[May 19 2004]
“There are fevers and fevers.” [“William the Conqueror”, Part II. (The Day's Work)]
Kipling had plenty of first-hand experience of fever, as Volume I of his letters, edited by Thomas Pinney, attests:
“Draw from the drain its typhoid germ....and
"The fever’s in the JungleEven the names of fevers were confusing. I think the following were all due to malaria.
The changes in temperature would have been recorded on a fever chart (mentioned in “With The Night Mail”).
In 1880 while working as a doctor for the French Foreign Legion in Algeria, Charles Laveran was the first to see the malarial parasites in the blood of a human being. But it wasn’t until 1895 that Ronald Ross showed that malaria was transmitted to man through the bite of the anopheles mosquito. Prior to 1895 many thought the malarial parasite was transmitted in drinking water.[Source: Andrew Spielman and Michael D’Antonio, Mosquito, Faber & Faber, 2001, p.85-87.
Mosquitoes were frequently mentioned in the Indian tales: In 1892, in "My Lord The Elephant" Major Dewey was "skippin’ about through the dust like a mosquito-worm in a tank”.
Mosquito curtains, mentioned in “A Conference Of The Powers”,(1890), and “My Own True Ghost Story”,(1888), had been in use for many years, not as an anti-malarial measure, but simply because of the nuisance and discomfort of mosquitoes and their bites.
In “His Majesty The King”, (1888), His Majesty tied a large knot in his mosquito-curtains to remind himself to ask Patsie to lend him her blue ribbon.
Mulvaney called Ortheris “a bloodthirsty little mosquito” in “On Greenhow Hill” (1890). Until 1912, the Indian Army did not issue mosquito nets to all soldiers - on grounds of expense - although some regiments found funds to do so and individuals who could afford to bought their own. [Source: Philip D Curtin, Death By Migration, Cambridge University Press, 1989, p.140]
When Kipling was a child in Bombay, he had mosquito-curtains around his cot at night. But he used to get up and untuck them to let in more air when the night was very hot. Then he would get bitten for the rest of the night. [Source: Bonar Sykes, “Memories of the Kiplings”, the Kipling Journal, Vol. 70, No.277, March 1996, p.42]
Getting wet or catching a chill seemed to predispose one to fever. In “The Taking Of Lungtungpen” (1887) fifty seasoned soldiers (as compared with the young recruits of the tale) wouldn’t have crossed the river because they’d know the risk of “fever and chill” and in The World Without (1888) Doone said he got fever from sleeping in quarters with a leaky roof.
Prevention of Fever
Mud and dampness were thought to have something to do with fevers. In “Judson And The Empire” (1893) Judson took his gun-boat to “a river full of the smell of fever and mud”.
In “The Knights Of The Joyous Venture” (1906), “Morning and evening a blue mist covered the mud, which bred fevers.”
In “In The Rukh” (1896) the men working in the Department of Woods and forests “experiment with battalions of foreign trees, and coax the blue gum to take root and, perhaps, dry up the Canal fever”.
Forest trees were thought to prevent the passage of malaria from one locality to another and it was thought advisable to plant trees between inhabited places and adjacent swamps and marshes. The Eucalyptus globulus, or Australian blue-gum tree, and the common sun-flower, were planted to absorb the damp of marshy places. [Source: William Moore, A Manual of Family Medicine and Hygiene for India, 6th edition, 1893, p.597.
A flannel wrapping or waist-band was often recommended to avoid chills.
In 1893 Kipling wrote to Alfred Baldwin : “In fever districts opium is much used as a guard against fever...”
Also in 1893 in “The Bridge Builders”, Findlayson knew opium was “at least a good guard against fever - the fever that was creeping upon him out of the mud....” According to William Moore’s Manual of Family Medicine & Hygeine For India, 6th edition, 1893, p.11 : “In malarious seasons or localities when the bowels are disturbed with a feverish condition of system, a combination of Dover’s powder and quinine is often very beneficial.” (Dover’s powder contains ipecacuanha powder and opium.)
Quinine is used to prevent and control overt attacks of malaria. It works by suppressing the asexual cycle of the development of the malaria parasite in red blood cells. It has no action on the tissue forms of the parasite and therefore does not prevent relapse of Plasmodium Vivax (the principal Indian plasmodium) infection. [Source: Martindale’s Extra Pharmacopoeia, The Pharmaceutical Press, 25th edition, 1967, p.1214.
Advice in the 1880s was that prophylactic quinine should be taken once or twice a day, during the malarious seasons, 2 or 3 grains every morning; or a larger dose, as 10 grains, taken previous to passing through a malarious locality. [Source: William Moore’s Manual of Family Medicine & Hygiene for India, 6th edition , 1893, p.596] In “The Story Of A King” (“The Smith Administration” - 1887), Bahadur Khan was given an ounce phial of cinchona febrifuge “to distribute against the fevers of September”. A preparation called Cinchona febrifuge was made at the Government cinchona plantations in India. It could be used in most cases when quinine was required. Sometimes it caused nausea when taken in large doses. [Source: William Moore, A Manual of Family Medicine and Hygiene for India, 6th edition, 1893]
In a letter to Margaret Burne-Jones in 1884, one of Kipling’s friends had fever “through sleeping in the thermantidote” and it took 50 grains of quinine in the day to “pull him through”. [Information from Thomas Pinney, editor, The Letters of Rudyard Kipling, Vol.1, p.67]
In “William The Conqueror”, Part 2, (1895) Scott was taking 30 grains of quinine a day, prophylactically, This was three times the usual amount. He experienced some of the signs of cinchonism: his head “ringing like a bell” and “the earth swayed under his feet”. Other symptoms of cinchonism include headache, nausea, abdominal pain, skin rashes and disturbed vision - this may have accounted for the fact that when he wrote “his hands grew large as pillows or small as peas at the ends of his wrists”. Treatment
In fever the balance between heat production and heat loss is adjusted to a higher level. First there is a diminution in heat loss (cold stage); later there is an increase in heat production (hot stage). [Source: William Boyd, A Textbook of Pathology, Lea & Febiger, 8th edition, 1973, p.58.
