Karen Blixen / Isak Dinesen Home

Excerpted from Out of Isak Dinesen in Africa by Linda Donelson MD. Copyright © 1998. Reprinted by permission. All rights reserved

1. Introduction
2. Mercury vs arsenic poisoning
3. Karen Blixen's medicines

Karen Blixen is often remembered as the wrinkled icon with luminous eyes photographed in the 1960s by Richard Avedon and Peter Beard. But I prefer to think of her as the apple-cheeked teenager who plotted marionette comedies for her sisters in the first decade of the century. Karen Blixen was always playful, and even in her youth she hid behind the mask that was to become her persona, the mysterious purveyor of exotic dreams. Throughout a literary life that produced several outstanding collections of tales, two well-known memoirs, a speaking career and two nominations for the Nobel Prize, Karen Blixen promoted her public image. She became internationally acclaimed. Newspapers described the baroness's visit to America in 1959 in more glowing terms than Charles Dickens's tour a century before. New York high society arranged for her hotels and feted her with illustrious engagements. Poets Marianne Moore and e. e. cummings paid their respects, Nobel laureate Pearl Buck traveled two days to meet her, and, as the crowning measure of Karen Blixen's celebrity power, she requested and received a visit from the cultural goddess of the epoch, Marilyn Monroe.

The high-profile tour did not conceal that the author was ill. She spent part of her three months in the United States on intravenous infusions. At this time of her life, three years before her death, she weighed less than eighty pounds and ate almost nothing. Her hosts offered oysters, grapes, and champagne--foods she could keep down--but even these she ignored in favor of entertaining the assembled guests. Through a variety of hints, confidences, and declarations, she told intimates that she suffered from syphilis.

Karen Blixen does not mention her illness in her lyrical memoir Out of Africa. Her book offers her impressions of Africa and the friends she made there--not insights into her private life. Denys Finch Hatton is a friend, not her lover, in her story.

Karen Blixen went to Africa to marry her second cousin Bror Blixen and gain the title of Baroness. Her husband was generous with his affections, and his infidelities resulted in her syphilis in their first year of marriage. Bror Blixen recovered without medications, but Karen Blixen's more serious symptoms required that she take mercury and arsenic--the only medicines used to treat the disease at that time. Despite complications, she persevered with her life in Kenya. Years later she developed unusual abdominal pain, which she feared was caused by tabes dorsalis, late syphilis of the spine.

A physician reading contemporary accounts of Karen Blixen's medical history recognizes that the symptoms described do not add up to tabes dorsalis. Yet entire books have been written around the thesis that Karen Blixen died as a tragic victim of the disease. It is not clear if Karen Blixen herself believed the diagnosis.

According to medical reports by her doctors, the reflexes and sensation in Karen Blixen's legs diminished before she left Africa in 1931--signs first diagnosed as vitamin B12 deficiency. She also suffered from panic attacks, which she describes in Out of Africa. Her first episodes of abdominal pain occurred in Kenya in 1921.

Her physicians have not reported on Karen Blixen's panic attacks--if they occurred in Denmark. Nor have they noted the association of her pain with traumatic episodes in her life. Her first abdominal crises appeared when her sister Ea was dying of a complicated pregnancy and when at the same time her husband Bror requested a divorce. Her pain resumed in 1939, the year her mother died, and increased when she failed to receive the Nobel Prize in 1954.

Mercury vs arsenic poisoning

In 1986 I wrote to Karen Blixen's secretary, Clara Svendsen (now Clara Selborn), asking to know more about Karen Blixen's use of arsenic as a medicine--which seemed from the evidence a more likely cause of the loss of sensation in her legs than syphilis. In her memoir Shadows on the Grass, Karen Blixen talks about taking arsenic. Her letters from Africa show that she used arsenic for many years as a tonic against recurrent syphilis.

Clara Svendsen sent me a copy of an essay about Karen Blixen's long illness by Mogens Fog, her neurologist. He makes no reference to arsenic poisoning. He says that, even though tests of her blood and spinal fluid were negative for syphilis, knowing her history he treated Karen Blixen for tabes dorsalis--which may present itself in many ways, including unpredictable abdominal pain.

