Kipling and Medicine

Other Neurological condiitons

(by Gillian Sheehan)

Locomotor Ataxia

“Love-o’Women” (1893) is a sad story concerning a gentleman-ranker, Larry Tighe, an acquaintance of Mulvaney’s, who, after numerous love affairs – from which he earned his nickname “Love-o’Women” – eventually showed signs of the later manifestations of syphilis. He returned to the one woman he really loved – he called her ‘Di’monds an’ Pearls’ and ‘Aigypt’ – and died in her arms. She shot herself.

When Mulvaney first knew him, Tighe was a big strong, handsome man. They went their separate ways before meeting again several years later. Then Tighe told Mulvaney that he was now called “Love-o’Women”, and that “Larry had been dead for three years”.
It seems to me that Kipling was implying that Tighe had noticed the first signs of tabes dorsalis three years before meeting Mulvaney for the second time.
Tabes dorsalis tends to occur ten or more years after primary infection with syphilis and affects males more than females. Mulvaney thought Tighe had been injured as “he shtaggered a little, an’ laned over all twisted” when he got up. (Ataxia is one of the early symptoms of tabes). Over the next few days, on active service, it became obvious to Mulvaney that Tighe was trying to get himself killed. He would wait until the fire was heaviest, “an’ thin stand up trying to draw the firing on himself”.

Tighe was also suffering from ‘General Paresis of the Insane’ (GPI). This also occurs ten or more years after primary infection and is due to brain damage caused by the spirocaetes responsible for syphilis. In this case it had not caused the ‘delusions of grandeur’ usually associated with it, but it had caused depression, anxiety, lack of concentration, and the bad tremor of his hands which made it impossible for him to button his tunic. It may have also been responsible for his inability to get drunk. Tighe knew a lot about his condition. He told Mulvaney that he would take a very long time to die. He would have been right about this if he had only been suffering from tabes, which is a self-limiting condition, death usually being due to urinary infection. But untreated GPI usually causes death within two years of its onset.

The Army doctor, whom Tighe had repeatedly refused to consult, noticed his ataxia and stamping gait – typical of a person with tabes. He made a spot diagnosis and, to prove himself right, ordered Tighe to stand to attention with his eyes shut (‘Romberg’s Sign’). Tighe, much to Mulvaney’s amazement, was unable to do this because of the loss of position sense in his legs. He was ordered to hospital where his condition rapidly deteriorated.

At the end of the story Tighe was reunited with his one true love, the prostitute Di’monds an’Pearls, and died in her arms. Mulvaney went off to get the doctor and when they returned she was also dead, having shot herself. Why did she shoot herself ? Was she broken hearted at the death of Tighe ? Had she recognised from his condition that he was dying from the effects of syphilis, which she may have given him, or may have contracted from him ? Could she have been aware that she had syphilis for years and was now filled with remorse for infecting him and a great many others ? Was she afraid that, when Mulvaney returned, the doctor would insist on examining her and she would be sent to the nearest ‘Lock Hospital’ where she would have been quite likely to die from the treatment used ?

One would like to think that she ended her life because of her love for Tighe. The doctor was prepared to think so and said it was “a double death from naturil causes” and paid for them to be buried together in the Civil Cemetery. (But later that year he ran off with Major Van Dyce’s lady.) Mulvaney was clearly afraid that he was going to develop “locomotor attacks us” and went around for days kicking his feet against stones “for the pleasure av feelin’ thim hurt”. The only advice the doctor had given him was that Locomotor ataxia was due to being called “Love-o’-Women”, and to “come and see (him) if iver you feel that you’ve got a felt sole in your boot instid av a Government bull’s wool (sock)”.

Veneral disease and the Lock Hospitals

As Kipling said in his autobiography, Something Of Myself :

“it was counted impious that bazaar prostitutes should be inspected or that the men be taught elementary precautions in dealing with them . This official virtue cost our Army in India nine thousand expensive white men a year laid up with venereal disease.”

Venereal disease was one of the most frequent causes of admission to hospital among British troops in India throughout the nineteenth century. Most of the men and approximately two thirds of the officers were unmarried and protitutes provided “a vitally important form of relaxation”. The military authorities recognised this and so did not forbid access to prostitutes.

In the late eighteenth century the East India Company had approved the establishment of ‘Lock Hospitals’ for the compulsory treatment of “diseased women”. But the system of inspection was degrading and repulsive to the civil authorities in charge of these hospitals. Also the standard treatment, which used mercury, was extremely dangerous, and by 1835 Lock Hospitals had been abolished. After the Mutiny the military authorities again established Lock Hospitals, and in 1868 the Contagious Diseases Act was introduced – to have prostitutes examined and brothels regulated. But it was difficult to enforce for several reasons – religious societies objected to “licenced impurity”; there was dishonesty and extortion among the native Indian police – for a Hindoo woman to be sent to a Lock Hospital meant loss of caste and extreme degradation. The Indian (CD) Act was repealed in 1888. [Information from Mark Harrison, Public Health in British India, Cambridge University Press, 1994, p.72 et seq.]