The great object was to shorten the cold and hot stages. The patient was put to bed and covered with blankets with hot bricks or hot water bottles at the feet. In the hot stage the patient was encouraged to drink cold water, to promote perspiration, and was sponged down with tepid water or vinegar and water. Scott, in “William the Conqueror” was covered with blankets and quilts and given a horrible stew of herbs and his servant Faiz Ullah “sweated him” for two nights and a day until the fever left him. When the patient started perspiring he would be “sweated’”even more by being kept well covered and given tea or cold water to drink, or in the case of Mrs Gadsby in “The Valley Of The Shadow”,(1888), by stopping the punkah at just the right time.
For a patient with fever 5,6,8, or even 10 grains of quinine were given every three hours or until singing in the ears, or noises in the head or partial deafness occurred when the quinine had to be stopped at once. [Source: William Moore, A Manual of Family Medicine & Hygiene for India, 6th edition 1893, p.226.]
Quinine was usually taken with sherry or mixed with water and lime juice. (According to the manufacturer’s label, modern tonic water contains not less than half a grain of quinine sulphate per pint).
As there was no quinine available in St.Paul’s time, in “The Church That Was At Antioch”,(1929), St.Paul was given lime juice and hot water and covered with a heavy travelling-fur, when he was suddenly struck down with “deadly Syrian malaria”. Possibly Kipling meant this malaria to be due to Plasmodium Falciparum which is more deadly than that due to Plasmodium Vivax.
Malaria may recur from time to time because the parasites hide in the spleen and bone-marrow and may emerge years later. As a result of long-continued infection, the spleen may become greatly enlarged (ague-cake spleen), and the children in malarial districts may have a pot-bellied appearance as a result. The enlarged spleen may be ruptured even by slight trauma and this used to be a favourite method of assassination in the crowded bazaars of the Orient. It may have accounted for the death of Boh da Thone in “The Ballad Of Boh da Thone” (1888). [Source: William Boyd, A Textbook of Pathology, Lea & Febiger, 8th edition, 1973, p.419 and 1166]
Kipling's own experience
In “The Tomb Of His Ancestors”, (1897) John Chinn was “fever-proof. A night’s sitting out in a damp valley, that would have filled the Major with a month’s malaria, had no effect on him. He was, as they said, “salted before he was born". It is now known that people with the tissue type HLA-B53 have a 40% lower chance of developing the more serious forms of malaria. Only 1% of Europeans possess this tissue type.[Information from The Times, 22 April, 1995] Kipling must have known or heard of someone who was apparently resistant to malaria.
In 1907, when Kipling was in Stockholm to receive the Nobel Prize for Literature, Charles Laveran was there to receive the Nobel Prize for Medicine, (for work on the part played by protozoa in the generation of disease). In a letter to Elsie and John Kipling said he was “a French doctor who had found out things about fever and sleeping sickness”. [Information from Thomas Pinney, editor, The Letters of Rudyard Kipling, Vol.3, p.286.]
In 1909, Kipling was in correspondence with Ronald Ross, at that time Professor in the Liverpool School of Tropical Medicine, about a proposed annual dinner for Nobel prizewinners. In a letter to Ronald Ross on 18 May 1909, Kipling apologises for not being able to “get up to you on the 21st.”. Kipling wanted to read Ross’s Malaria lecture in full and thanked Ross for thinking of sending it. This was probably Ross’s lecture on "The Campaign Against Malaria" delivered at the Royal Institution on 9th May 1909. [Information from Thomas Pinney, editor, The Letters of Rudyard Kipling, Vol.3, p.376 and notes 1 & 5, p.377.]
In a letter to Colonel Feilden in February 1912, Kipling said he had met a man from Lagos, who was Inspector of Works , PWD, Southern Nigerian secretariat, who told him “interesting things about blackwater fever and mosquito annihilation”. [Information from Thomas Pinney, editor, The Letters of Rudyard Kipling, Vol. 4, p.84.]
Blackwater fever appears to be an allergic response to reinfection with the parasite of malignant tertian malaria. Most people develop a certain degree of immunity, but a few become allergic. it is characterised by the passage of red or almost black urine. [Information from William Boyd, A Textbook of Pathology, Lea & Febiger, 8th edition,1973, p. 419.]
Typhoid Fever is caused by Salmonella bacilli of which there are several varieties, the most important of which is Salmonella Typhosa. The old name of 'Enteric Fever' comes from the days when it was believed to be just a disease affecting the intestine. The infection is spread in contaminated water, usually sewage, or in food or milk infected by the contaminated fingers of a nurse or typhoid carrier. It can also be dust-borne if the bacillus is fresh enough. A carrier is a person who has recovered from the illness, but still carries the bacilli, usually in the gall-bladder, where they may live for years, being excreted in the stools and sometimes in the urine.
Fever, headache, lethargy, and a clouding of the mind (typhus = a cloud) are symptoms caused by the endotoxin produced when the bacteria are broken down in the bloodstream. There is also severe intestinal ulceration leading to haemorrhage or perforation followed by peritonitis. [Information from A Textbook of Pathology, by William Boyd, Lea & Febiger, 8th edition, 1973, p.327-330.]