In 1992 I brought up to a group of Scandinavian scholars at the University of Wisconsin the information that many physicians examined Karen Blixen after her return from Africa in 1931, and none made the diagnosis of syphilis. Recently a Danish physician, Kaare Weismann, also came forward to question whether Karen Blixen suffered from tabes dorsalis. Dr. Weismann's article was translated in the May 1995 edition of Sexually Transmitted Diseases: Journal of the American Venereal Disease Association. "No reports in the medical literature, aside from Fog's, claim the existence of 'gastric crises' as the single symptom of tabes dorsalis," Dr. Weismann writes. "If Blixen's 'gastric crises' in 1922 were a manifestation of syphilis in the central nervous system [as claimed by erroneous accounts], it is inexplicable how the spinal fluid was normal in 1920 and 1925." Dr. Weismann also says, "Her preoccupation with the disease was not that of a venereophobic. Rather, it was a natural reflection of the general attitude toward the venereal scourge, which at that time was feared as much as acquired immunodeficiency syndrome is feared today."

In Karen Blixen's day syphilis inspired terror in those who believed the illness led inexorably to madness. Patients dreaded the disease even more because they feared contaminating their partners. Karen Blixen's family thought her father committed suicide because he had syphilis. He killed himself rather than infect his wife. It is now known that two thirds of patients with syphilis recover without treatment, but this fact does not diminish the devastating effect of the diagnosis in Karen Blixen's time. She was convinced she would never recover.

Dr. Weismann reviews the information about her illness [see the earlier essay in this book "On Isak Dinesen's Medical History"] and presents the theory that Karen Blixen's gastric crises were the result of mercury poisoning. She was prescribed mercury tablets--the only treatment available in Nairobi in 1915--when her syphilis was first diagnosed. No record exists of the amount she received from her physician in Kenya, but Dr. Weismann estimates her dose on the basis of existing standards. The exact dates she was given the mercury are also unknown. She did not discuss her syphilis in her letters because they were read by the wartime censor in Nairobi.

Fog's report says she first took mercury in the final months of 1914, but there is evidence to suggest that his account is approximate. In letters to her mother Karen Blixen did not report being ill until February 24, 1915, when she attributed her symptoms to an overdose of the sleeping medicine Veronal (a barbiturate). She was well enough to go on safari later the same month, and it seems unlikely that she would undertake a safari in the face of illness.

She reported to her mother in a May letter from Paris that she was ill with fever and malaise. These are symptoms of the second stage of syphilis, and there is no reason to believe she was symptomatic for more than several weeks prior to leaving for Europe. She continued to take mercury tablets until she came under the care of Carl Rasch, a Danish venereologist, in June. Karen Blixen arrived in Denmark with an inflamed throat and mouth, and anemia, which Rasch diagnosed as mercury poisoning.

Dr. Weismann estimates that Karen Blixen took mercury for a year before consulting Rasch but, given the above information, the actual length of time was likely only a few months. Rasch stopped the mercury and prescribed a series of intravenous arsenic (Salvarsan) treatments, given to Karen Blixen for a few months until her tests for syphilis were negative.

Dr. Weismann emphasizes that Rasch administered an additional two treatments of mercury ointment, rubbed on Karen Blixen's skin in 1919. Mercury is absorbed from the skin, and some of it may be deposited in the brain. Dr. Weismann recognizes that Karen Blixen also took arsenic as treatment for her syphilis but the doctor stresses her poisoning with mercury. Both substances are heavy metals which may initially cause similar symptoms. Both lead to abdominal distress if taken by mouth and to damage of the nervous system over time. But mercury poisoning creates disturbances in thinking, including depression, irritability, and decreased memory. Arsenic affects the nerves of the arms, legs and torso in a syndrome similar to tabes dorsalis.

Dr. Weismann does not provide data that Karen Blixen took mercury late in life when her symptoms of gastric distress were most severe. Karen Blixen's intellectual prowess also argues against mercury poisoning. No tremor, hearing loss, or ataxia (imbalance)--the most characteristic signs of mercury poisoning--are documented in her medical history. Her mental powers were undiminished up to the time of her death. Acute, or recent, mercury poisoning may cause abdominal pain but does not explain Karen Blixen's frequent abdominal distress thirty years after she stopped taking mercury as a medicine.

