[November 19 2013]
Before Robert Koch isolated the tubercle bacillus in 1882, tuberculosis, especially pulmonary tuberculosis was known as consumption. During the nineteenth century nineteen million people died on battlefields but tuberculosis was responsible for the death of thirty-four millions. The pulmonary form accounted for 85-90 per cent of all deaths from tuberculosis. [Boyd, William, An Introduction to Medical Science, H Kimpton, 2nd edition, 1941, p.91.] As it was such a common cause of death during Kipling’s lifetime, it is not surprising that it turns up in several of his stories.
In his book called The Life and Death of Mr Badman, John Bunyan called consumption ‘The Captain of the Men of Death'. At the British Congress on Tuberculosis in 1901, Sir William Osler, a friend of Kipling’s, recalled Bunyan’s description of consumption as the ‘captain of the men of death’; the captain, he said had been reduced to a lieutenant and would soon be brought down to an ensign and from thence to the ranks. But finally to drum him out of the regiment was too much to expect. [British Medical Journal 2:205, 1901.]
Tuberculosis is characterised by fever, night sweats, and haemoptysis (coughing up blood). It was called ‘consumption’ because those affected were almost literally consumed by the disease.
In most cases the natural defensive powers of the body prevent tuberculous infection taking hold. But these defences may be broken down by several different factors. A fresh dose of tubercle bacilli, or a viral infection such as influenza may be responsible. Also, various stresses such as overwork, malnutrition, and the poor hygienic conditions associated with overcrowding can all play a part. At the beginning of the twentieth century almost the entire adult population of large cities was positive to the tuberculin test indicating that, at some time, they had all been infected. Under the age of five years the disease was common and could progress rapidly to death. Then it declined until late adolescence. In women it was most common between the ages of 20 and 25 and in men between 40 and 45, especially in alcoholics. It took a more chronic form in adults than in children. [Boyd, William, A Textbook of Pathology, Lea & Febiger, 8th Edition, 1973, p.337]
Pulmonary infection occurs by inhalation of the tubercle bacilli in the expectorated sputum of a person with pulmonary tuberculosis.
In ‘A Child’s Garden’, (1919), Kipling writes:
Now there is nothing wrong with meBefore the advent of suitable antibiotics, after the Second World War, the treatment of consumption consisted of physical and mental rest, fresh air, good food, and freedom from worry. [Boyd, William, An Introduction to Medical Science, p. 93.] Those who could afford to went abroad to warmer, drier climes hoping to halt the progression of the disease.
In "Judson and the Empire", in Many Inventions (1893), Kipling mentions ‘the consumptive invalids of Madeira’.
In "A Bank Fraud", in Plain Tales From The Hills (1887), Silas Riley’s father arranges a job in India for his son, hoping the warmer climate will help his lung condition. But the condition develops slowly so the rate of production of symptoms is also slow and hence the chronic nature of the condition. [Boyd , p.336.] Riley has several periods of illness after his arrival in India. He finally takes to his bed and stays there until his death five months later. He had said 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 the formation of cavities in the affected part.
In "On Greenhow Hill" in Life‘s Handicap (1890), Liza Roantree and her father are poor and when the doctor tells them that Greenhow air is ‘too keen’ for her, she is taken to Bradford, to live with her uncle, a mill-worker, in ‘a long street o’little houses’. But even there her condition gradually deteriorates and she eventually dies.
In "Marklake Witches", Rewards And Fairies, (1910), a story set in the early nineteenth century, Rene Theophile Hyacinthe Laennec, the inventor of the stethoscope, is a prisoner of war in England. (In reality, Laennec was never a prisoner of war.) Philadelphia, the squire’s daughter in the story, is suffering from consumption. Kipling takes great care in describing her - a thin pale girl, with delicate shiny little finger nails, who is always slightly breathless, and has a cough, and develops a ‘stitch’ in her side when she tries to dance. In a letter to Sir Andrew Macphail, 25 June, 1910, Kipling mentions that Macphail had told him about ‘the consumptive girl’s delicate nails’. [Pinney, Thomas, (Ed.), The Letters of Rudyard Kipling, Macmillan, 1996, Vol.3, p.441.]
The local doctor, Dr Break, is unable to help her. But Jerry Gamm, who is called ‘The Witchmaster on the Green’ cures people with herbs and charms when Dr Break has ‘given them up’. Laennec, although a prisoner, has a considerable amount of freedom. He wants to try out his ‘little trumpets’, as he calls his stethoscopes. Dr Break distrusts him and his newfangled ideas. So Laennec takes them to Jerry Gamm who has a much more open mind. He listens to Laennec’s chest with the stetheoscope and hears, what sounds to him, like the breath sounds of a consumptive patient - ‘like breakers on a reef’. He explains this to Laennec, who already has a very good idea of what is wrong with him. Laennec replies:
‘I drive on the breakers. But before I strike, I shall save hundreds, thousands, millions, perhaps by my little trumpets.’Laennec’s invention of the stethoscope was certainly a colossal advancement in physical examination, and hence in diagnosis, but actually did nothing to treat the patient. In real life Laennec suffered from a chest complaint, probably consumption, from which he died in 1826.