In “The Parting Of The Columns”, (1903), Kipling referred to “The same old saw-backed fever-chart” associated with typhoid. Many medical people had suspected for a long time that typhoid fever was water-borne and this was confirmed in 1880 by Karl Joseph Eberth.[Information from Death By Migration, by Philip D Curtin, Cambridge University Press, 1989.]
In a letter to Edith Macdonald in April 1884, Kipling was anxious for his Mother and Trix to go to Dalhousie as soon as possible because “measles, typhoid and smallpox among the natives in April are pretty certain to grow unpleasant in July and August”. [Information from Thomas Pinney, editor, The Letters of Rudyard Kipling, Vol.1, p. 61.] In December, 1891, Kipling’s friend, Wolcott Balestier, died of typhoid in Dresden.
In “By Word Of Mouth”(1887), Mrs Dumoise “went down” with typhoid and “five days were wasted” before her husband, the Civil Surgeon at Meridhi, “realised she was burning with something worse than simple fever, and three days more passed before he ventured to call on Mrs Shute the Engineer’s wife and timidly speak about his trouble”. With an epidemic of typhoid in the Station, Dumoise was up to his ears in work and worry and I don’t think he was in any way to blame for not realising what was wrong with his wife. The onset of typhoid is usually gradual with feelings of malaise, aching in the limbs, headache, loss of appetite and chilliness. But for some days the sufferer is able to go about thinking there is not much the matter. At about the end of the first week the patient takes to bed with fever and diarrhoea to add to the previous symptoms. The fever usually lasts about three weeks but sometimes considerably longer.
“Nearly every household in India knows that Doctors are very helpless in typhoid. The battle must be fought out between Death and the Nurses minute by minute and degree by degree.”Kipling was quite right. According to William Boyd, in his Introduction to Medical Science, H Kimpton, 2nd edition, 1941 , p.178 : “the treatment of typhoid fever is largely a matter of good nursing and it is much more important to have a good nurse than a good doctor”. The nurse’s duties were to prevent the spread of infection to herself and others, and the care of the patient. This consisted of temperature control with cold sponging, cold baths, cold packs; prevention of bed-sores; oral hygiene, and recognition of symptoms of perforation.
In “By Word Of Mouth”: “We had 7 cases of typhoid in the Station that winter and as the average of death is about one in every 5 cases....” According to William Moore’s Manual of Family Medicine and Hygiene for India, 6th edition , 1893, p.215 : ‘The mortality from typhoid fever is one in every six attacked’.
In “By Word Of Mouth”: “We wrestled with those typhoid cases for 56 days....”
In “William the Conqueror”: “William had survived six weeks of typhoid fever and had her head shaved (to help lower her temperature) before she was twenty-three.”
Typhoid fever usually lasts three weeks, but sometimes considerably longer. The incubation period for typhoid is 10-14 days. It can be very difficult to say when the fever began. [Information from Introduction to Medical Science, H Kimpton, 2nd edition, 1941, p. by William Boyd, 2nd edition, 1941, p.177.]
In “By Word Of Mouth” : “But just when we thought it was all over....little Mrs Dumoise got a relapse and died in a week.” According to Essentials Of Fever> by Gerald E Breen, E & S Livingstone, 2nd edition,1948, p.168-9: “Within a fortnight or so of defervescence, in, roughly one case in ten, the disease (typhoid) sets in anew, following usually a milder, though occasionally a more severe, course than the original attack.”
Typhoid in the Boer War
During the Boer War, while working on the staff of The Friend at Bloemfontein, Kipling helped to nurse the son of Julian Ralph, an American who represented The Daily Mail. They thought he had typhoid. The water supply had been cut off by the Boers. But they managed to get his temperature down from 103 F to 99 F by sponging him with some sort of alcohol, possibly surgical spirit. Then they got him into a hospital which was “rank with typhoid”. Apparently the boy had Veldt Fever and not typhoid. This was probably bacillary dyentery.
In “The Parting Of The Columns”, (1903), Kipling referred to “Bloemingtyphoidtein”. In Something Of Myself he estimated that there were eight thousand cases of typhoid in Bloemfontein. This was close to the official estimates. Mary Kingsley volunteered to help and was sent to nurse Boer prisoners at the new makeshift Palace Barracks Hospital at Simonstown. Kipling met her when she started work there. Most of the patients were suffering from typhoid; a few had measles and some had been wounded. The death rate was very high. She smoked,even when on duty, and drank wine in the evenings, in an attempt to ward off infection. But just six weeks after starting work there she knew she had typhoid. This caused an intestinal perforation requiring emergency surgery. She survived the operation, but died of heart failure two days later. She was thirty-seven years old. Kipling referred to her in “The Dirge Of The Dead Sisters”(1902), as “Her that fell at Simonstown in service on our foes”. [Information from A Voyager Out, by Catherine Frank, Corgi, 1988, p.320-1.]
