in his book “Medical Reports on the Effects of Water, Cold and Warm, as a Remedy in Fever and Febrile Diseases, whether applied to the Surface of the Body, or used as a Drink, with observations on the Nature of Fever and on the Effects of Opium, Alcohol and Inanition”
Currie is said to have been a reformed alcoholic himself. It would appear that he decided to make an example of Burns. Currie wrote extensively of the poet’s drinking in his biography.
“Perpetually stimulated by alcohol in one or other of its various forms... in his moments of thought he reflected with the deepest regret on his fatal progress, clearly foreseeing the goal towards which he was hastening, without the strength of mind necessary to stop, or even to slacken the course. His temper became more irritable and gloomy; he fled from himself into society, often of the lowest kind.”
Currie even suggested that Burns contracted venereal disease from those low companions.
“He who suffers the pollution of inebriation, how shall he escape other pollution? But let us refrain from the mention of errors over which delicacy and humanity draw the veil”
It was Currie who related the questionable story of Burns falling down drunk and sleeping outside in January of 1796, which Cunningham repeated. Numerous other authors since have dutifully attributed Burns’ death to the effects of alcohol. Burns had certainly made himself unpopular for some of his libertine behaviour and revolutionary political views. There was likely no shortage of people willing to propagate the idea that he was ruined by drink.
It is clear that Burns liked alcohol and was inebriated on numerous occasions. However, it is false to suggest that his drinking contributed to his demise. The symptoms strongly suggest he had terminal heart failure from bacterial endocarditis, as a complication of rheumatic fever.
In 1844 Dr. John Thomson claimed that Burns died as a result of mercury poisoning. He alleged that Dr. Maxwell had administered this treatment. However, a group of modern forsenic physicians and medical physicists got permission to test that lock of Burns’ hair. In a 1971 article in Lancet Dr. J Lenihan et al announced that the amount of mercury was far below the level seen in mercury poisoning, putting that theory to rest.
Compiled by Stewart Cameron, Halifax Burns Club, January 2013
1. It is interesting that Burns refers to the Elizabeth Riddell Burns as his “only daughter”. At that point he had several daughters, including another one already named Elizabeth. That girl was a result of his affair with Elizabeth Paton. Paton’s daughter was his first child, and was the subject of Burn’s poem “To a Bastart Wean”. It appears when he refers to Elizabeth Riddell Burns as his only daughter he was confining himself to his legitimate progeny.
2. In Burns' circumstances the bacteria released by the dental extraction could have persisted and grown on a heart valve damaged by rheumatic fever. This can cause heart failure, fevers, and septic emboli. The latter is the result of bits of the infected tissue breaking away and travelling downstream in the blood where they can cause tissue damage.
The image above shows the inside of a human heart, which has been opened to show growths on the valves (at the top of the string like structures). Symptoms can include weakness, rapid heartbeat and loss of appetite.
The patient with endocarditis and valvular dysfunction can die of heart failure. This is usually associated with fluid accumulation in the tissues, and one report had it that Burns suffered from this (“the dropsy”).
3. Burns and Dr. Maxwell shared many political sympathies. Both supported the ideals of the French Revolution. Maxwell’s politics were undoubtedly influenced by his medical studies in France. He had sufficient stature in Paris that he played a part in the execution party for King Louis XVI. It was reported that he dipped his handkerchief in the king’s blood after he was guillotined.
4. The term “gout” comes from the Latin word “gutta” which meant “drop”. It was used to describe any acute arthritis. The ancient humoural theory of medicine, which still held sway at the time, believed that such arthritic complaints were caused by a drop of poison in the joint. The “Flying” likely meant that the inflammation was moving from one joint to another.
5. It must be appreciated that the medical knowledge of the later 18th century was quite primitive. Not only were there no antibiotics, it was not even appreciated that germs caused disease. Vitamins, aspirin, morphine and the immune system were unknown. The stethoscope would not be invented for another 20 years. The biggest technological breakthrough of the age was the adoption of the thermometer to measure body temperature. With so little knowledge of physiology and pathology, doctors could do little medically.
6. While the Greeks and Romans held bathing in high esteem, this was not the case among Europeans during the Middle Ages. Bathing was regarded as unhealthy and even sinful. Some held that evil humours might enter the body through the pores of the skin, and a good coating of dirt was considered a healthy defense. The Catholic Church discouraged bathing, perhaps because of the fact that public bath houses in Roman times were often locations for sexual liaisons. St. Jerome, the author of the Latin Vulgate version of the Bible, warned against washing the body in case it inflamed the carnal passions. St. Theresa of Rome was said to have boasted she had never bathed a day in her life (although she only lived 13 years before being martyred).