Jerry Gamm, in Kipling’s story, realises the benefits of regular breathing exercises for those with consumption. Over the centuries people have come to rely on spells and magic as well as prayer to cure disease. They would not have accepted the fact that simple breathing exercises alone could be beneficial. So Jerry gives Philadelphia a stick of maple, ‘ the warmest tree in the wood’, to prop her window open. It is 16 inches long, an inch for every year of her life, and she is to keep her window open with it whatever the weather. He tells her he has said words over it which will have ‘virtue on your complaints’. He instructs her to stand by the open window and say the names of the Twelve Apostles, inhaling deeply between each one, five times a day, fasting, as ‘there’s virtue for your cough in those names spoke that way’. Both Gamm and Laennec think her condition reasonably stable, but expect her to deteriorate in time.
Apparently Laennec never tries his stethoscope on Philadelphia. It would probably have been unseemly to try it on a lady. But Jerry Gamm tries it on several of his patients, and has quite a lot to answer for as a result. They call the stethoscopes ‘the devil’s ear-piece’ and say it leaves ‘round red witch-marks on peoples’ skins, and dries up their lights and makes ’em spit blood, and throws ’em into sweats….’ Coughing up blood and sweating could both have been symptoms of consumption.
According to Dr Break, the locals think Jerry has been ‘impudently prying into God’s secrets by means of some papistical contrivance’ - Laennec’s stethoscopes. This is very similar to the ideas and fears of the Abbot in "The Eye Of Allah", (1926), Debits And Credits, a story set in the Middle Ages.
In this story one of the monks brings an early microscope back from Spain. Several of the monks look through it and see various minute organisms in a drop of water. But the Abbot fears the microscope is too revolutionary for their times, that the world is not ready for it. The discovery that they have a microscope which they were using for ideas to illuminate manuscripts might lead to them all being burnt at the stake. He destroys it.
In "Teem, A Treasure-Hunter", an ‘uncollected’story in Vol XXX of the Sussex edition, (1935), a French truffle-hunting dog, Teem, is accidentally brought to England, and is befriended and adopted by a poor charcoal-burner whose daughter has tuberculosis. She sleeps on a cot in the open air at night. Two officious women are keen to have her removed to a sanatorium. Teem starts finding truffles. When the value of the truffles is appreciated and the charcoal-burner finds he can sell them, there is money to buy good food and ‘an outside bed-house’, and medical attention for his daughter. She is apparently recovering, or, at least the disease is not progressing. As Teem puts it ‘the Taint of her distemper diminishes’.
In "Wireless" in Traffics And Discoveries, (1902), Mr Shaynor, the pharmacist’s assistant, is very ill with consumption and Mr Cashell the pharmacist expects him to die within the year. He has a persistent cough and is bringing up blood in the sputum. He is easily exhausted and is liable to fall asleep in a chair. He tries out various things to relieve the cough such as asthma cigarettes and pastilles. He finds ‘Blaudett’s Cathedral Pastilles’ relieve the cough ‘as much as anything’. These are 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). The Narrator, looking after the shop for a few minutes, while Mr Shaynor goes for a walk with his girlfriend, makes up a drink containing cardamoms, ground ginger, chloric ether and dilute alcohol. He drinks a glass of it as does young Mr Cashell, the pharmacist’s nephew. Neither of them are affected in any way by it. Mr Shaynor, on returning, also drinks it. They light some benzoic pastilles. Shaynor writes a letter and then has another glass of the concoction.
Young Mr Cashell is experimenting with a very early wireless in the back room, hoping to pick up a message through the airwaves, broadcast from Poole. However, it is Mr Shaynor who is affected by some mysterious transmission. After his second glass of the concoction he goes into a trance in which the Narrator watches him compose some poetry. With a little difficulty getting things to rhyme, he produces verses which are recognised by the Narrator as coming from Keats’s poem ‘The Eve of St. Agnes’. When he wakes up he doesn’t remember anything about it, and says he isn’t interested in poetry and doesn’t know anything about Keats.