After the Boer War, Henry Edward Leigh Canney, who took his MD in London in 1890 , campaigned for measures to prevent typhoid in armies. Kipling wrote to him in September 1903:
“Some years ago the average length of service among typhoid cases was 1 year 11 months; the majority of the dead being little over 22 years. You, of course, know how the curse of typhoid drops as men gets older till one arrives at what is more or less accurately called the “practically immune age”. (I fancy I must have reached it, because I drank stuff at Bloemfontein that ought to have poisoned me out of hand.)” [Information from Thomas Pinney, editor, The Letters of Rudyard Kipling, Vol.3, p.139-140.]In November 1908, in a letter to William Heinemann, Kipling wrote:
“I would see ever so many people damned before I inoculated myself for enteric. Have you seen men after the treatment ? I’ve watched a whole company of C.I.V.’s (City Imperial Volunteers seen in S Africa). besides you, like me, are over 40 and will not lightly catch disease....” Information from Thomas Pinney, editor, The Letters of Rudyard Kipling, Vol.3, p.345.The early inoculation against typhoid used on the C.I.V.’s during the Boer War must have had severe side effects, probably pyrexia, nausea and vomiting. The vaccine had been developed by Almoth Wright. When the Boer War started he was reluctantly given permission by the War Office to inoculate “such men as should voluntarily present themselves”. Only 14,628 volunteered for the vaccine out of a total of 328,244. Throughout the three year campaign there were nearly 58,000 cases of typhoid fever amongst the British troops, and there were 9,000 deaths. During the Great War soldiers benefited from Almroth Wright’s Typhoid Vaccine as it became the policy to vaccinate all troops being sent abroad. [Information from Irish Masters of Medicine by Davis Coakley, Town House, 1992, p.246.]
In 1916 the new typhoid-paratyphoid A + B Vaccine was introduced. As a result deaths from typhoid were only 1% of those during the Boer War. [Information from A History of Medicine, CD-ROM, Focus Essential, Flag Tower]. In "The New Army In Training" (1915), Kipling reported seeing a battalion from Bolton which had been innoculated for typhoid and “Consequently it wasn’t up to what it would be in a little time”.
Kipling’s idea of a “practically immune age”, and of not catching disease lightly after the age of forty, may be due to the fact that most people who had not succumbed to the disease by then may have had a sub-clinical infection,or been misdiagnosed. After the Rawalpindi Durbar in March 1885, Kipling went to Lahore and then to Simla where he had a bout of dysentery. This could have been typhoid as could the “touch of dysentery” he had in Yellowstone in 1889.
This is an acute inflammation of the colon (colitis), accompanied by frequent diarrhoea and the passage of blood, mucous and pus in the liquid stools. Two entirely different diseases are known by this name as a result of ancient usage. These are Bacillary dysentery, caused by the Shigella group of bacteria and Amoebic dysentery, caused by Entamoeba histolytica. [Information from A Textbook of Pathology, by William Boyd, Lea & Febiger, 8th edition, 1973, p.331.]
In 1859, living amoeba were discovered in the stools of infected patients. In 1875, Frederick Losch identified Entamoeba histolytica and showed its role in transmitting the disease from person to person. It wasn’t until 1898 that Kiyoshi Shigu of Japan isolated one of the bacteria that causes bacillary dysentery. [Information from Death By Migration, by Philip D Curtin, Cambridge University Press, 1989, p.149.]
Bacillary dysentery occurs in the tropics and anywhere men are crowded together under poor hygienic conditions. It may be of any grade of severity from symptomless to fatal. It is a great destroyer of armies in the field. Infection is acquired by eating contaminated food or water, just as in the case of typhoid. The infection may have come from a patient suffering from the disease or from a carrier. It is an acute infection, though of varying severity and may clear up in a week or two, or it may drag on for months. [Information from Introduction to Medical Science by William Boyd, H Kimpton, 2nd edition, 1941, p.179-180.]
Amoebic dysentery is also a disease of the tropics, though it may occur in temperate regions. It is spread from person to person, and by flies passing from infected material to food. The chief danger in cities is from food handlers who are chronic carriers and in whose stools the cysts may be found. The cysts may live outside the body for weeks or months in moisture and shade. Water supplies may also be infected.The disease is gradual in onset and more protracted in its course than bacillary dysentery, sometimes lasting months or years. [Information from A Textbook of Pathology, by William Boyd, Lea & Febiger, 8th edition, 1973.]
In “The Taking Of Lungtungpen”, (1887) Mulvaney was invalided to India with dysentery shortly after Lungtungpen was taken. If he was infected during the taking of Lungtungpen he may have had bacillary rather than amoebic dysentery because the incubation period for amoebic dysentery is 10 to 90 days.
In “The Drums Of The Fore And Aft” (1888) “the Fore and Aft studied animalculae in water, and developed a few cases of dysentery in their study”. The cysts of entamoeba histolytica found in infected water are 5 to 20 microns in diameter. (A micron is one thousanth part of a millimetre.) [Information from Gould’s Medical Dictionary, Lewis, 4th edition, 1935.] The 'Fore and Aft' must have been using a microscope. They could have been infected with either type of dysentery from the water.
Treatment of dysentery
Ipecac, derived from the root of a Brazilian plant, was used to treat some of the dysenteries. It had been known since the seventeenth century. By the 1830s it was used in a variety of medicines, often combined with calomel and opium. Information from Death By Migration, by Philip D Curtin, Cambridge University Press, 1989, p.149.
This occurs in “Brother Square-Toes”, (1910), as “ship’s fever”. It is caused by Rickettsia Prowazeki which, when carried by the body louse, can cause epidemics in time of war or famine, or whenever people are crowded together in squalid conditions with little or no personal hygiene. It has also been called “famine fever” and “gaol fever”. The onset of the disease is acute, with high fever, great weakness and prostration, a rash and then great mental apathy which may pass into stupor. There may be necrosis of the skin. [Information from A Textbook of Pathology, by William Boyd, Lea & Febiger, 8th edition, 1973, p.395-6.]
In “Brother Square-Toes”, Pharaoh Lee was treated with “bleeding and pills” and he “didn’t remember much of any account for the next few weeks.” The word “typhus”, which implies a confused or clouded state of mind, was formerly applied to both enteric and typhus when these two diseases were erroneously regarded as one. When they were separated, enteric was renamed typhoid, or the typhus-like fever. [Information from Essentials of Fevers, by Gerald E Breen, E&S Livingstone, 2nd edition, 1948, p.318-9.]
