The Tender Achilles

Notes on the text

These notes, by Gillian Sheehan and John McGivering, are partly new, and partly based on the ORG. The page and line numbers below refer to the Macmillan (London) Standard Edition of Limits and Renewals, as published and frequently reprinted between 1932 and 1950.


[Page 347 line 1] St Peggotty’s most teaching-hospitals have an annual dinner for staff and past students, so all branches of the medical profession would be represented.

[Page 347 line 5] Keede he also appears in “A Madonna of the Trenches” and “In the Interests of the Bretheren” (Debits and Credits) together with “Fairy-kist” earlier in this volume.

[Page 347 lines 8 – 9] G. P.‘s: whose faces … light cars the General Practitioners, backbone of the medical and surgical world, who would look somewhat weatherbeaten as they drove about their districts in open cars.

[Page 347 line 10] Sir James Belton ORG believes he is modelled on Sir John Bland-Sutton (1855-1936) His autobiography

The Story of a Surgeon

has a Preamble by Kipling. (Methuen, 1930) See “Some of Kipling’s medical acquaintances” in this guide, and “A Doctor’s Work”, Kipling’s speech to the Middlesex Hospital in A Book of Words.

[Page 347 line 17] bacteriologist a specialist in the science and study of bacteria.

[Page 347 line 21] esoteric known only to a select few.

[Page 348 line 1] Pharmacopoeia Britannia the standard list of drugs and medicines then issued by the General Medical Council. A book consisting of a collection of formulae and methods of drug preparation that is recognised as a standard in Great Britain.

[Page 348 line 2] Galenical Physician Galen, born about 130 A. D. who studied medicine in Greece and Egypt,, was regarded as one of the greatest physicians of early times (see page 347 line 8 above). In this case it can mean a real pukka or official physician.

[Page 348 line 6-7] Howlieglass … walked the hospitals This nickname is believed by ORG to be derived from Tyll Eulenspiegel (Owl-glass) and to refer to the large horn-rimmed spectacles he wore; and also a character in Scottish Satirical Verses by Robert Sempill (fl.1567-1583). . ‘Glass’ was also used at one time for ‘mirror’. ‘Walking the hospitals’ was an early term for medical students.

[Page 348 lines 15] diggings… slang for lodgings;

[Page 348 line 16] Wimpole Street parallel with Harley Street, just north of Oxford Street in central London, and containing many professional consulting rooms and the Royal Society of Medicine.

[Page 348 line 16] the tray set with assorted drinks.

[Page 348 line 20] ‘tripe’ the lining of the stomach – he was a specialists in abdominal surgery.

[Page 348 line 21] Scree the heap of small rocks etc. at the foot of cliffs, or covering mountain slopes.

[Page 348 line 24] Matterhorn a mountain in the Alps between Switzerland and Italy. Horringe is a mountaineer, which explains his nickname.

[Page 348 line 26] knife-wallahs surgeons.

[Page 348 line 31] a sixpenny doctor at Lambeth a general practitioner working in Lambeth, then a poor area of sounth London, who charged sixpence for a consultation – inexpensive. (sixpence in pre-decimal currency was a fortieth of a £, 5p today).

[Page 349 line 7] barbers The Barber Surgeons, medical and surgical practitioner of medieval Europe, eventually split from the Barbers and in Britain formed the Company of Surgeons, receiving a Royal Charter in 1800. They later became the Royal College of Surgeons.

[Page 349 line 11] pew-opener an aged man or woman who opened the doors of the old box-pews in some churches – regarded as a very humble job.

[Page 349 line 18] Maldoni a family of Italian descent, but we have not found another reference. (Google has ‘Astrophysics’ but no other help).

[Page 349 line 25] bug-run slang for a bacteriorlogical laboratory.

[Page 350 line 11] agar-agar a jelly-like substance made from certain sea-weeds, used for growing bacteria and other micro-organisms in the laboratory.

[Page 350 line 13] The Lancet one of the oldest medical journals in the world, published weekly since 1823.

[Page 350 line 23] any other post-War assassin there are not enough surgeons to go round in wartime, and men like Keede would be put to emergency surgery. After the war some of them would try to set up as surgeons in civil practice without the proper qualifications or experience.. This is the implication of the paragraph following line 23.

