[May 11 2004]
Sunstroke and Heat Apoplexy
In India in Kipling's day it was thought advisable to wear a pith helmet at all times during daylight, or the rays of the sun would drive one mad. In 1886 the British army medical records removed “sunstroke” from the category of mental disease and placed it under “injuries”. Sunstroke is no longer a recognised disease although heatstroke is.[Information from Michael Edwardes, The Sahibs and the Lotus: the British in India, p.233 and Philip D Curtin, Death By Migration, Cambridge University Press, 1989, p.156.]
According to William Moore in his Manual of Family Medicine and Hygiene for India, reprint Delhi 1989, (6th edition 1893), heat apoplexy was thought to be a form of sunstroke. And:
“sunstroke of all kinds is due to nervous disturbance from prolonged high temperature, either with or without direct exposure to the sun’s rays. The liability to sunstroke is increased by fatigue, mental excitement, depression of spirits, living and especially sleeping in crowded apartments; by want of ventilation, by want of water, by constipation, and by the abuse of alcoholic drinks”.The premonitory symptoms of sunstroke included irritability, restlessness and headache, inability to make much exertion without great effort, confusion of ideas, confusion of vision, loquacity, and fits of laughing and crying. Heat apoplexy could be preceded by the premonitory symptoms described above, or it might begin with the person fainting, being hot to the touch, with flushed face and bloodshot eyes, and noisy breathing or snoring. In a short time the person could become unconscious and have convulsions. [Information from William Moore, A Manual of Family Medicine and Hygiene for India, reprint Delhi, 1989, (6th edition 1893), p. 372.]
Nowadays heat stroke is thought to be a paralysis of the heat-regulating mechanism of the body, caused by excessive heat. The actual temperature required depends on the humidity and varies with different persons. When heat stroke is caused by the direct exposure to the sun the condition is called sunstroke. But it may be caused by exposure to any great heat, especially when combined with marked humidity. When a person falls down unconscious as a result of heat stroke it is called heat apoplexy. He may die very suddenly. This was not uncommon in soldiers on forced marches in tropical countries. Mortality may be as high as 20% and depends partially on the duration of the acute condition prior to treatment. [Information from William Bord, A Textbook of Pathology, Lea and Febiger, 8th edition, 1973, p.469, and the Merck Manual, Merck, Sharpe and Dohme, 11th edition, 1966, p.1177.]
In “The Man Who Would Be King” (1888), Peachey Carnehan was found at noon “in the hot blinding Mall ... crawling along the white dust of the roadside, his hat in his hand, quavering dolorously after the fashion of street-singers at Home”. He was admitted to the Asylum suffering from sunstroke, and died the following day. The Superintendent was shocked that he had been “half an hour bare-headed in the sun at mid-day”.
In “The Judgement Of Dungara”, (1888), when the Buria Khol had hammered the Rev.Justus Krenk for attacking the statue of Dungara with his umbrella, Gallio, the Assistant Commissioner, told their priest, Athon Daze, that “a man of his wisdom ought to have known that the Sahib (Rev.Krenk) had sunstroke and was mad”.
In a letter to Margaret Burne-Jones, 3 May-24 June 1886, Kipling complained about the very hot weather, and said that three soldiers had died of heat-apoplexy the previous night, (June 16) and that there had been a funeral nearly every day for a fortnight. He continued: “But Tommy is so careless. He drinks heavy beer, and sleeps at once after a full flesh meal and dies naturally.”
Kipling described how he went to the main guardroom at Fort Lahore on a “pitchy black, choking hot” night, when the temperature was 97 F in the guardroom verandah at midnight. He saw “every man jack of the guard stripped as near as might be sitting up. They daren’t lie down for the lives of ‘em in heat like that. It meant apoplexy.” [Information from Thomas Pinney, editor, The Letters of Rudyard Kipling, Vol.1, p.134.]
Regarding the lives of the soldiers in “In The Matter Of A Private”, (1888):
“All their work was over at eight in the morning, and for the rest of the day they could lie on their backs and smoke Canteen-plug and swear at the punkah-coolies. They enjoyed a fine, full flesh meal in the middle of the day, and then threw themselves down on their cots and sweated and slept till it was cool enough to go out with their “towny”....”In general it was known that, in the tropics, several small meals were better than a few large ones. Also meat was not required in the same amounts as in temperate climes. Regarding alcohol:
“it would be well, if at all, for at least some months after entering the tropics, to refrain from anything more powerful than a little claret-and-water, and, perhaps, a glass of sherry daily. Spirits should be shunned as poisons. Beer of good light quality is less deleterious, but is not necessary. As a rule, no beer, wine, or liquor should be taken excepting at meals. In the hot weather it is advisable that none be taken till after sundown”.In “The Other Man”, (1886), Colonel Schreiderling “dangled on the brink of heat-apoplexy, but it never quite killed him”.