In “The Trouble Of Curtis Who Lodged In The Basement” (!882), (Andrew Rutherford, editor, Early Verse) the woman who died could have had either typhoid or typhus. But she appears to have died rather quickly for either.
I wonder why she went so fast.In “New Brooms”,(1888), Kipling said “there was typhus among the women in the zenana,....” The illness appears to have originated from mud “scooped from a green and smelly tank”, and was water-borne. Kipling must have used typhus as the old sense of the word, whereas nowadays it would, in this case, be called typhoid.
This is also known as “Breakbone Fever” because “one feels as if every bone in one’s body is breaking”. It is caused by a virus carried by the Aedes Aegypti mosquito (the carrier of the yellow fever virus). Attacks are rarely fatal. In Kim the Kulu woman and a cousin treat Kim’s “heavy dengue-aches” with massage. [Information from The Geography of Life and Death, by L Dudley Stamp, Fontana Library, 1964, p.43.]
This is 'African Sleeping Sickness'. In “The Knights Of The Joyous Venture” (1906), Witta’s ship sailed along the coast of West Africa. When they came to the Forest in the Sea, they lost the sun.
The water was foul, and great glittering flies tormented us. Morning and evening a blue mist covered the mud, which bred fevers. Four of our rowers sickened, and were bound to their benches, lest they should leap overboard and be eaten by the monsters of the mud. The Yellow man lay sick beside the Wise Iron, rolling his head and talking in his own tongue.Human Trypanosomiasis (Africal Sleeping Sickness) is caused by Trypanosoma gambiense, and is carried by the tsetse fly, Glossina Palpalis. The disease may be of relatively short duration, a few months, or may be very chronic and continue for years. The signs and symptoms vary with the severity of the disease. They include fever, rashes, glandular enlargement, and when the central nervous system becomes involved, severe headaches, lethargy, coma and death. [Information from DB Blacklock and T Southwell, A Guide to Human Parasitology, H K Lewis, 1948, p.62.] Tsetse flies are approximately 2cm long, brownish, with banding or other markings. Both sexes are active blood suckers on humans and animals. Between 1896 and 1906 trypanosomiasis killed half a million people in the Congo, and over a quarter of a million around the shores of Lake Victoria. This aroused a lot of public interest in the disease. [Information from Roy Porter, The Greatest Benefit To Mankind, Fontana Press, 1999, p.476-7.]
It is interesting that among Kipling’s medical books, he had A Monograph on the Tsetse Flies, by E.E.Austen, published by The British Museum of Natural History, 1903. [Information from Geoffrey Down, Curator, The Royal Australasian College of Surgeons.]
This is mentioned in “The Phantom Rickshaw” (1885). It is a complication of a streptococcal throat infection, characterised by a widespread inflammatory reaction of the fibrous tissue of the joints, the heart and other organs. It has been said that “rheumatism is a disease that licks the joints, but bites the heart”. [Information from A Textbook of Pathology, by William Boyd, Lea & Febiger, 8th edition, 1973, p.319.]
In “The Phantom Rickshaw”, Rickett, the man who got rheumatic fever, and stayed six weeks instead of two nights, would have had intensely painful joint swellings and a high fever preceeded by a sore throat. During the acute illness there may be no evidence of any cardiac lesion, but months or years later, symptoms of these lesions may appear. The heart valves and the heart muscle are affected and these lesions are much more serious than the joint lesions. Prolonged bed rest was essential to give the affected heart every chance of recovering as much as possible. Hence the reason for Rickett staying six weeks instead of two nights. [nformation from Introduction to Medical Science, by William Boyd, H.Kimpton, 2nd edition, 1941, p.79.]
In “A Friend Of The Family” (1924), Bevin got trench fever: “that nice taste in the mouth and the nice temperature they call trench-fever, an’ I had to feel inside my head for the meanin’ of every order I gave or was responsible for executin’ ”. 'Trench Fever' was the commonest of all the diseases affecting troops in France in the Great War. It is due to a rickettsia carried by the body louse and is an acute febrile illness characterised by great prostration, severe pain in the muscles and bones (shin bone fever), and recurring attacks of fever often at intervals of 5 or 6 days. Sometimes there is a rash. The organisms are present in large numbers in the excreta of the louse. Infection is due either to bites or to excreta being rubbed into scratches and abrasions. Mortality is so low that nothing is known of the lesions caused by the disease in man.[Information from A Textbook of Pathology, by William Boyd, Lea & Febiger, 8th edition, 1973, p.398.]
This occurs in “Brother Square-Toes” (1910). There was a terrible outbreak of this disease in Philadelphia in 1793, resulting in 4,000 deaths. The chief symptoms are fever, vomiting, diarrhoea and intense jaundice, so that the skin turns yellow. In epidemics there is a mortality of 80%. If the patient recovers he has a lifelong immunity.
In the story, the yellow fever in Philadelphia was so dreadful that everyone was running away. But Apothecary Tobias Hirte, “the famous Seneca Oil man ... went down to the City and bled ’em well again in heaps”. It seems likely that Tobias Hirte was based on Dr Benjamin Rush, (c.1745-1813), the first American doctor to achieve an international reputation. He was also a politician who had signed the Declaration of Independence. He graduated from the College of New Jersey at Princeton in 1760 and later took a medical degree at the University of Edinburgh. At his home, between the 8th and 15th September 1793, he bled 100-120 patients a day, and turned away 50-60. He also advocated purging with calomel and jalop. (Tobias Hirte had bottles of calomel and senna.) At one time Dr Rush decided to investigate the desirability of admitting Indian remedies to the pharmacopoeia, but concluded that “we have no discoveries in the materia medica to hope for from the Indians of North America”.