According to his autobiography, Something Of Myself, Kipling visited Lock Hospitals in India, but, I think he must have had expert help with this story, because he described so accurately the clinical features of the later manifestations of untreated syphilis. It has been said that Sir William Gowers (1845-1915) and Kipling were friends. Gowers was an eminent London neurologist with a special interest in neurosyphilis. Kipling made a speech at a congratulatory dinner for Gowers on the occasion of his knighthood in 1897; but “Love-O’-Women” had been published four years earlier, in 1893.

In The Light That Failed, (1890), Dick Heldar, while working as a war correspondent in the Sudan, sustained a head injury – “Dick was conscious that someone had cut him violently across his helmet.” Shortly afterwards “something seemed to crack inside his head, and for an instant he stood in the dark – a darkness that stung”. He returned to London, where, apparently, he did not have any ocular trouble for some months. Then he began to get “pains across his head and spots before his eyes”. This was followed by “a veil of the filmiest gauze” that “unrolled itself from one corner of the studio” leaving a gray haze before his eyes. He consulted an oculist. “The blaze of the gas-microscope in his eyes made him wince.” The oculist said he had “decay of the optic nerve” and that he would be blind in a year. He advised “extreme caution” and “the avoidance of mental anxiety”. At that time Dick “could see perfectly, until a procession of slow-wheeling fireworks defiled across his eyeballs”.

Dick continued to paint, and drink. He found he could see best when he was drunk. “The yellow devil of whisky stood by him and chased away the spots in his eyes.” With the help of the whisky he completed his painting of the Melancholia. But he couldn’t sleep the following night. “The well-known Catherine-wheels inside his eyes had given place to crackling volcanoes of many-coloured fire.” Then “something cracked inside his temples like an overstrained bowstring, the glittering dome broke inward, and he was alone in the thick night”. He was blind.

Each eye has one optic nerve. Damage to one of them would cause blindness in one eye, not in both. The spots before his eyes, the gray haze, Catherine-wheels and cracking volcanoes of many-coloured fire could all be attributed to migraine.

Kipling’s eyesight problems

Kipling suffered from migraine from an early age. Although migraine is uncommon in children, it may have started while he was at Southsea, especially as he was suffering from eyestrain, probably caused by excessive reading in bad light conditions. [Information from Mitchell-Nelson, Textbook of Paediatrics, 4th edition, WB Saunders & Co., 1946, p.1011.] In Something of Myself, (p.17), he recalled how “Some sort of nervous break-down followed, for I imagined I saw shadows and things that were not there.”

While still at boarding-school in 1882, Kipling wrote to Mrs John Tavenor Perry saying that he had been “rather unwell and upset of late”. He blamed the hot summer weather and the fact that he had been working very hard. As a result “My head is aching awfully and the letters are hopping about in front of my eyes.” [Information from Thomas Pinney, editor, The Letters of Rudyard Kipling, Vol.1, p.20.

In a letter to Edith Macdonald in April 1884, Kipling wrote: “I myself have, for the last seven days, suffered from pains in the head – not a head-ache, understand – and all sorts of disturbances in my eyes.” His doctor thought he had been overworking and advised him to “go easy” until he could go to the hills. Information from Thomas Pinney, editor, The Letters of Rudyard Kipling, Vol.1, p.61.

In July 1884, the month Flo Garrard, the young woman who Kipling loved, broke off their ‘understanding’, Kipling’s father had gone to Dalhousie for a week and:

“as soon as I was alone in the big dark house my eyes began their old tricks again, and I was so utterly unstrung (you’d be as bad if you sweated twenty four hours a day for three weeks on end) that they bothered me a good deal. I could only avoid the shadows by working every minute that I could see….” [Information from Thomas Pinney, editor, The Letters of Rudyard Kipling, Vol.1, p.69.

In June 1886, he had a very disturbed night after having had to report on the deaths of three schoolboys. He had known one of them. He wrote: “You know my peculiarity about eyes. It recurs whenever my tummy’s out of order or I’m overworked or unstrung and it came back in full force that night.”

In the same letter he wrote:

“Do you know what hemicrania means ? A half head ache so – (drawing of head with line dividing it from top to bottom). I’ve been having it for a few days and it is a lovely thing. One half of my head in a mathematical line from the top of my skull to the cleft of my jaw, throbs and hammers and sizzles and bangs and swears while the other half – calm and collected – takes notes of the agonies next door. My disgusting doctor says its overwork again and I’m equally certain that it arose from my suddenly and violently discarding tobacco for three days. Anyhow it hurts awfully – feels like petrifaction in sections and makes one write abject drivel.”

The following week he was unable to sleep for three consecutive nights apparently because of headache. His doctor treated him with morphine, which didn’t work, and Kipling spent an afternoon “trying to make some coquettish leeches stick on my temples, but they wouldn’t”. [Information from Thomas Pinney, editor, The Letters of Rudyard Kipling, Vol.1, letter to Margaret Burne-Jones, 3 May – 24 June 1886, p.130 et seq.]

