What Killed William Morris?

I’m genuinely asking, because I don’t know, although I suspect the reason given in the official account of his life is not right.

So yes: why did William Morris die? At 62 he was not an especially old man; and everyone who knew him remarked on his vitality, his energy, his prodigious work-ethic, his productivity. Wikipedia says:

In July 1896, Morris went on a cruise to Norway with construction engineer John Carruthers, during which he visited Vadsö and Trondheim; during the trip his physical condition deteriorated and he began experiencing hallucinations. Returning to Kelmscott House, he became a complete invalid, being visited by friends and family, before dying of tuberculosis on the morning of 4 October 1896.

So there you have it: he died of TB. Fiona MacCarthy’s William Morris: a Life for our Time (Faber 1994) gives us more detail. Once past his sixty-second birthday Morris began to appear ‘noticeably feebler’. A doctor (not just any old doctor: Sir William Broadbent, physician extraordinary to Queen Victoria) was called. Writing to Philip Webb, Morris reports on the consultation:

He examined me, partly bare, for about 3 quarters of an hour. And said that sugar there was in my water, but not so much as to be serious and expected to get rid of it by rigid diet, eggs, milk, purée of meat, at first, and when my stomach can stand it un-fat flesh meat. Thought he would soon get rid of it. The other thing is that my stomach is swollen immensely, and even when it has digested the stuff, is too lazy to get rid of it. He is giving something of a knitting-up character for that and expects to get it right soon. But you see he may be wrong, and it may go worse with me.

Diabetes was poorly understood in the nineteenth-century, and insulin treatment was a long way off; but it was easy to diagnose, by testing levels of glucose in the urine. This account suggests that Dr Broadbent found glucose in Morris’s urine, but not at alarming levels. Morris was given an enema, put on this attenuated diet, and told he would get better. He didn’t. MacCarthy notes: ‘Morris’s doctors were puzzled by his lack of improvement.’ He lost weight sharply: ‘in early June he had lost two pounds within a fortnight: he now weighed under ten and a half stone.’ A cruise to Norway was prescribed as an opportunity for recuperation, but actually Morris, now an invalid, grew worse on the voyage — the hallucinations Wikipedia mentions were him believing coiled ship’s ropes were snakes. When he got back to Britain, Kelmscott House was ‘turned into a nursing home’ for him. Then we get this:

By the end of August Dodgson wrote to tell Cockerell in confidence that the lung trouble had proved to be tubercular. [MacCarthy, 667]

This is the first and last mention of tuberculosis in MacCarthy’s book. But the symptoms MacCarthy describes in the remaining weeks of his life don’t sound like it: ‘he was now failing mentally, suffering from loss of memory and disturbed with wild hallucinations, which he called “the screaming horrors” … one of these, in mid-September, was that he was composing Dean Farrar’s Life of Christ.’ Morris’s mind grew more confused. Then, rather abruptly, he died: ‘Morris was never in much pain,’ MacCarthy reports, but according to his brother Ned ‘his weakness was pitiful’. On the 5th October his temperature rose. A nurse was called. He died at eleven-fifteen the next morning.

I have to say, none of this sounds much like tuberculosis. When Keats died, it was after many weeks of constant, violent coughing, bringing up blood. When an autopsy was performed on his corpse (as required by Italian law in such cases) the doctor found no lung left in his chest at all: he had coughed it all away. It was agony for Keats, and agony for Joseph Severn, who nursed him — more agonising that it needed to be, since Severn had religious scruples about Keats committing suicide by overdosing on laudanum, and so kept the analgesic away from him. TB is, in short, a horrible disease, and I recommend you do not get it.

‘Consumption’, as it used to be called, is an infectious disease caused by the mycobacterium tuberculosis. The infective agent was only discovered by German physician Robert Koch in 1882. The bacillus happens to be impervious to gram staining — a technique for identifying bacteria developed by Danish scientist Hans Christian Gram in 1884 — which meant doctors had to wait for later developments in staining accurately to identify it.

Typical symptoms of active TB are: chronic cough with blood-containing mucus; fever; night sweats; and weight loss. Morris clearly underwent the last of these, although there are many reasons why a person might lose weight. He does not appear to have had night sweats, his temperature only started to rise the day before he died, and there are no reports of chronic coughing, let alone coughing up blood. Hallucinations (such as Morris experienced) can be feverish, but not without a raised temperature; and (again) there might be many reasons why an individual becomes hallucinatory.