Kipling is suggesting in this story that while young Mr Cashel is trying to pick up a radio transmission, having fixed an ‘installation pole’ to the roof of the house, and inadvertently electrifying the water in the taps, Shaynor himself is the receiver of a poetic transmission reminiscent of the work of John Keats, who had died of consumption in 1821. From one of the lines of verse ‘re-invented’ by Shaynor while in the trance:
‘And lucent syrups tinct with cinnamon’it is obvious to Shaynor that Keats had been a ‘druggist’. And he is correct. When Keats was orphaned at the age of 15, he was apprenticed to a surgeon in Edmonton. In 1816 he became a dresser at Guy’s Hospital and later qualified as a surgeon. It is likely that he had contracted consumption from his mother, who died in 1810. The disease remained relatively quiescent for several years until he went on an extensive walking holiday taking in the English Lake District, the Western Highlands of Scotland and ascending Ben Nevis. On doctor’s orders he cut short this holiday and went home only to find his brother, Tom, extremely ill. After Tom’s death he moved into the house of his friend Charles Armitage Brown. While staying there he fell in love with Fanny Brawne the daughter of a neighbour, and wrote ‘The Eve of St. Agnes’. (When Shaynor goes out for a walk with his girlfriend, Fanny Brand, they go by St Agnes’s Church.) By 1820 Keats knew he was dying. In a final attempt to improve his health he sailed for Naples. He died in 1823 at the age of 25 and was buried in the Protestant cemetery in Rome.
We are never told Shaynor’s age. His employer, Mr Cashell, is in bed with influenza, and there is a lot of influenza in the town. Shaynor expects at least a dozen prescriptions to come in that night. The weather is bitterly cold. Shaynor is coughing almost continuously and coughing up blood. The effort of coughing is very exhausting. Mr Cashell expects Shaynor to be dead within the year. But with the cold weather and his debilitated condition, Shaynor will have been very susceptible to the influenza that has knocked out his employer, and may be only days away from death at the time of the story.
It is interesting that Shaynor is allowed to go on working and making up prescriptions when he has such a bad cough and is obviously very ill. Young Mr Cashell - we never learn his occupation - is not concerned in the least. To him Shaynor seems to be just another unfortunate consumptive. There wasn’t any law to stop Shaynor from working as a pharmacist’s assistant, however ill he was. He could go to a sanatorium, free of charge, if he liked, but he isn’t prepared to give in to the disease. He is fascinated by his work and is the best assistant Mr Cashell had ever had.
Diphtheria is spread by droplet infection usually from carriers. It may sometimes be inhaled in infected dust. In an unvaccinated population it is usually seen in children aged between two and five years. It is unusual to see it after the age of fifteen as immunity has usually been acquired by then from recurrent attacks of low virulence.
Samuel Bard, a medical practitioner in Philadelphia, described diphtheria in his treatise on Angina Suffocativa, which was published in 1771. He described the diphtheritic membrane he found at post-mortem as follows:
‘The whole trachea quite down to its division in the lungs, was lined with an inspissated mucous, in the form of a membrane, remarkably tough and firm; which, when it came into the lungs, seemed to grow thin and disappear; It was so tough as to require no considerable force to tear it, and came out whole from the trachea which it left with much ease; and resembled more than any thing, both in thickness and appearance, a sheath of thin shammoy leather.’In 1826 Pierre-Fidele Bretonneau described the illness and coined the word diphtherie from the Greek for leather. In 1883, Theodor Albrecht Klebs isolated and described the diphtheria bacillus, Corynebacterium diphtheriae. [Porter, Roy, The Greatest Benefit to Mankind, Fontana, 1999, p.438.]
In "The Record of Badalia Herodsfoot", in Many Inventions, (1890), Mrs Churner’s baby gets diphtheria and Sister Eva is sitting up one night a week with old Mrs Probyn who lives in the same street. The curate fears that because Sister Eva is in the same street with the diphtheria case she will catch the infection. Badalia arranges that Sister Eva be prevented from entering the street.
In "An Habitation Enforced", in Actions and Reactions, (1905), George Chapin, an American millionaire, and his wife, Sophie, come to live at a remote English village. They buy and renovate a beautiful old house called Friars Pardon. When there is a sore throat nearby, at Gale Anstey, Chapin tells his wife to stay away from the place until he has ‘made sure’. He wants to make sure it is not diphtheria before his wife goes there.
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.’In "A Second-Rate Woman", Under the Deodars, Wee Willie Winkie, (1888), Dora Bent contracts diphtheria. Kipling says she is a baby. But 85 per cent of nursing babies have natural immunity which lasts eight months, so she is probably older than this. [Moore, William, A Manual of Family Medicine and Hygiene for India, Sri Satguru Publications, reprint 1989, p.153.]
The Bent family are staying in an hotel. When word gets out that there is a case of diphtheria in the hotel some of the other residents are very upset. According to Mrs Hauksbee:
‘….the Bent baby has got it (diphtheria), and the whole hotel is upside down in consequence. The Waddy has “set her five young on the rail” and fled. The Dancing Master fears for his precious throat, and that miserable little woman, his wife, has no notion of what ought to be done. She wanted to put it into a mustard bath - for croup! ... The manager of the hotel is abusing the Bents, and the Bents are abusing the manager.’Mrs Waddy has taken her five children away by train. Dora is removed from the hotel . But we are not told whether this is at the request of the hotel manager or on the advice of the doctor. Mrs Hauksbee, very kindly takes her in. She doesn’t think Dora’s parents capable of looking after her during the illness. She calls them ‘a feckless couple’. Part of her treatment would have been to have her in a well-ventilated room, isolated from the rest of the family, where she could have complete quiet and rest to help conserve her strength.
