‘Consumption’ was the name for what we now call tuberculosis, particularly pulmonary tuberculosis, since Robert Koch isolated the tubercle bacillus in 1882. Kipling’s friend, Sir William Osler, called it the “Captain of the Men of Death”, because during the nineteenth century 19 million people died on the battlefield but tuberculosis killed 34 millions. The pulmonary form accounted for 85 to 90 per cent of all deaths from tuberculosis. [Information from William Boyd, An Introduction to Medical Science, 2nd edition, H.Kimpton, 1941, p.91.]
Tuberculosis is characterised by fever, night sweats, and coughing up blood (haemoptysis), and was called ‘consumption’ because it’s victims were almost literally consumed by the disease. [Information from Roy Porter, The Greatest Benefit to Mankind, Fontana, 1999, p.401.]
In most cases the natural defensive powers of the body prevent tuberculous infection taking hold. But these defences may be broken down, on the one hand, by a fresh overwhelming dose of tubercle bacilli and, on the other hand, by an infection such as influenza which undermines the health, by overwork, or by poor hygienic conditions such as overcrowding, or by malnutrition. At the beginning of the twentieth century almost the entire adult population of large cities was positive to the tuberculin test indicating that at one time they had been infected.
Pulmonary infection is by inhalation of expectorated sputum from a person with pulmonary tuberculosis. Treatment consisted of physical and mental rest, fresh air, good food and freedom from worry. [Information from William Boyd, An Introduction to Medical Science, 2nd edition, H Kimpton, 1941, p.93.] Those who could afford to went to warmer, drier climes hoping to halt the progression of the disease. There is a mention of “the consumptive invalids of Madeira” in “Judson and The Empire”(1893).
In “A Bank Fraud”, (1887), Silas Riley’s father arranged a job in India for his son, hoping the warmer climate would help his lung condition. But the tubercle bacillus grows slowly so the rate of production of symptoms is also slow and hence the chronic nature of the condition. [Information from William Boyd, A Textbook of Pathology, Lea & Febiger, 8th edition, 1973, p.336.]
Riley had several periods of illness during the winter there before finally taking to his bed in April and dying five monhs later. Before he died he told Reggie Burke that his chest was “all hollow inside” and that “he had nothing to breathe with”. He was right. The end result of tuberculous infection is cavity formation in the affected part.
In the story “On Greenhow Hill”, (1890), ’Liza Roantree and her father were poor and when the doctor told them that Greenhow air was “too keen for her, she was taken to Bradford, to live with her uncle, a mill-worker, “ in a long street o’ little houses”.
In “Marklake Witches”, (1910), several people appear to be suffering from consumption. Kipling took great care in describing Philadelphia - a thin pale girl, with delicate shiny little (finger)nails, always slightly breathless, with a cough, and a “stitch” in her side when she tried to dance.
In a letter to Andrew Macphail, 25 June 1910, Kipling mentions that Macphail had told him about “the consumptive girl’s delicate nails”. [Information from Thomas Pinney, The Letters of Rudyard Kipling, Vol.3, p.441.] In the same story, Laennec, Gaffer Macklin, and probably young Copper, all had chest complaints. Jerry Gamm had tried out Laennec’s early stethescope on them. This ‘devil’s earpiece’ was blamed for making Gaffer Macklin worse by giving him stitches in his side. It was also said to put “round red witch-marks on people’s skins, and dried up their lights, and made ’em spit blood, and threw ’em into sweats”. The stitches in the side, sweating and spitting of blood could all have been due to consumption. In real life, Laennec suffered from a chest complaint, probably consumption, from which he died in 1826. Jerry Gamm did his best to treat the unsuspecting Philadelphia by giving her breathing exercises and a stick of maple to prop her window open, whatever the weather, so she would have fresh air. Both he and Laennec thought her condition reasonably stable at the time of the story, but expected her to deteriorate in time.
In “Teem”, (1935), the charcoal-burner’s daughter had consumption and slept on a cot in the open at night. Two officious women were anxious to have her removed to a sanatorium. But when her father found he could sell Teem’s truffles, there was enough money to buy her good food, an “outside bed-house”, and medical attention. She was apparently recovering, or at least the disease was not progressing. As Teem put it “the Taint of her distemper diminishes”.
In “Wireless”, (1902), Mr Shaynor, the pharmacist’s assistant was very ill with consumption and Mr Cashell, his employer expected him to die within a year. He had a persistent cough and was bringing up blood with the sputum. He became exhausted easily and was liable to fall asleep in a chair. He tried out various things to relieve the cough such as asthma cigarettes and pastilles. He found ‘Blaudett’s Cathedral Pastilles’ relieved the cough “as much as anything”. These were described as “brown, gummy cones of benzoin” which when set alight “fumed in thin blue spirals”. Benzoin was an ingredient of inhalations used to treat catarrh of the upper respiratory tract. [Information from Martindale’s Extra Pharmacopoeia, The Pharmaceutical Press, 25th edition, 1967, p. 223.]
It is interesting that Shaynor was allowed to go on working and making up prescriptions when he was coughing his head off and obviously very ill. Young Mr Cashell - we never learn his occupation - was not concerned in the least about Shaynor’s condition. To him Shaynor seemed to be just another unfortunate consumptive. Mr Cashell was in bed with influenza, and there as a lot of influenza in the town. The weather was bitterly cold.
Shaynor was coughing almost continuously and coughing up blood. With the cold weather and his debilitated condition, he would have been very susceptible to the influenza that was about, and may have been only days away from death at the time of the story.
The story also involves the poet John Keats, another consumptive. On being orphaned at the age of 15, Keats was apprenticed to a surgeon. In 1816 he was appointed a dresser at Guy’s Hospital and later qualified as a surgeon. He may have contracted consumption from his mother who died in 1810, but the disase remained relatively quiescent for several years until he attempted an overambitious walking holiday. After his brother’s death he lived with a friend, Charles Armitage Brown and wrote “The Eve of St.Agnes” while staying with him. He fell in love with Fanny Bawne, the daughter of a neighbour. In 1820, Keats knew he was dying. In a final attempt to improve his health he sailed for Naples. He died in 1821 at the age of 25 and was buried in the Protestant cemetery in Rome. [Information from Everyman’s Dictionary of Literary Biography, Dent, 1965.]
Damp regions were thought to make consumption worse and dry elevated regions to improve the condition. The diminished pressure of the air at high altitudes was thought to be a curative factor in the early stages of consumption. Kipling made use of this when he wrote “With The Night Mail”, (1909). It is now just a few years after the date Kipling set this story (2000 A.D.) and treatment of tuberculosis has taken a different direction to the one he envisaged. But he appears to have expected the incidence of tuberculosis to continue to increase, and, to cope with the multitudes of consumptives, he invented a whole new branch of medical science with sanatoria over the poles and deserts, and of hoisting patients into sterilised air in “Hospital boats”. It is fascinating to read of airships with great open platforms for the consumptives, bound for “one of the Glacier sanatoriums”.
In the correspondence (written by Kipling) following the story “With The Night Mail”, is the answer to a letter from “Pulmonar” advising the Gobi Desert Sanatoria “for the symptoms you describe”, explaining that “the low levels of the Saharan Sanatoria” were unsuitable except in the early stages of the disease. The medical personnel in charge of these sanatoria would have been acquainted with the books advertised by The Bee-Line Bookshop (again, invented by Kipling) such as Mutlow’s High Level Bacteriology. Walton’s The Pole and Pulmonary Complaints and Dahlgreen’s Air Currents and Epidemic Diseases.