Other neurological conditions

In “The Children Of The Zodiac” (1891) Leo’s earlier neurological symptoms consisted of difficulty in walking and deteriorating vision. He was also losing the power to sing. This may be interpreted in several ways. Weakness of any of the muscles used in singing would make it harder for him to sing, as would a pulmonary disease limiting the amount of breath available for singing. A brain lesion might have made it difficult or impossible for him to produce the right words for a particular song. At the end his “speech was taken from him and he lay still and dumb, watching Death until he died”. In the story Cancer the Crab told Leo “you were born into my House, and at the appointed time I shall come for you.” Cancer is described as being like “the eating of a smothered fire into rotten timber in that it is noiseless and without haste”. I believe Kipling intended the diagnosis to be a brain tumour and the symptoms would fit with that diagnosis.

In “Simple Simon” (1910) cannon-shot from a Spanish ship struck the rail behind Simon’s back, and the rail then jarred his spine. He explained to Una, “from my shoulders down I didn’t act no shape”. He immediately felt “most won’erful cold”. He was able to tell Sir Francis Drake, his Captain, that he couldn’t move his legs, but was then unable to speak for months. He was carried to his Aunt’s house, where he lay “bed-rid and tongue-tied” while “she rubbed (him) day and night, month in and month out”. Eventually “something loosed itself in his back” and he was “whole restored again, but kitten-feeble”.

Injury to Simon’s back, neck, or shoulders, would not have affected his speech.
The massage his aunt gave him would have been of great help to him in preventing bed-sores. These would have developed quickly if he had been left lying paralysed in bed without being turned regularly or massaged. Nerve fibres that have been damaged by injury can sometimes re-grow -at the rate of 1mm per day, so he might, in time, have regained the use of his legs. But the loss of speech does not fit in with the other symptoms.

In “Friendly Brook” (1914) Jim Wickenden’s mother was “took dumb”.

’Twadn’t no stroke. It stifled the old lady in the throat here. First she couldn’t shape her words no shape; then she clucked, like, an’ lastly she couldn’t more than suck down spoonmeat an’ hold her peace”.

Dr Harding, the general practitioner, sent her to Brighton Hospital. From there she was referred to London where “they lit a great old lamp inside her”, but “they couldn’t make out nothing in no sort there … and she came home a hem sight worse than when she started”. From then on she carried a slate tied to her waist-string and wrote down on it whatever she wanted to say. We are not told, but it appears that her condition did not deteriorate noticeably in the following two years.

A cerebro-vascular accident (stroke) affecting the part of her brain that controls the tongue, larynx and vocal cords, that occurred slowly over several weeks, is a possibility, although we are told “’Twadn’t no stroke”. The London doctors must have thought she had a local lesion of the throat or larynx but were unable to see anything abnormal with the “great old lamp”.

In “Mary Postgate” (1915) the German airman, after his crash, was sitting very stiffly at the foot of one of the oaks. “His head moved ceaselessly from side to side but his body was as still as the tree’s trunk.” But “his hands picked at the dead wet leaves”.

This confuses the issue. If he had broken his neck, and was paralysed from his neck down, he would not have been able to move his hands. But it is also unlikely that he would have been moving his head “ceaselessly” on a broken neck. If he had just broken his legs (and he did have a broken branch lying across his lap), he would have still been able to move his arms and his head and would not have been “as still as the tree’s trunk”.

In “The Wish House” (1924) Mrs Ashcroft’s husband was bedridden. “’E lasted eight or nine week. Then he was took with a seizure-like; an’ laid stone still for days.” Then he propped himself up in bed and spoke to her. He appears to have died a few days later. Possibly he was getting multiple transient ischaemic attacks, where the blood supply to part of his brain was temporarily diminished or cut off. If he had had a full-blown cerebro-vascular accident, (stroke), he wouldn’t have been able to prop himself up in bed to speak to her.
With generalised artherosclerosis he may have had peripheral vascular disease reducing the blood supply to his legs, initially causing pain on walking, (intermittent claudication), and later causing pain at rest, making him bedridden.

In “Dayspring Mishandled”,(1928) Vidal Benzaguen’s mother suffered and died because “she loved one unworthy”. Manallace earned money for her “when her husband ran away and the first symptoms of her paralysis showed”. Her condition appears to have progressively deteriorated over some years until she became wholly paralysed and could only move her eyes. Motor Neurone Disease would have killed her in 2-3 years of the onset of her symptoms. [Information from David Rubenstein and David Wayne, Lecture Notes on Clinical Medicine, Blackwell Scientific Publications, 1976, p.96-7.

Neuromyelitis optica is due to a more massive demyelinization than disseminated sclerosis. It could have caused her paralysis but this would have been accompanied or followed by bilateral retrobulbar neuritis with consequent loss of the central fields of vision. Mortality rate is 50%. [Information from Arthur H Douthwaite, editor, French’s Index of Differential Diagnosis, John Wright & Sons, 7th edition, 1954.