The Doctor is extremely worried about her and calls to see her three times in twenty-four hours. We are told that the house reeks of Condy’s Fluid, chlorine water and carbolic acid washes. These are being used to prevent the spread of infection. The child is 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 going to the dance at the Viceregal Lodge, Dora is again steamed and at that time:
‘there was no sign of the membrane getting to the air passages’.At the dance the doctor meets Mrs Delville and tells her of his concern for the child. It must be the general weakness, (may have been due to heart failure caused by the exotoxin), that he most fears at this time. Mrs Delville leaves the dance and goes directly to Mrs Hauksbee’s house. She finds Dora about to suffocate. The child’s mother and Mrs Hauksbee are too panic-stricken to do anything. She immediately demands a bottle of caustic, and with this she burns the membrane blocking the child’s trachea. If she had dropped the caustic anywhere but on the membrane the result could have been fatal. She is courageous to attempt it, but also extremely lucky. The Doctor is obviously very shaken firstly by the rapid deterioration in Dora’s condition and, secondly, in Mrs Delville’s action:
‘It was the general weakness I feared,’ said the Doctor half to himself, and he whispered as he looked, ‘You’ve done what I should have been afraid to do without consultation.’After six weeks at Mrs Hauksbee’s house Dora has not developed any complications and is able to return to the hotel with her mother. At the end of the story we are told that Mrs Delville’s son had died of diphtheria.
In "A Little Prep" in Stalky and Co. (1899), Stettson Major, a day boy at the school, contracts diphtheria. The source of the infection is traced to an outlying farmhouse. There are no other cases of diphtheria in the school. The Head (Headmaster) goes to stay at the boy’s house, and when Stettson’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.
Intubation - the pushing of a tube through the membrane to prevent suffocation, was first described in 1895, four years before "A Little Prep" first appeared in print. Prior to 1895, tracheotomy, inserting a tube through the skin and tissues to below the blockage, was sometimes advocated. The use of a caustic agent to burn through the membrane was not a usual procedure. But Kipling must have heard of someone in desperate straits who resorted to using it.
Whooping Cough (Pertussis)
As far as I know Kipling did not use pertussis in any of his stories. But, in 1899, his eldest daughter, Josephine, died, apparently of complications of pertussis. She was 6 years old.
Kipling and his family had crossed a very rough Atlantic to New York in January 1899. The three children and their mother were ill when they reached New York. According to Kipling the children had ‘bronchitis caught en route to America’ [Letters, Vol.2, p. 364, Letter to Dr Conland, 6 Feb 1899.] They did not improve much and were diagnosed as having whooping cough with complications. On 20 February, the weather being milder, the children were taken for an outing in Central Park. Later that day their father was dull and feverish. By the following day (22nd) he was seriously ill with ‘inflammation in one lung’. Josephine also was ill with a high temperature. Kipling remained at the hotel with a night nurse. Josephine was taken to Long Island, to the home of their old friend, Lockwood de Forest. Here her condition deteriorated with diarrhoea and vomiting. She died early on 6 March.
Whooping cough is an acute infection of the respiratory tract. Haemophilus pertussis, the bacillus responsible, was not discovered until 1906. In a typical case the course of the illness runs over about six weeks, with a prior incubation period of seven to fourteen days. It is characterised by frequent repeated attacks of coughing ending with a prolonged inspiration (which gives the whoop). It may be followed by vomiting. It may begin with a mild nocturnal cough and runny nose. The cough gets worse and may appear to be bronchial. After about a fortnight the cough occurs in paroxysms that end with a whoop and are may be followed by vomiting. The violent paroxysms of coughing can be very exhausting. After about four weeks the paroxysms gradually become less, and the vomiting ceases.
Complications include bronchopneumonia, atelectasis (collapse of part of a lung). Vomiting may be severe and continuous and may be accompanied by diarrhoea. There may be rapid weight loss, and dehydration. There may also be neurological complications. [Mitchell-Nelson, Textbook of Paediatrics, W.B.Saunders & Co, Philadelphia & London, 4th edition, revised, 1946, p.354 et seq.]
In August 1880 Kipling and his mother were staying at 26 Warwick Gardens, Kensington. Alice Kipling wrote to Edith Plowden:
I have Ruddy laid up since Friday last. He has been very ill with Quinsy - but the fever has gone down at length and I hope to have him down stairs tomorrow. He has been patient and cheerful - even amusing, and on Saturday after reading Swinburne, wrote the following verses descriptive of his condition….Are they not comic?:In this condition the tonsils are enlarged and inflamed and covered in spots of pus. Quinsy, is a diffuse inflammation of the whole tonsil that extends into the surrounding tissues. The uvula may be deviated away from the affected side. The cervical lymph nodes, are enlarged and tender. The patient may have throbbing pain in the throat, earache, headache, a constant desire to swallow, but may be unable to do so. With a quinsy, when the abscess bursts or is lanced, there is immediate relief.The Song of The Sufferer[Rutherford, Andrew, Early Verse by Rudyard Kipling, 1879-1889, Clarendon Press, Oxford, 1986, p.53.]