At the Annual meeting of the American Medical Association in 1896, Sir William Osler gave an address on "The Study of Fevers of the South" in which he recalled the confusion that existed in the days of Benjamin Rush, “who ....claimed there was but one fever - that all were correlated - that under different conditions yellow fever, malaria, typhus, and so on, could pass into one another....” . Seneca Oil was, in fact, crude oil skimmed from the surface of water near Lake Seneca and used for rheumatism, coughs, burns, sprains, etc.
[Information from: Roy Porter, The Greatest Benefit To Mankind, Fontana Press, 1999, p.300; William Boyd, Introduction to Medical Science, H Kimpton, 2nd edition, 1941, p.108; Art Newman, The Illustrated History of Medical Curiosa, McGraw Hill,1988, p.45; Annual Report of the Smithsonian Institution, 1941, p.522; Harvey Cushing, The Life of Sir William Osler, Oxford University Press, 1940, p.435; Chambers’s Encyclopaedia, 1959, Vol X, p.619.]
Two of Kipling’s stories are about diphtheria, “A Second Rate Woman” (1888), and “A Little Prep”(1899), and it is mentioned in: “The Record of Badalia Herodsfoot”(1890), and “An Habitation Enforced”(1905).
In 1826 Pierre-Fidele Bretonneau distinguished it as a specific disease and coined the word diphtherie from the Greek for leather. In 1883, Theodor Albrecht Klebs isolated and described the diphtheria bacillus, Corynebacterium diphtheriae. [Information from Roy Porter, The Greatest Benefit to Mankind, Fontana Press, 1999, p.438.]
Diphtheria is spread by droplet infection from carriers, occasionally from infected dust. In an unprotected population it is likely to be seen between the ages of two and five, being rare after the age of 15, immunity being established by then through repeated attacks of low virulence. The onset is marked by fever, chills and malaise, and a sore throat. The diphtheria bacillus remains on the surface of the throat and produces a powerful toxin which kills the cells with which it comes in contact. The dead cells are bound together by threads of fibrin to form the tough leathery layer known as the false membrane. The exotoxin produced can lead to death from heart failure about a week after the development of the throat symptoms. And some weeks later there may be neurological symptoms. [Information from William Boyd, A Textbook of Pathology, Lea & Febiger, 8th edition, 1973, p.334.]
In the 1880s when “A Second-Rate Woman” was written, although it was known that diphtheria spread by infection, it was also thought that “the poison itself (diphtheria) is believed to be intimately connected with, if not to arise in, stagnant pools, foul drains, sewage or privies.” Bad sanitary conditions and poor ventilation were thought to have a lot to do with it. [Information from William Moore, A Manual of Family Medicine & Hygiene for India, 6th edition 1893, p.153.]
In “A Second-Rate Woman” Dora Bent contracts diphtheria. Kipling said she was a baby, but 85% of nursing babies have natural immunity which disappears after 8 months, so she was probably older than this. [Information from William Boyd, Introduction to Medical Science, H Kimpton, 2nd edition, 1941, p.84.] The child was removed from the hotel where her family were staying, but whether this was because the hotel manager wanted them to leave, or whether it was on the advice of the doctor, we are not told. Part of the treatment would have been to put her in a well ventilated room, isolated from the rest of the family, where she would have complete quiet and rest, to preserve her strength.
The Doctor was extremely worried about the child and called three times in 24 hours. We are told the house reeked of Condy’s Fluid, chlorine water and carbolic acid washes. This was to prevent the spread of infection. The child was made to inhale steam. This makes sense as warm moist air is easier to inhale and is still used in the treatment of croup. On the doctor's last visit to the child before he went to the dance at the Viceregal Lodge, Dora was again steamed and at that time “there was no sign of the membrane getting to the air passages”. At the dance he told Mrs Delville about his concern for the child. It must have been the general weakness (due to the exotoxin possibly causing heart failure) that he particularly feared at that time.
Mrs Delville left the dance and went directly to Mrs Hauksbee’s house where she found Dora about to suffocate, and her mother and Mrs Hauksbee too panic-stricken to do anything. She immediately demanded a bottle of caustic, and with this she burnt the membrane blocking the passage of air. This was an extremely dangerous procedure. If she had dropped the caustic anywhere other than on the membrane the result could have been fatal. After six weeks at Mrs Hauksbee’s house Dora had not developed any complications and was able to return to the hotel with her mother. Mrs Delville’s son had died of diphtheria, presumably of suffocation, due to a false membrane. (I have found no mention in the medical literature of the use of caustic to burn the membrane, but Kipling must have heard of someone in desperate straits who resorted to it).
In “A Little Prep” in Stalky & Co. (1899) Stettson Major, a day boy at the school, contracts diphtheria. The source of infection is traced to an outlying farmhouse. There are no other cases in the school. The Head has gone to stay at the boy’s house, and when the boy’s condition deteriorates one night, he is on hand, and in time, to push a tube through the false membrane and suck out the mucous secretions gathering on it. The doctor in the story thinks the Head ought to get diphtheria himself after doing this. As he didn’t succumb, he was probably immune through repeated attacks of low virulence.
Intubation - pushing a tube through the membrane to prevent suffocation - was first described in 1895, four years before the publication of “A Little Prep”. Prior to that, tracheostomy, inserting a tube from the outside to below the blockage, was sometimes advocated.
In July 1888, Kipling’s mother had a very sore throat for a few days which was diagnosed as tonsillitis brought on by “low condition”, but Kipling and Trix were fearful of diphtheria. [Information from the Thomas Pinney, editor, The Letters of Rudyard Kipling, Vol.1, p.231-2.]