TB almost always involves the lungs (in about 90% of cases) and chronic TB causes extensive scarring in the upper lobes of the lungs in particular (although it can also affect the lower lobes). It kills either by degrading the lungs to the point where they can no longer function, as happened with Keats, or else by damaging tissue elsewhere (‘if TB bacteria gain entry to the blood stream from an area of damaged tissue they can spread throughout the body and set up many foci of infection, all appearing as tiny, white tubercles in the tissues’) causing necrosis, tissue cavities that fill with necrotic material, which in turn can result in catastrophic infection. But in this latter case the patient will manifest the symptoms of infection: high temperature, fever and so on.

MacCarthy’s sources and reference notes don’t divulge from where she took the medical details of Morris’s last months, but some are from J W Mackail’s enormous Life of Morris (1901). Mackail was a classicist (a notable Vergilian scholar in fact) and academic. He was not a doctor. This is his broader assessment of Morris’s health towards the end:

No man on earth dies before his day: and least of all can the departure be called premature of a man whose life had been so crowded in activity and so rich in achievement. To one judging by the work done in it, his working day was longer and ampler than often falls to the lot of our brief and pitiable human race. But the specific reasons why that life was not protracted beyond its sixty-third year are not difficult to assign. On the paternal side of his family there was a marked neurotic and gouty tendency. Himself of powerful physique, deep-chested, sound-lunged, big-hearted, he yet carried in him that family weakness, which was developed under the pressure of an immensely busy life. On a constitution made sensitive by gout, the exposure of the years of the Socialist crusade, when he had perpetually spoken in the open air in all weathers, and in the worse than open air of indoor meetings, and had often neglected or forgone proper food and rest, told with fatal effect. “I have no hesitation,” his family doctor writes to me, “ in saying that he died a victim to his enthusiasm for spreading the principles of Socialism.” Yet this was only the special form that, in those years, his unceasing and prodigious activity had taken: and these words may be enlarged or supplemented by those of an eminent member of the same profession: “ I consider the case is this: the disease is simply being William Morris, and having done more work than most ten men.” [Mackail, Life of Morris (1901), 750]

This is spectacularly unconvincing from a medical point of view. Gout, though unpleasant, is not in itself fatal; and one does not expire from speaking at public meetings, even ‘in the open air in all weathers’. Mackail does not mention tuberculosis, but does report that ‘on his return from Norway congestion of the left lung had set in, which remained persistent, and the general organic degeneration made steady progress.’ Congestion is easily diagnosed, and could be a number of things: it sounds like a respiratory tract infection, the kind of thing a Victorian doctor could assess easily by percussing the chest (where he would need a biopsy properly to diagnose TB).

It seems clear that Morris was diabetic (Mackail: ‘he was [early in 1896] induced to consult Sir William Broadbent. The existence of diabetes and other complications was confirmed, but not to a degree which implied immediate danger’) and diabetes is an illness that can be fatal — indeed, the WHO estimates that globally four million people died of diabetic-related complications in 2019 alone. But the vast majority of diabetic deaths are related to damage to blood vessels: ‘diabetes doubles the risk of cardiovascular disease and about 75% of deaths in people with diabetes are due to coronary artery disease. Other macrovascular diseases include stroke, and peripheral artery disease.’ This does not appear to have been what killed Morris.

So what was it? ‘Gout’ is a specific disease (needle-like crystals of uric acid are deposited in the joints, and painfully aggregate) but it’s also a catch-all term from nineteenth-century medicine, encompassing diseases we now know to be quite distinct: arthritis, lupus and others. One symptom everyone agreed on was Morris’s sudden weight-loss, unrelated to his diet (which did not change across 1896). This might point to coeliac disease or irritable bowel syndrome (IBS), or perhaps an overactive thyroid, or heart failure. But I don’t have the medical expertise to make an educated guess. Should we call-in House M.D.?

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Postscript 13th March 2023: I consulted with a couple of medical friends, including my sister (a doctor in York). She thinks the glucose in Morris’s urine a red herring — that is, though he clearly was a little diabetic, that’s not what killed him — and agrees that it doesn’t look like TB. Her best guess is cancer: perhaps a colon or kidney cancer that had metastasized to the brain. Cancer would explain the weight loss and ascites, and the metastasis the psychotic episodes. A GP friend agreed with this diagnosis. Other possibilities are Sarcoidosis (which could very easily be confused with TB by a 19th-century doctor), or late-stage syphilis. I’m not sure about this latter: it was a common disease back then and I think doctors would have been able to diagnose it — but conceivably they did, and did not make their diagnosis public for reasons of discretion. Still, we can at least say it’s more likely that William Morris died of cancer than of TB.