Kipling’s doctor and his mother were following the accepted treatment of the time for acute tonsillitis. In The Dictionary of Medical and Surgical Knowledge of 1869 the advice given was:
The treatment in the first stage of the disease must be of the antiphlogistic character, acting on the bowels by means of aperient medicine, such as one or two antibilious pills and a dose of Epsom salts, the warm bath, and, if necessary, an emetic; abstaining from all stimulating drinks or animal foods, applying harts-horn and oil to the throat on a piece of flannel, and covering the whole with a hot bran poultice, so as to encircle the throat, and by inhaling the steam of warm water, or sage tea. Sometimes leeches and blisters are required….This is a disease very liable to return….In such cases blisters are often necessary, or the application of iodine or camphor, and mercurial ointment, to induce absorption….In Kipling’s case, the ‘disease’ appears to have ‘returned’ for in January 1881, while at Westward Ho! he wrote:
I have got something swollen in my neck, they say it’s a gland and I’m regularly blistered with iodine in consequence. It makes your neck look like crocodile-skin and utterly ruins your temper.A few years later when working in Lahore he had a sore throat and in a letter to his cousin, Margaret Burne Jones, 28 November 1885 - 11 January 1886, wrote: :
Cold fever, Cataplasm. ‘Sister sitting on bed, slapping hot plaster on throat askin’ if it stung. Throat like superannuated organ pipe - Jus’ so. Camphor, Rubinis and balsam of quinine - no balsam of aniseed and Rubinis quinine - no Coleman’s pectoral quinine and Rubini’s plaster of aniseed…This appears to be a deliberate confusion of terms. Rubini’s Camphor Essence or Solution was used for diarrhoea! The dose was 2 to 5 drops on sugar every 5, 10, or 15 minutes according to the severity of the symptoms. Martindale p.275. ‘Pectoral’ means that the substance was used to relieve respiratory problems. Quinine was used, but was not as effective as the salicylates, for bringing down the temperature and relieving pain. Aniseed oil was used as an expectorant and was a common ingredient of cough mixtures and lozenges.
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 his sister, Trix, were fearful of diphtheria. The doctor said it was tonsillitis and Trix had to apply poultices to her neck every fifteen minutes. [Letters, Vol.1., p.231-2.]
At that time mild cases of sore throat were treated by the application of a mustard poultice to the neck. An alum gargle was also used. The patient was made to inhale steam and, if available, was given ice to suck. Chloral was given ‘to allay pain and procure rest’. For severe pain the throat was painted with a 10 per cent solution of cocaine. [Moore p. 390.]
In January 1900, Kipling’s wife, Carrie, got a sore throat “which for a while (an agitated and hectic while) we thought might be diphtheria”. At the time Kipling and his family were living at The Elms, Rottingdean. His aunt, Georgiana Burne Jones, lived at North End House, just across the Green from the Elms. Kipling’s children were sent to stay with her and a nurse was employed to look after Carrie. [Letters, Vol.3.,p.10.]
This acute inflammatory disease affects the upper respiratory tract. It is accompanied by lassitude and general debility. Usually it is a mild infection, but sometimes there are pulmonary complications. Sometimes it appears in a virulent form and sweeps across continents killing millions as occurred in 1918-19. In that pandemic there were five hundred million cases worldwide, of whom fifteen million died, mostly from streptococcal pneumonia. [Boyd, p.714.]
Kipling got married in London during the earlier, less virulent pandemic of 1889-92. Years later, in Something of Myself, he wrote:
... and then to London to be married in January ’92 in the thick of an influenza epidemic, when the undertakers had run out of black horses and the dead had to be content with brown ones. The living were mostly abed. (We did not know then that this epidemic was the first warning that the plague - forgotten for generations - was on the move out of Manchuria.)I do not know why Kipling associated the influenza epidemic in London with plague in Manchuria. It must have been a strange wedding. Kipling’s only relative present was his cousin, Ambrose Poynter. His future mother-in-law, and sister-in-law, (later Josephine Dunham) were both ill with ’flu and unable to attend the wedding on 18 January 1892. On his side, his aunt Georgiana Burne-Jones and her son, Philip, were ill as was his aunt Agnes. After the church ceremony, Carrie, his wife, left him at the church door as she had to rush off to give her mother medicine and did not attend the wedding breakfast at Brown’s Hotel.
Frau Ebermann in "Swept And Garnished" in A Diversity Of Creatures (1915), is told by her doctor that she has mild influenza:
Meantime, every bone in her body ached; her head throbbed; her hot dry hands would not stay the same size for a minute together; and her body, tucked into the smallest possible compass, shrank from the chill of the well-warmed sheets.The sensation that her hands were changing size is not a common symptom of influenza. But it is a sensation that Kipling would have experienced from taking too much quinine when suffering from malaria.