In January 1900 Carrie Kipling got a sore throat “which for a while (an agitated and hectic while) we thought might be diphtheria”. They had to get a nurse for her and send the children to stay with “Aunt Georgy”, across the Green, at Rottingdean. [Information from Thomas Pinney, editor, The Letters of Rudyard Kipling, Vol.3 p.10.]
This is an acute infectious fever characterised by the formation of pocks or pustules in the skin. It is extremely contagious, the infection being conveyed by the discharge from the lesions and by the crusts that form on them. Anything that comes in contact with these may be infectious. The virus can also be carried on particles of dust from the scabs. The incubation period is 10-12 days. A person who survives smallpox infection is permanently immune to further attacks. The live virus of cow-pox (vaccinia) is used for vaccination against smallpox.
Mrs Hauksbee, in “A Second-Rate Woman”, (1888), was afraid of “nothing in the world except smallpox. Diphtheria kills but it doesn’t disfigure.”
In “The Light That Failed” (1890), Kipling wrote; “Vincent caught smallpox in Cairo, carried it here (to London), and died of it.” His fellow travellers on the way from Cairo to London may have escaped contracting the disease from him if he had not developed pocks before they separated in London. But they may have also have been infected in Cairo from the same source. Those he met in London, and those caring for him during the illness, would have been much more likely to contract the disease from him, unless they had already had smallpox or cow-pox themselves, in which case they would have a lifelong immunity.
In “New Brooms”,(1888), the Faquir, Ari Booj, who had come “all the way from Delhi, and had slept on no less than fifteen different charpoys”, was just recovering from smallpox and infected many, including Eshmith Sahib’s Dhobi, who “sent home a beautiful sample among the Sunday shirts”, leading to the death of Eshmith Sahib.
Smallpox vaccine is made by inoculating the skin of healthy animals, usually calves, with vaccinia (cow-pox) virus. Lesions form at the sites of innoculation. The fluid obtained from these lesions is called ‘vaccine lymph’. [Information from Martindale’s Extra Pharmacopoeia, The Pharmaceutical Press, 25th edition, 1967, p.1481.]
The method of vaccination is as follows: Usually a small area of skin on the upper arm is scratched with a lancet and a small amount of vaccine lymph applied to the scratched area. Results of the vaccination are known as “takes”.In a person who had no immunity to smallpox until vaccinated, the “take” will appear as a small red papule which over the course of several days turns into a vesicle and then into a pustule. A crust forms on this which falls off in about three weeks to leave a shining red scar.
In “Their Lawful Occasions”, (1903), Emmanuel Pyecroft and other crew members of the torpedo boat No.267, are involved on naval manoeuvres and paint markings on the sides of two first-class cruisers, HMS Devolution and HMS Cryptic to indicate these ships have been hit by torpedoes. Pyecroft took the Narrator with him because he wanted him “for prima facie evidence, in case the vaccination don’t take”. And when about to paint similar marks on HMS Devolution, Pyecroft tells his helper, Alf, who would have been wielding the lancet if they’d really been vaccinating people, to “....rub along, Alf, I’ve got the lymph !” Then when Mr Moorshed enquired how they’d got on, Pyecroft answered “Vaccination aint in it. She’s took beautiful.”
But there were many problems with smallpox vaccination in India. Following successful vaccination, relative immunity develops within 8 days and lasts 5 to 7 years. But in areas of recurrent epidemics annual vaccination may be necessary to maintain protective immunity. Kim was re-vaccinated at school when he was 14 years and ten months old. So presumably there had been another typhoid epidemic at Lucknow. [Information from The Merck Manual, Merck, Sharp & Dohme, 11th edition, 1966, p.7440.]
Vaccine made from calf lymph was introduced on an experimental basis in Bombay in the late 1850s. Initially there was considerable opposition from the Hindu population who saw this as a violation of their sacred animal. But the only other method of vaccination was arm to arm vaccination which Hindus objected to when the lymph was taken from the arms of low caste children. [Information from Mark Harrison, Public Health in British India, Cambridge University Press, 1994, p.85.]
The smallpox deity, Sitala, mentioned in “The Bridge-Builders” (1893), and in “The Miracle of Purun Bhagat” (1894), was honoured each year at festivals throughout the country. Cow-pox was non-existent in India and calf lymph was not manufactured there until after 1860. There were also problems with calf lymph. To retain its potency for a year it should be stored in the dark, at -10 C to -20 C. This would have been extremely difficult in the India Kipling knew and is the reason why the Mahratta State-educated vaccinator in “The Tomb Of His Ancestors”(1897), had to bring an officially registered calf with him when he went to vaccinate the Satpura Bhils. [Information from Martindale’s Extra Pharmacopoeia, The Pharmaceutical Press, 25th edition, 1967, p.1481.]
In a letter to Mrs Hill, July 1888, Kipling was ‘suffering from all the agonies of a vaccinated arm'. A few days later he wrote: “My arm has begun to take already and oh how I detest the Black Baby to whom I am indebted for my torments.....Don’t believe that a calf would have hurt half so much.” Following this experience Kipling wrote “Little Tobrah”, about a boy whose parents died of smallpox and whose sister was blinded by it. [Information from Thomas Pinney, editor, The Letters of Rudyard Kipling, Vol.1, p.250 & 253.]
In a letter to Margaret Mackail, 11-14 February 1889, from Allahabad, Kipling said smallpox was “raging round the station and knocking over good men left and right”. His assistant on the Pioneer contracted it, as did a doctor, a barrister, a chaplain, and two or three other men in the club were “feverish and headachy” and probably also infected. [Information from Thomas Pinney, The Letters of Rudyard Kipling, Vol.1., p.285 & 287.]