[Page 351 line 7 onwards] Why on earth was Wilkie sent to the Front ? Surgery is regarded, by the lay public anyway, as the highest form of medical art and practice. Many medical men not doing surgery believe that, given the chance, they could have been brilliant surgeons. Wilkett’s “bleedin’ vanity” (line 32 below) made him believe that because he was a good bacteriologist he could also be a good surgeon. How often have we met this type and how wrong they usually are, as was Wilkett who was a very good bacteriologist in the early days of the speciality. It was a waste sending him to the Front. There may not have been another bacteriologist, certainly not one as good, to replace him. He was a perfectionist and even if he had been an excellent surgeon, he would have been ‘broken’ from working at a C.C.S.

[Page 351 line 16 and line 25] the base … Clearing Station In the 1914-18 War stretcher-bearers retrieved the wounded from where they had fallen and carried them to regimental first-aid posts which were close to the front line, often in shell-holes or dug-outs. Here each was labelled stating the injuries and the treatment given. From here they were taken to dressing-stations run by the divisional field ambulances, and from there by ambulance to the casualty clearing stations which were usually several miles behind the front line.

Having been treated here, the seriously wounded were taken by ambulance train to one of the big base hospitals like Boulogne, thirty or more miles from the front. Here they could have further or more specialised surgery before being sent to England by hospital ship. Wilkie had been working at one of the base hospitals, where he could probably have worked in a bacteriology department, or at least in a much calmer environment than that of a clearing station.

[Page 351 line 30] broke in this context, broken – see page 352, line 24 onwards and page 356 line 1 below.

[Page 352 line 1] Lambeth has spoken Keede’s remark ‘Bleedin’ vanity’ is an echo of the Cockney accents of his patients in Lambeth where he was a sixpenny doctor – see page 348 line 31 above and “Toby Dog” in Thy Servant a Dog, page 76 line 15.

[Page 352 line 13] hawk-headed Egyptian god perhaps Ra, the sun-god, or Horus.

[Page 352 line 17] dresser in this context an assistant to a surgeon.

[Page 353 line 28] C. C. S. Casualty Clearing Station: the nearest point to the front line where operations could be carried out after the casualty had been treated at a Regimental Aid Post, Advanced Dressing Station or Main Dressing Station. The procedures are vividly described in the following lines.

[Page 252 line 32] E.P. tents tents provided for European Privates – see Notes to “The Drums of the Fore and Aft” (Wee Willie Winkie, page 350, line 10).

[Page 352 line 33] tarpaulins that have – been in use large waterproof sheets that would be badly soiled with mud and blood – almost impossible to clean.

[Page 353 line 1] acetylene ethyne – a flammable gas then used for lighting away from main gas supplies.

[Page 353 line 3] dope and the pads probably ether put on a pad which was then held over the nose .

[Page 353 line 4] cutlery surgical instruments.

[Page 353 line 6] tagged and labelled as ‘abdominal, fracture of bone’, or whatever the nature of the wound: also the amount of morphia injected by the Regimental Medical Officer in the front line and the time it was given would ne noted, lest it should be repeated too soon at the C. C. S.

[Page 353 line 11] someone vomits This could slow things down if instruments have to be re-sterilized and new dressings put out.

[Page 353 line 16] shrapnel A shell filled with bullets which scatter in the air when the shell bursts, causing a large proportion of head wounds.

[Page 353 line 17] five-point-nines the calibre of the guns firing high-explosive shells (five and nine-tenth inches – 15 cm.) in which case the wounded were hit by shell-splinters.

[Page 353 line 19] abdominals….You have to explore examine all the intestine to find perforations.

[Page 353 line 23] Second Vermuizendaal one of the battles in Flanders during the offensive of 1916.

[Page 353 line 26] our tea-bucket there was no water laid on at a C. C. S. so one bucket-full was used over and over again and very quickly became filthy.

[Page 353 line 27] per capita Latin, per head or per person.

[Page 353 line 28] trephining This usually means cutting out a circular piece of bone from the skull. It is not a very lengthy procedure. Possibly, in this context, the operations being performed were craniotomies where a larger piece of bone is removed, the damage to the brain tissue examined, and any foreign bodies such as shrapnel removed, sometimes with the aid of an electro-magnet.