Influenza was treated with aspirin. Frau Ebermann also sends her maid out to buy her formamint, ammoniated quinine, eucalyptus and a steam inhaler.
This is a condition in which the smaller passages in the lungs show an allergic reaction to foreign proteins such as plant pollen, animal hair, foodstuffs such as egg-white or peanuts. Heredity may play a part and other family members may also be affected. Sometimes there is a psychosomatic factor involved and an asthmatic attack may be precipitated by an emotional upset.
The patient with asthma has recurring attacks of breathlessness, wheezing and a sensation of constriction in the chest. [Boyd, p.699]
In "A Friend of the Family", Debits And Credits, (1924), Bert Vigor’s father, a market-gardener, aged 68, has asthma. When Bert was called up the business collapsed.
In "One View of the Question", Many Inventions, (1890), Shafiz Ullah Khan, a visitor from India, describes the London fog ' the air being filled with the smoke of Hell - sulphur and pitch as it is written - they die speedily with gaspings, and so are buried in the dark.'
Kipling much admired Olive Schreiner’s Story of an African Farm. In 1891 he went to the Karoo village of Matjiesfontein where she lived, to see her. When he returned to South Africa in 1898, she had gone to live in Kimberley in an attempt to find relief for her asthma. Kipling and his father visited her there. Unfortunately there is no record of what they discussed, but presumably she would have mentioned her asthma being responsible for her move to Kimberley. In "The House Surgeon" in Actions and Reactions (1909), Miss Mary Moultrie suffers:
... from some obscure form of chronic bronchitis, complicated with spasm of the glottis.This makes her have very severe attacks of breathlessness when she is unable to speak and feels she is ‘nearly choking to death’. She treats herself with ‘washes, gargles, pastilles and inhalations’. Her younger sister, Miss Elizabeth, is:
... victim to very much the same sort of throat but secretly devoted to another set of medicines...A third sister, Agnes, has also had the condition, and has accidentally fallen out a window and been killed when trying to get more air during an attack. This has been mistaken for suicide. Mr Baxter, a cousin, also has the same affliction which makes him cough and clear his throat frequently. The Narrator, mistaken for a doctor, (as in "An Error in the Fourth Dimension") sees Miss Mary when she has ‘some sort of seizure’ which comes on while she is asleep at night. He says ‘she crowed and whistled as she struggled towards the window’. Also ‘she writhed and fought for breath’
. Kipling wrote that this condition was ‘obscure’. I don’t know why he had to use an ‘obscure’ condition. If by ‘crowed and whistled’ he meant ‘wheezed’ then she appears to have had an acute asthmatic attack. Possibly he was trying to describe the cough associated with croup (acute laryngo-tracheo-bronchitis) in children.
. In adults an acute laryngitis may occur as an isolated disease, or as part of an infection in the air passages. This type of laryngitis may be precipitated by straining the voice when suffering from a mild head cold. Actors and singers who use their voices professionally are often affected. But this does not occur in very acute attacks as described by Kipling. However, the treatment, apart from resting the voice, consists of inhaling moist air. A steaming kettle and steam inhalations containing Friar’s Balsam are beneficial. Miss Moultrie cousin, Baxter, buys her a new ‘bronchitis-kettle’ and her room is ‘reeking of steam and Friar’s Balsam’.
. Croup (Acute Laryngo-tracheo-bronchitis)
Acute inflammation of the larynx, trachea and bronchi can occur rapidly in children and unless treated can be fatal. Badalia Herodsfoot’s baby dies of croup in ‘The Record of Badalia Herodsfoot’, Many Inventions, (1890). Kipling had croup when he was young. In later life he remembered having croup when he was staying with his Aunt Georgiana at The Grange, North End Road. On that occasion he slept in his aunt’s room and woke up to find himself in a mustard bath. [Letters, Vol.2, p.178-9.] The steam from the bath would have relieved his symptoms far more than the mustard.
The pleura are the membranes that cover the outside of the lung and the inside of the chest wall. Inflammation of these membranes is called pleurisy. In most cases infection spreads from the lung to the pleura. Occasionally the infection originates in the pleura. Sometimes it spreads from the chest wall. Pleurisy usually causes pain in the side of the chest that is made worse by breathing. Nowadays antibiotics are available to treat the infections responsible. In the late nineteenth century the patient was kept in bed and kept warm. William Moore advised using leeches, one for each year of the patient’s age, up to thirty in number; three or four will be enough in most cases. He suggested bruised poppy-head poultices applied over the painful part if leeches were unavailable. [Moore, p.308.]