It is clear that Karen Blixen was subjected for a time to the effects of heavy metal poisoning from several compounds, including mercury, arsenic, and bismuth (administered to her early with intravenous arsenic). When first taken, these elements cause nausea, vomiting, and colic. However, no reports suggest that Karen Blixen was exposed to the toxic medicines during the thirty-one years of her life after she returned to Denmark from Africa.

Karen Blixen's medicines

For reasons that are not clear today, her symptoms were rumored to be psychological while she lived. Whether because of her histrionic public gestures or because of some deeper distrust, Danish society was skeptical about her alleged physical illnesses. Sometime before her death she sent her secretary, Clara Svendsen, to a pharmacy to collect her prescriptions. Ms. Svendsen noticed after she left the store that one of the medicines was missing. When she returned to the pharmacy to point out the error, she was treated rudely by the clerk.

An unfortunate story circulated afterwards that Karen Blixen had tried to receive illegal doses of her medications. The incident illustrates that Karen Blixen was easily misunderstood by her public and that questions were raised even in her own time about her diagnosis. In private, her publisher told many that Karen Blixen's syphilis was a myth designed to attract attention to her work. Her literary output seemed more extraordinary within the context of her illness.

In her book Notater om Karen Blixen, Clara Svendsen reveals that she acted not only as Karen Blixen's secretary but as the Farah in her Danish household. Like Karen Blixen's African servant, Ms. Svendsen waited upon Karen Blixen, administered to her comfort, and offered encouragement to her artistic endeavors. She mentions several medications taken by her employer. (Neither arsenic nor mercury is among them.)

When Karen Blixen first complained of abdominal pain to Mogens Fog, he prescribed an antispasmodic drug, Algospasmin. Karen Blixen took the medicine for many years until her pains became so frequent in 1945 that her doctors ordered severing of some spinal nerves. Unfortunately, her symptoms resumed a short time after the surgery. Later Karen Blixen was prescribed Largactil, a drug known by its generic name, chlorpromazine. Among its many uses, it acts as a sedative and anti-anxiety agent. It also offers relief from nausea and vomiting. Karen Blixen was given at various times Butalgin and Pethidin--narcotic painkillers--but, according to Clara Svendsen, her employer never found these as effective as Algospasmin. Karen Blixen's family physician, Vibeke Funch, prescribed vitamin B12 injections and showed Clara Svendsen how to administer them. Ms. Svendsen also counted out for Karen Blixen one tablet of Mecodrin (an amphetamine) in the morning and one and a half tablets of Carbromal--a barbiturate sleeping pill--in the evening. The prescriptions and dosages were not unusual in Karen Blixen's time for someone suffering from chronic, sleep-depriving pain. Today more is known about the addictive side-effects of the medications.

According to Dr. Weismann, Rasch declared Karen Blixen cured of syphilis in 1925. The neurologist Fog entertained the diagnosis of tabes dorsalis and made several attempts to cure her although her blood and spinal tests showed no syphilis. By 1955, seven years before her death, after over fifteen years of treatment and several operations--including the removal of a stomach ulcer, which did not relieve her abdominal pain--Fog and her various surgeons and local doctors concluded that syphilis played no role in her continuing symptoms.

Karen Blixen's writing genius argues that she did not suffer from late syphilis nor from cerebral poisoning due to mercury treatments. She did suffer a mild permanent loss of sensation in her legs that could be attributed to chronic use of arsenic in Africa. The source of her abdominal distress remains unknown. In her letters from Africa and later during her life in Denmark, Karen Blixen wondered if her pain was psychosomatic. Publicly she blamed her trouble on syphilis--a disease that afflicted heroes and poets, as well as her own father. Whatever her belief about her illness, the disease suited the artist's design for creating her own personal legend.

Linda Donelson MD is author of Out of Isak Dinesen: Karen Blixen's untold story.