In “William The Conqueror" Part I (1895), William gave Scott tea, saying it was the “best thing in the world for heat-apoplexy”. Apparently the hot tea was thought to save “the veins in the neck from swelling inopportunely on a hot night”.
In “With The Main Guard”, (1888), on a very hot night at Fort Amara, “Learoyd, half mad with the fear of death presaged in the swelling veins of his neck, was begging his Maker to strike him dead, and fighting for more air between his prayers”.
In “At The End of The Passage” (1890):
“Every door and window was shut, for the outside air was that of an oven. The atmosphere within was only 104....Spurstow packed his pillows craftily so that he reclined rather than lay, his head at a safe elevation above his feet. It is not good to sleep on a low pillow in the hot weather if you happen to be of the thick-necked build, for you may pass with lively snores and gugglings from natural sleep into the deep slumber of heat-apoplexy.”In July 1911, Kipling wrote to Lieutenant WH Lewis, who had just been assigned to No.5 Mountain Battery in India advising him:
“wear a flannel band next your skin and always have a dry one in reserve, no matter how wet you get elsewhere. Never drink water; never touch any fizzy-water outside a regimental mess whose mineral water machines are above reproach; take boiling hot tea in hot weather. This will make you sweat but will cool you and keep you from heat-apoplexy.”Prickly Heat
This condition is characterised by pin-point to pin-head sized vesicles and papules, with prickling and burning sensations, and is due to inflammation of coil glands in the skin. Treatment consists of wearing light clothes and avoiding heavy meals and alcohol. Cool bran or oatmeal baths are useful. Steroid sprays are temporarily beneficial. Unfortunately once the tendency to prickly heat is established, it can rarely be abolished. [Information from Blackwell Solomons, Lecture Notes on Dermatology, 1965, p.95]
In a letter to Margaret Burne-Jones, 3 May-24 June, 1886, Kipling said he was “a raw red lump of prickly heat - the direct result of damp moist air”. [Information from Thomas Pinney, editor, The Letters of Rudyard Kipling, Vol.1, p.136.]
In “The Hill Of Illusion”,(1888), a boy, who had very bad prickly heat on his forehead, was asked if he had tried sulphate of copper in water for it.
In “The World Without”, Curtiss of the Royal Artillery had prickly heat between his shoulders.
In “With The Main Guard”, (1888), the two-year-old Nora M‘Taggart had heat-rash.
The following verses, obviously modelled on Kipling’s “In The Neolithic Age”, written by “Momos” are from British Life in India, edited by R.V.Vernede, 1995:
“In the symptomatic stage, savage warfare did I wageChildren in the Tropics
In “At The Pits Mouth” (1888):
“Each well-regulated Indian Cemetery keeps half-a-dozen graves permanently open for contingencies and incidental wear and tear. In the Hills these are usually baby’s size, because children who come up weakened and sick from the Plains often succumb to the effects of the Rains in the Hills or get pneumonia from their ayahs taking them through damp pine-woods after the sun has set.”Lady Emily Metcalfe, who lived in Delhi in the 1830s and 40s wrote of every mother’s expectation to lose “at least three children out of every five she bore” [Information from Mark Harrison, Public Health in British India, Cambridge University Press, 1994, p.50.]
In “The Daughter Of The Regiment”, (1887), Bridget Mckenna, Ould Pummeloe, lost five children in fourteen months. Mulvaney said “Whin the childher wasn’t bornin’, they was dying; for, av our childher die like sheep in these days, they died like flies thin.”
In The Naulahka, (1892), the “woman of the desert” had borne one stillbirth and three live children. One died of smallpox and the other two of fever.
According to William Moore “Infants and children should be indoors by 7 a.m., for by that time the comparative coolness of the morning air is gone.”(p.584). It was thought that the Indian climate would damage children permanently if they were exposed to it for too long.