Pleurisy is only mentioned briefly in Kipling‘s works. In ‘On The Gate: A Tale of ’16’, Debits And Credits, (1926), a hospital nurse, who has been working in France for two years of the War, dies of heart failure after neglected pleurisy following overwork. In ‘In the House of Suddhoo’, Plain Tales From The Hills, (1888), Suddhoo’s son in Peshawar, has pleurisy. Kipling’s friend Mrs Hill had ‘ a sharp go of pleurisy’ in February 1889. [Letters, Vol.1, p.285.]
James Gravell in ‘Beauty Spots’, Limits And Renewals, (1932), had ‘a dusky mottled complexion and a pleuritic stitch which he had got during the War through a leaky gas-mask’.
There are several types of pneumonia but the ones of interest in Kipling‘s works are lobar pneumonia and bronchopneumonia.
Lobar pneumonia (like Kipling had), was more common before the advent of penicillin. In his textbook The Principles and Practice of Medicine, Sir William Osler called it ‘The Captain of the Men of Death’. [‘Pneumonia has become the ‘captain of the men of death’ to use the phrase applied by John Bunyan (1628-1688) (from The Life and Death of Mr Badman) to consumption.]
It occurs suddenly with cough, blood-stained sputum, fever and rigors. It affects the whole of a lobe, or more than a lobe of one lung. The affected area becomes completely solid and cannot be used for breathing until resolution occurs and the lung regains its normal spongy texture. If the patient doesn’t develop complications, the pneumonia runs a course of from 4 to 12 days, before terminating with a ‘crisis’ when, quite suddenly, the temperature falls and the pulse and respiratory rates approach normal again. The patient then begins to improve.
Predisposing factors for pneumonia include stressful conditions such as exposure to bad weather, lack of sleep and contact with patients who have infections or are healthy carriers.
Kipling had taken his family across the North Atlantic in January 1899.The three children developed bad colds on the way, and on disembarking at New York on 2 February, were kept hanging around in a draughty customs shed for two hours before being allowed to go to their hotel. The children were diagnosed as having whooping cough (pertussis) with complications. Six days later their mother fell ill with a high temperature and apparently spent four days in bed. No mention is made of her husband’s health until, on 20 February, Carrie wrote in her diary that, when he returned to the hotel he was ‘dull and feverish’. Next day he was much worse and too ill to get out of bed. Carrie’s sister, Josephine, had recently married Dr Theo Dunham. Initially he looked after Kipling, but called in Dr Edward G. Janeway on 22 February. They diagnosed acute lobar pneumonia in the right lung. The lung gradually solidified and, to the great consternation of all, the left lung also became infected and began to solidify. By 25 February respiration was ‘alarmingly difficult’ and Kipling was delirious. The delirium continued the following day. Then, although consolidation continued in the left lung, that in the right began to resolve allowing him more functioning lung to breathe with. On the night of 28 February he reached ‘the crisis’: his temperature began to come down and he fell into a natural sleep. By 4 March he was reported ‘out of danger’.
New York must have been very cold in February 1899, and Kipling had been very busy there before becoming ill. Also, the rest of his family were ill, and may have passed on infection to him.
"Sea Constables: A Tale of ’15" in Debits and Credits, (1926), is a story set during the Great War and tells how a certain neutral captain and his ship, suspected of supplying oil to German submarines, was followed by various ships of the Royal Navy : first by Winchmore in Ethelreda, then by Jarrott in the mine-sweeper Cordelia and then by Maddingham in Hilarity, and was prevented from meeting any German ships. Eventually, having been escorted from the Scottish coast down the North Sea, through the English Channel and up the Irish Sea, the Neutral became ill and put into Cloone Harbour on the Irish coast where he sold his oil to the Admiralty agent and deliberately damaged his engines to put them out of action. At Cloone, Maddingham, a member of the RNVR on active service, went to see ‘Uncle Newt’ as they had taken to calling him. The neutral told Maddingham he had an acute attack of ‘bronchial pneumonia’. He died during the night.
By ‘bronchial pneumonia’ the Newt may have meant ‘bronchopneumonia’. But this doesn’t come on in acute attacks and is usually secondary to some other disease such as acute bronchitis, measles or scarlet fever, or as a complication of cardiac disease or cancer. It applies to areas of consolidation spread throughout both lungs and it comes on gradually.
For the Neutral to say he had an acute attack of bronchial pneumonia was very strange indeed. Did Kipling want us to accept this at its face value, and, knowing that the mortality rate of pneumonia a hundred years ago was very high, say ‘Oh yes, he had pneumonia’? Had the events in New York in 1899 when his eldest daughter Josephine died, been too painful to remember so that he tried to blot them out of his mind, and had never taken an interest in the type of pneumonia that had nearly killed him ? Or did he mean us to question this ‘acute’ attack of ’bronchial pneumonia’ ?
We are not told how long the Newt had been bed-bound by the time Maddingham visited him. He must have felt he couldn’t go on any longer to have sold his oil to the Admiralty and put his engines out of action. He was extremely anxious to get back to England ‘to see (his) doctor in town’, and apparently persuaded himself that if he ‘surrenders’ Maddingham will get him there. When Maddingham refused he threw in the sponge saying ‘But that finishes me, too’. The next morning he was dead.