[Page 353 line 31] his own troupe the anaesthetist, assistant surgeon and nurses he usually worked with.

[Page 354 line 3] Amiens city on the River Somme and scene of much action during the war.

Villers Bretonneux some 12 miles (19 km) east of Amiens.

[Page 354 line 15] egg in this context a German shell.

[Page 354 line 18] waggling your foot a method of awaking a sleeper without being punched or shot – see “In the Interests of the Bretheren” Debits and Credits page 78.

Inquisition the Holy Office of the Roman Catholic Church, established in 1248 for the suppression of heresy.

[Page 354 line 20] warmed and slept off some of his shock This is the type of shock caused by severe trauma and/or massive haemorrhage. The circulation of the blood around the body is severely reduced. The injured patient may be semi-conscious, pale and sweaty with a feeble rapid pulse and a low blood pressure. They would probably die if operated on in this condition. Even warming him up would improve his circulation to some extent.

[Page 354 line 24] Mespot Mesopotamia , the Land between two rivers, Euphrates and Tigris, now part of Iraq. Scene of British operations against the Turks in the 1914-18 War.

[Page 354 line 25] stitch his diaphragm to his larynx the diaphragm is the muscular wall that divides the chest cavity from the abdominal cavity. Keede means he had not made some stupid mistake because of being exhausted.

[Page 354 line 32] duodenum the junction of stomach and small intestine. Perforating abdominal wounds would puncture the coils of intestine in as many as a dozen places, so much of it would have to be removed.

[Page 354 line 33] Plaxtol a village in Kent, in
south-east England.

[Page 355 line 19] blown off their big toes the easiest wound to inflict on one-self so as to escape military duties. See also “With the Main Guard” in Soldiers Three page 56, line 28. To deliberately wound one-self was a serious offence in war-time’, hence the fact that these men would be court-martialled as soon as they were fit enugh to stand trial.

[Page 355 line 21] send a tank up the pole The first battle involving tanks took place on the River Somme. on Friday 15 September 1916, when about thirty British Mark 1 tanks attacked German positions between the villages of Flers and Courcelette. ‘up the pole’ is slang for going mad.

[Page 355 line 23] Eleventh 11 November, 1918 when the Armistice came into force at 11 o’clock – the end of the Great War.

Gotha the earliest type of German aircraft used for long-range bombing.

[Page 356 line 1] he hung onto himself He kept himself under control despite a mental breakdown.

[Page 356 line 12] a doss slang for a sleep.

[Page 356 line 16] a long shot with a dog’s-chance no chance at all !

[Page 356 line 22] a hair-trigger stomach very inclined to vomit like a firearm with a very sensitive ‘pull’ on the trigger.

[Page 356 line 24] He had ‘em bad see line 1 above.

[Page 356 line 27] drums and horns This may be an echo of Joshua 6, in which the walls of Jericho are knocked down with with rams’ horns. The noises Wilkett heard in his nightmares were certainly threatening.

[Page 357 line 7] “To whom much has been given…” An echo of Luke 12,48, and Kipling’s speech to the Canadian Club, Winnipeg in 1907 (A Book of Words, page 37.)

[Page 357 line 19] “nervous” hospitals for the shell-shocked or those suffering from what is now known as ‘battle fatigue’. See the verse “The Mother’s Son” which accompanies “Fairy- kist” earlier in this volume.

[Page 357 line 22] demobbed demobilised, discharged from the army and returned to civil life,

[Page 357 line 23] locum-tenens a physician who temporarily acts as a substitute for another physician; ‘holding the place’ in Latin. Commonly referred to as a ‘locum’.

[Page 358 line 2] bug-runs laboratories

[Page 358 line 7] a gynaecologist ORG believes that those specialising in the diseases and functions of women acquire a very smooth manner when dealing with that sex. Probably quite right ! (G.S.)

[Page 358 line 31] bathing-machine a feature of the seaside until the 1930s or thereabouts. A small shed on wheels in which bathers could change; it would then be towed into the sea by a horse. (I remember using one at Bournemouth in 1929 or so; Ed.)

[Page 358 line 32] mental retina in his mind’s eye.

