Kipling and Medicine

Cholera


(by Gillian Sheehan)
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The disease | Sources of infection
Kipling's experience | Cholera in the stories


[May 11 2004]

The disease

The word “cholera” has been used rather freely in the past and has been applied loosely to a number of diseases in which diarrhoea is a prominent symptom. Nowadays “cholera’”refers to Asiatic cholera. This is an acute infectious disease characterised by copious diarrhoea, (rice-water stools), and vomiting leading to such severe dehydration that it kills the patient in 75% of untreated cases. The victim can die of dehydration within a few hours of first becoming ill. It is caused by the comma-shaped bacillus, Vibrio cholerae, discovered by Robert Koch in 1883. Infection is due to drinking polluted water.

The incubation period is from one to three days. The onset of symptoms is usually very sudden. (In “The Bridge Builders”,(1893), cholera “came in the night”.) Treatment consists of restoring fluid and electrolytes to the blood as soon as possible. Antibiotics may kill the organisms but they do nothing to neutralise the endotoxin responsible for the copious diarrhoea. [Information from William Boyd, A Textbook of Pathology, Lea & Febiger, 8th edition, 1973.]

Sources of infection

In the cholera endemic areas in the Ganges delta the infection was passed from man to man by means of the primitive water supply systems: most of the villages in these areas depended entirely on surface water collected in crude reservoirs, or ‘tanks’, for their water for all purposes ,and, as there was no sewage system, this water was heavily infected with human excreta. Local outbreaks of cholera occur here in the dry season. Then, in the monsoon season, the vibrio cholerae would be spread far and wide and sustained by fast passage from one person to another. [Information from Chambers’s Encyclopaedia, Vol.3, 1959, and Philip D Curtin, Death By Migration, Cambridge University Press, 1989.]

Kipling and Professor Hill noted sewage irrigation when travelling from Kobe to Osaka by train in 1889.

Cholera epidemics were started when there were great movements of population, when the road and rail networks were overcrowded with pilgrims travelling to religious festivals. Kipling gives a perfect description of the way cholera spread in “Without Benefit of Clergy”,(1890) :

“It (cholera) struck a pilgrim-gathering of half a million at a sacred shrine. Many died at the feet of their god; the others broke and ran over the face of the land carrying the pestilence with them. It smote a walled city and killed two hundred a day. The people crowded the trains, hanging on to the footboards and squatting on the roofs of the carriages, and the cholera followed them, for at each station they dragged out the dead and the dying....”
In “Without Benefit Of Clergy”, (1890), Ameera had the “black cholera”. This is not a different illness. It refers to the blue or black colour of the face of a person with cyanosis from circulatory collapse.The greater or less lividity of the countenance has given rise to such appelations as ‘blue’ and ‘black’ cholera. Such patients would also be stuporose, as Ameera was.

Although Robert Koch isolated the Vibrio cholerae in 1883, it took at least another ten years before it was finally accepted that this was the cause of the disease. It was generally accepted that “the great cause of cholera is the contamination of water used for drinking purposes with the dejections of persons suffering from the complaint.” But it was thought that various factors such as intoxication, exhaustion, overcrowding, chill, damp, filth, destitution, drought, famine and even fear of the disease could all predispose one to contracting cholera. To avoid chill, every soldier in India was issued with a flannel waistband, or “cholera belt”, a practice which continued into the twentieth century. [Information from : William Moore, A Manual of Family Medicine & Hygiene for India, reprint Delhi 1989, 6th edition, 1893. Mark Harrison, Public Health in British India, Cambridge University Press, 1994.]

Kipling's experience of cholera

In November, 1905, Kipling advised a man going to work in Northern Nigeria, to “keep a spare and dry belly-band (cholera belt or whatever they call it) about one......to change into after a wetting or a sweating and it just fortifies the lower intestines and the kidneys.” [Information from Thomas Pinney, The Letters of Rudyard Kipling, Vol.3.] In a letter to Edith Macdonald, 2-7 June 1884, Kipling called cholera “the Abominable”, and said he saw it “knock a man down ... he died in a trifle under two hours”. He blamed “rotten melons and bad arrack”. But, surprisingly, he went on to assure her that “an English East wind is more deadly than most epidemics of Asiatic cholera.” [Information from Thomas Pinney, The Letters of Rudyard Kipling, Vol.1, p.63]

In 1889, when Kipling was in Hong Kong, he was mistaken for a doctor by an intoxicated woman terrified that she had cholera. A neighbour had died of cholera in 6 hours the previous week. He had to reassure her that cholera never attacks a person twice. In the circumstances he did his best to reassure and comfort her. But getting cholera once does not give enough immunity to guarantee against possible later infection. [Information from Philip D Curtin, Death By Migration, Cambridge University Press, 1989, p.71.]