In a letter to Mrs Hill, 21 February 1889, from Lahore, Kipling said there had been a “vaccination panic ... all Lahore took off its shirtsleeves and ran with one accord for the fatted calf.” [Information from Thomas Pinney, The Letters of Rudyard Kipling, Vol.1., p.292.]
In a letter to Anna Smith Balestier, 26 November 1908, Kipling commented:
“And talking about diseases - you seem to be having a thoroughly gay time at Brattleboro - twenty cases of smallpox, masquerading as chicken-pox - with the possibility of its having been loose and at large for two months - is something awful. I’m sure it would never have happened if dear old Conland had been alive.I only hope the cold weather will keep it within bounds - but how on earth, and why on earth it was not diagnosed before, altogether beats me !” [Information from Thomas Pinney, The Letters of Rudyard Kipling, Vol.3, p.349.]Plague
This is caused by the bacillus Pasteurella Pestis. It cannot exist outside the body except in the stomach of the flea. When a rat dies the infected fleas leave the cooling body to seek a new food supply. If man is available, the flea will bite and infect him. A human epidemic is accompanied or preceded by a rat epidemic. There are two forms of plague, bubonic and pneumonic, depending on the method of infection. In the bubonic, the bacteria spread from the flea-bite to the axillary and inguinal lymph nodes which enlarge, suppurate and form the ‘buboes’. The internal organs are also infected with abscess formation and toxic changes. Death occurs from overwhelming septicaemia. In the pneumonic form infection is spread by tiny droplets of sputum. There are no buboes. The patient is overwhelmed by one of the most deadly and rapidly fatal of all infections with a mortality, without treatment, of one hundred percent. [Information from William Boyd, A Textbook of Pathology, Lea & Febiger, 8th edition, 1973, p.365.]
The victims of plague suffer from lassitude, shivering, vomiting, and a heavy stupid expression of countenance, with redness of the eyes. Then high “fever”, and darting pains in groins and armpits where large boils quickly form in the glands. There is also often an eruption of mulberry-coloured spots or watery blisters on the body. Profuse perspiration is regarded as favourable....The conditions under which plague arises are: a warm moist atmosphere; low-lying alluvial soil, near the banks of rivers: crowded or badly ventilated dwellings: putrescent emanations from decaying animal or vegetable matters, and insufficient or unwholesome food. Treatment consists of affording a pure atmosphere, light but nourishing food, with stimulants. [Information from William Moore, A Manual of Family Medicine and Hygiene for India, 6th edition 1893, p.306.]
In “A Doctor Of Medicine”(1909), set in 1643, just after the first battle of Newbury, Nicholas Culpeper was captured by the Cavaliers, having been wounded in the chest by a musket shot. [Information from Christine Stockwell, Wakehurst Place, The Culpepper Connection, printed by Royal Botanic Gardens, Kew, p. 17.] He had been looking after some victims of plague and was gathering betony from the side of a stream when he was caught. (Betony is not one of the herbs advocated by Culpeper in his Herbal for treating plague, but he did suggest it for “bruises or hurts, whether inward or outward”). [Information from Nicholas Culpepper, Culpepper’s Complete Herbal, Foulsham, p. 46.]
Fear of the plague makes Colonel Blagg throw Culpeper and Jack Marget out of his camp. It also isolates the plague-stricken village in Sussex, forcing the inhabitants to put out a plague stone. Culpeper initially blames the lack of sunshine and the situation of the mills beside the river for the plague. Both these factors were thought to be predisposing causes of plague in Kipling’s time. And his treatment - fresh air and stimulants- are as prescribed by William Moore in the late eighteen hundreds. [Information from William Moore, A Manual of Family Medicine and Hygiene for India, 6th edition 1893, p.306.]
Later, having watched three rats die in the moonlight, Culpeper using his knowledge of Astrology, blames the Moon for the plague, and decides the rats in the village will have to be destroyed. In a letter to Colonel Feilden in 1910, Kipling recalls seeing a “hideous old, puffy scabby whitish rat”, climbing a fig tree in the garden of the Woolsack in 1901, when there was an outbreak of plague in Cape Town. Apparently that rat gave him the idea for the “Culpeper yarn”. He continues: “I admit the natural history of Mus rattus and decumanus and descendants but, white, sir, white is the color of the Plague-stricken rat in my mind.” [Information from Thomas Pinney, editor, The Letters of Rudyard Kipling, Vol.3, p.445.]
Some believe that plague was absent from Europe for eight hundred years after the plague of Justinian (A.D.542-3.[Information from Roy Porter, The Greatest Benefit to Mankind, Fontana Press, 1999, p.122] Kipling is not one of them. In “The Treasure And The Law”(1906), set at the time of Magna Carta (1215), Kadmiel the Jew is suspected of poisoning the common well of Pevensey Castle and thus causing plague among the occupants. During the Black Death, 1347-51, there was much persecution of Jews who were accused of poisoning the wells. [Information from Roy Porter, The Greatest Benefit to Mankind, Fontana Press, 1999, p.125]
This occurs in “The Eye Of Allah”(1926), where “a type of spotted fever was baffling them both in England and abroad”. Cerebrospinal Fever, caused by a meningococcus, sometimes occurs in epidemic form. Usually it is accompanied by a purpuric rash, responsible for the title of “Spotted Fever”. There may be periodic spike-like rises in the temperature - pyrexial “crises”, lasting 24 hours or less. [Information from Arthur H Douthwaite, editor, French’s Index of Differential Diagnosis, published by John Wright, 7th edition, 1954, p.667 and 718]