[Page 359 line 10] sinus a track leading from the exterior to a deep-seated abscess.

[Page 359 line 12] medieval speculations Possibly he means that the sinus acted as a safety valve by letting the badness, in this case, pus, out of him.

[Page 359 line 25 – 27] grateful appendices … foie-gras patients showed their appreciation for successful operations by Sir James Belton with gifts of champagne. General practitioners only received game and potted goose-liver.

[Page 359 line 29] kosher butcher one who kills and prepares meat in accordance with the tenets of the Jewish faith.

[Page 359 line 33] tuberculous many sinuses leading down to bone, as in this case, are due to tuberculous bone disease.

[Page 360 line 5] mania in delirious mania the patient’s speech is incoherent, he is continually restless and eventually becomes exhausted. Keede is really pointing out how difficult it can be to decide if a person is just hysterical or completely insane.

[Page 360 line 14] homeopathic a system of medical practice in Leipzig dating from 1794, in which diseases are treated by the administration of drugs which would produce in a healthy person symptoms like those of the disease treated.

[Page 360 line 18] third glass third glass of champagne.

[Page 360 line 29] British Riviera usually taken to be the south coast of Devon and Cornwall.

[Page 361 line 25] Tweed a chauffeur.

[Page 361 line 32] paying-rooms private rooms in the hospital that the patients would have to pay for.

[Page 362 lines 3-11] a Syme operation … very comfily developed by Dr. James Syme – see an article on the Internet by R. I. Harris.

‘The details in technique which are most essential to ensure a perfect Syme’s stump are the provision of a broad area of support for the heel flap by transecting the tibia and fibula as low as possible; the maintaining intact of the specialised weight-bearing qualities of the heel flap; and the proper placement of the heel flap under the cut ends of the tibia and fibula. If these aims are achieved a good and useful stump is assured; if they are neglected the stump will be imperfect and may be unsatisfactory and no further operation can restore the qualities of the heel flap which are lacking.’

[Page 362 line 4] Syme James Syme (1799-1870) a Scottish surgeon who first reported 14 cases of his new operation of amputation through the ankle joint in 1844. He was one of the first European surgeons to use ether anaesthesia.

[Page 362 line 7] Bob Sawyer the medical student in The Pickwick Papers by Charles Dickens (1812-1870). Bob Sawyer annoyed Mr Pickwick by talking about bodies and dissection at breakfast-time.

[Page 363 line14] register the medical register, the list of qualified medical doctors in the UK.

[Page 363 line 29] something scandalous ORG suggests it was a syphilitic infection. It might have been, but syphilitic disease of bone usually affects the diaphysis of long bones rather than the articular ends. The tibia is one of the bones commonly affected. Joints are seldom involved. Also with syphilitic disease, the affected bone becomes thickened due to the formation of new bone cells.

[Page 364 line 29] an operative mason, not a speculative one this remark confirms that the narrator, Keede and Scree are all Freemasons, as was Kipling.

[Page 365 lines 1 onwards] he’d been told to operate…. he would not amputate just because another doctor told tim to do so; he would establish the facts and make his own decision.

[Page 365 line 11] Gamaliel an echo of the Acts 22,3, where Paul addresses the men of Jerusalem: ‘I am a man … brought up in this city at the feet of Gamaliel, and taught according to the perfect manner of the law…’

[Page 365 line 17] the tiny muscle that twitches…. orbicularis oculi.

[Page 365 line 28] spirochetes Spirochetes of medical importance belong to the genera Treponema, Leptospira and Borrelia. Treponema pallidum causes syphilis. Leptospira are responsible for Leptospirosis icterohaemorrhagicae or Weil’s Disease. Borrelia recurrentis and B.duttoni cause relapsing fever in Europe and West Africa respectively.

[Page 367 line 10] the taxi-cup a final drink before departure, ‘one for the road’. A modern variation on the stirrup-cup drunk by foxhunters before the chase.

[Page 367 lines 16-17] We were playing for… etc the magazine version reads:

“Thanks, I’ll remember that the next time you call me in”, said Scree.

[Page 367 line 31] solemnity the last word in the collected versions – the magazine version has another sentence:

‘They both seemed to know all about it, but it was full time for me to go home.’