Birch’s Management expressed the view that “the higher the external temperature, the more susceptible is the system to nervous influences”. The blood would grow thinner and the circulation slower, leading to weakened muscles and congestion of the liver, spleen and bowels. The child would have a lowered resistance to infection and might also develop loose joints and curvature of the spine. Any parents who could possibly manage it sent their children “Home” by the time they were seven years old. [Information from Margaret Macmillan, Women of the Raj, Thames & Hudson, 1996, p.138-9, and, Green, C.R.M. and Green-Armytage, V.B., Birch’s Management and Medical Treatment of Children in India, 5th edition, Calcutta, 1913.]
“A little sigh, a little shiver -
And that means liver.
A little liver when June is nigh,
and then we die.”
[from “Nursery Idylls”, Echoes, 1884, reprinted in Early Verse, edited by Andrew Rutherford.] In “The God From The Machine”, (1888), Mulvaney said the Colonel “carries a power av liver undher his his right arrum whin the days are warm an’ the nights chill.” When the Colonel was “all liver today” and in bad form, he confined Mulvaney to Barracks for ten days for drunkeness.
In a holograph verse-letter to Edith Macdonald, 1 June 1883, (Library of Congress) Kipling wrote:
“May the Gods forgive my boasting, but nearly a year has fled[from “Dear Auntie, Your Parboiled Nephew”.] In “Pagett, M.P.”((1886), Pagett had ten days “liver” due to drinking beer.
In “The Bisara Of Pooree”, (1887), when Churton had the Bisara, “he knew liver and fever, and for weeks past had felt out of sorts”. When the Bisara was stolen from him he had "a striking release from liver".
According to William Moore in A Manual of Family Medicine and Hygiene for India, [reprint Delhi 1989, 6th edition 1893] the well-being of the liver is materially responsible for a cheerful and comfortable life. To quote a popular pun: “Is life worth living ? It depends on the liver.”
Congestion of the liver implied excess blood in, and distension of part, or all of the organ. It was caused by overcrowding; a sedentary life; too much sleep, especially in the daytime; excessive eating and drinking; rich and hotly seasoned food; stimulating liquors; repeated cold stages of intermittent or remittent fever. But the principal cause in the East was thought to be climatic - solar exposure, heat, and consequent excessive perspiration. The symptoms included depression of spirits, defective appetite, headache, nausea, irregular bowel motions, and a sense of weight or fullness in the right side.
Treatment consisted of 'liver pills' which were composed of Podophyllum resin, rhubarb and extract of Hyoscyamus. Mustard leaves were applied over the liver, and moderate exercise such as horse riding was advised. Podophyllum resin is a drastic purgative with a slow action. The hyoscyamus was to counteract griping. The rhubarb is a mild anthraquinone purgative. [Information from Martindale’s Extra Pharmacopoeia, The Pharmaceutical Press, 25th edition, 1967, p.1275-6.
In “The Phantom Rickshaw” (1885), Dr Heatherlegh treated Pansay with liver-pills, cold-water baths, and strong exercise.
In 1895, in a letter to C.E.Norton, Kipling said :
“....I’ve been expiating too good fortune by sorrow in my system - they call it the liver, and it makes me sad and sick and sodden all down the right side. No, it is neither too much “Italian decadence” nor champagne, but a genuine complaint of nature ....”[Information from Thomas Pinney, editor, The Letters of Rudyard Kipling, Vol.2, p.183.] In 1897, in a letter to Dr James Conland, Kipling said he had been feeling “hipped and depressed” and “sorrowful”. He thought it was “liver and ghastly depression”. The doctor he consulted in London told him that he “hadn’t a trace of liver” and prescribed a tonic and told him to stop smoking. [Information from Thomas Pinney, editor, The Letters of Rudyard Kipling, Vol.2, p.327.]
In “The Taking Of Lungtungpen” (1887), Mulvaney says that fifty seasoned soldiers would not have crossed the river in the nude to capture Lungtungpen because they would have known “the risk av fever and chill”.
In “Only A Subaltern”, (1888), Bobby Wick got “chilled to the marrow” the night he sat up with Private Dormer. Four days later he had cholera.
In India chill or cold was thought to be “a most fertile source of disease” - of secondary attacks of fever, rheumatism, dysentery, diarrhoea, croup and many other illnesses. Damp cold was thought to be worse. All precautions were to be taken to avoid chills from sudden drops in temperature:
“...when in a state of perspiration, if the clothes cannot be changed, evaporation should be limited, and chill prevented, by putting on more garments, and by avoiding draughts”. It was thought that protection from cold was more necessary in India than in a cooler climate. [Information from William Moore, A Manual of Family Medicine and Hygiene for India, reprint Delhi 1989, 6th edition, 1893.]