Fresh air was thought to be very important in the prevention of cholera. A regiment struck by cholera would leave their barracks and set up a 'cholera camp' in the countryside until the disease had run its course. [Information from George and Christopher Newark, Kipling’s Soldiers, The Pompadour Gallery, 1996, p.118]

Cholera in the stories

In “The World Without”, (1888), Curtiss of the Royal Artillery says they had two cases of cholera, one of which died, and if they had another they would be ordered into camp. In the same story “Miggy”(Mingle), was so fearful of catching the disease that he “dies of cholera once a week in the Rains and gets drunk on chlorodyne in between.”

“Only A Subaltern”, (1888), gives an excellent description of life and death in a cholera-camp.

In “My Lord The Elephant”,(1892), cholera was hanging round the cells used by the Ould Regiment “like mildew on wet boots, an’ ’twas murdher to confine in ut.”

When Kipling arrived in San Francisco in May 1889, he wrote: “but for the blessed sea-breezes San Francisco would enjoy cholera every season.” [Information from From Sea To Sea, Vol.1, p.487.]

In “The Daughter Of The Regiment”, (1887), Kipling described the trains overcrowded with soldiers - 870 troops, 12 women and 13 children in two trains - told to move to new quarters 600 miles away during very hot weather. He described the panic at “Ludianny”:
“ivry sowl av the followers ran for dear life as soon as the thrain stopped”. The telegraph clerk had to be physically restrained from bolting while he sent a telegraph 300 miles up the line asking for help. He describes the men “fallin’ over, arms an’ all” and the Doctor “dropped on to the platform from the door av a carriage where we was takin’ out the ead.”

The women were “huddled up anyways, screamin’ wid fear”. Presumably they and the children had travelled in a separate carriage and had so far escaped the infection. Ould Pummeloe knew that the men needed water and got all the women “wid horse-buckets and cookin’ pots” to carry water to them from a nearby well. She literally worked herself to death. Mulvaney said she died because of the sun “she misremembered she was only wearin’ her ould black bonnet”. That night there was a lot of wind and “it blew the cholera away”.
This could not have happened as cholera is not spread by the wind. It is water-borne. The well from which they were drawing water must have remained uninfected during the time they were quarantined there.

In “Cholera Camp”,(1896) :
“Though they’ve ‘ad us out by marches
an’ they’ve ad’ us back by rail;
But it runs as fast as troop trains,
and we cannot get away,.....”
The troops in question must have been using contaminated water or food all the time, and carrying the disease with them as they travelled.

In “A Germ Destroyer” (1887), E S Mellish had spent 15 years in Lower Bengal studying cholera and held the theory that cholera was “a germ that propagated itself as it flew through a muggy atmosphere and stuck in the branches of trees like a wool flake”. The germ could be rendered sterile by Mellish’s Own Invincible Fumigatory - a heavy violet-black powder containing nitrate of strontia, baryta, and bone meal.

In Kim (1901), the lama believed that the dung of a black horse, mixed with sulphur and carried in a snake-skin was a sound remedy for cholera.

The doctor in “At The End Of The Passage” (1890), was having about fifteen deaths a day among the cholera-stricken coolies building the Gaudhari State Line. He said:

“And the worst of it is that the poor devils look at you as though you ought to save them....My last attempt was empirical, but it pulled an old man through. He was brought to me apparently past hope, and I gave him gin and Worcester sauce with cayenne. It cured him; but I don’t recommend it.”
In “William The Conqueror” (1895), Raines, the editor of the daily paper told Scott he would be put on relief-works “with a horde of Madrassis dying like flies; one native apothecary and half a pint of cholera-mixture among the ten thousand of you”.

William had previously been through a very bad cholera year, “seeing sights unfit to be told”. One of Martyn’s loaned policemen died of cholera when the Rains came, but there was no mention of a major cholera epidemic.

The “cholera-mixture” referred to in “William The Conqueror” may have been a mixture of tincture of ginger, aromatic spirits of ammonia, spirits of nitrous ether and brandy, or it may have consisted of a mixture of chloroform, aromatic spirits of ammonia, chlorodyne and brandy. Chlorodyne was a mixture of chloroform and morphine. [Information from William Moore, A Manual of Family Medicine & Hygiene for India, reprinted Delhi, 1989, 6th edition 1893, p.637-8]

The verses at the beginning of “At The End Of The Passage” (1890), mention “the blasts they blow on the cholera-horn”. According to Hobson-Jobson’s Anglo-Indian Dictionary this was really a “Collery Horn” - “a long brass horn of hideous sound, often used at native funerals”.

In “Without Benefit Of Clergy”, (1890), during a cholera epidemic, the conches used in the Hindu temples “screamed and bellowed, for the gods were inattentive in those days”.

After death from cholera there is sometimes a contraction of the muscles of the limbs “which has led to stories of persons being removed to the dead-house while yet alive”. Possibly hearing of such a story gave Kipling the idea for ‘The Strange Ride Of Morrowbie Jukes’, (1885). [Information from William Moore, A Manual of Family Medicine & Hygiene for India, reprinted Delhi, 1989, 6th edition 1893, p.103]


The disease | Sources of infection
Kipling's experience | Cholera in the stories



[G.S.]