Cloone was ‘a god-forsaken hole’. Although the dispensary doctors in Ireland were very hard-worked and had large districts to cover, I think the local general practitioner would have managed to see him during the twenty or so hours he was in Cloone before he died. On first appearances it seems the Newt was too much of a snob to send for the local general practitioner. A consultant from Dublin or Belfast might have done, but they might well have refused to travel so far unless specifically requested to come and give a second opinion by the general practitioner. Most people so seriously ill would have summoned the nearest doctor and been glad of his attentions. Not so the Newt. This begs the question: Why not ?
If the Newt was really going to die of pneumonia that night, his condition would have been much worse when Maddingham saw him, 12 or 14 hours earlier. He might have been delirious or comatose or just difficult to rouse, but he would not have been able to carry on an argument with Maddingham as he did. So he died too soon if Kipling really meant him to have pheumonia.
There are other possibilities. Firstly I am quite wrong and he just ‘gave up the ghost’ when Maddingham refused to get him to England. Secondly, he did have pneumonia, but took something to hasten his death. The third possibility is that he didn’t have pneumonia at all. He might have been a drug addict and had been expecting to collect a supply of whatever he was addicted to from a German U-boat. Unfortunately for him, he was prevented from meeting any German ships by the combined efforts of the Sea Constables, Winchmore, Jarrott and Maddingham. When his supplies failed completely he began to suffer withdrawal symptoms. His last, unreasonable, hope was to get Maddingham to take him back to England where he could have obtained a supply of the drug. His death may have been due to heart failure secondary to withdrawal of the drug, or, possibly he took a very large dose of something and, either accidentally or on purpose, finished himself off. I would love to know what Kipling meant us to think.
‘Rheumatism is a disease which licks the joints, but bites the heart.’ [Boyd, p.319]
Rheumatic fever is an acute illness that starts with a sore throat and affects mainly the joints and the heart. Since the advent of penicillin it has diminished markedly in frequency.
It is a disease of childhood with 75 per cent of cases occurring before the age of 20. When it occurs in adults, 50 per cent of the cases occur in those aged 20-30 years. It is associated with overcrowding, poverty and malnutrition with Vitamin C deficiency.
Usually there is an interval of 10-14 days between the throat infection and the onset of rheumatic fever. The acute inflammation of the joints is extremely painful but the joint tissue does not become damaged and as the infection subsides these joints return to normal. During the acute illness there may be no sign of involvement of the heart. This may not appear for months or even years afterwards. The heart valves and heart muscle are both affected and do not recover like the joints. The patient could die from heart failure during the acute phase or a long time afterwards as a result of the valvular problems. In the pre-antibiotic era it was important to keep the patient at rest in bed for a considerable time to allow the heart time to recover. [Boyd, William, An Introduction to Medical Science, p.78-9.]
Rickett in ‘The Phantom Rickshaw’, Wee Willie Winkie, (1885), had intended to spend two nights with Polder but:
... was knocked down by rheumatic fever and for six weeks disorganised Polder’s establishment, stopped Polder’s work, and nearly died in Polder’s bedroom.Agnes Laiter’s husband in "Yoked With An Unbeliever"in Plain Tales From The Hills (1886), had rheumatism of the heart. (We are not told when he had had rheumatic fever.)
Three years after he was married, - and had tried Nice and Algeria for his complaint, - he went to Bombay, where he died and set Agnes free ...A combination of intermittent fever and a diseased heart valve caused problems in "The Other Man" in Plain Tales From The Hills (1886).
Rheumatic fever was the commonest cause of heart disease. The commonest heart valve to be affected by rheumatic fever was the mitral valve. This valve usually became narrowed (mitral stenosis). [Boyd, William, An Introduction to Medical Science, p.79 and as 4, p.526.]
Heart failure is suggested in ‘The Dying Chauffeur’ in The Muse Among The Motors (1904):
That cursed left-hand cylinder the doctors call my heart‘Pinking past redemption’ refers to an irregular beating of the heart such as occurs with atrial fibrillation. This could be due to coronary artery disease. It could also refer to ventricular fibrillation which frequently precedes death, but in that case the chauffeur would be unconscious and unable to complain about it.
The Common Cold
When Kipling had ‘a beast of a cold’ in November 1901 he wrote:
‘Now I will steep myself in camphors and benzoins and the abominable drugs of the merchants.’In 1906, while in South Africa, Carrie had a bad cold which she treated with a vibrator. Apparently Kipling had found it while staying with his parents the previous year. He called it ‘an American notion’. When applied to the side of the nose it was supposed to cure colds. It seems very unlikely that it ever actually worked efficiently. Possibly it could have loosened mucous secretions in the nasal passages and partially relieved the symptom of ‘blocked nose’ that is commonly associated with the common cold.