Disease, illness, and death in Shakespeare Cliff (3)

An early 20th century doctor

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Welcome to the third blog about health issues referenced in my novel, Shakespeare Cliff.

Historical fiction involves a lot of research which informs the story but is not always included in it. This blog is for sharing some of the interesting and fun facts I discovered while researching the novel.

Illnesses covered in previous blogs have been childbed fever, duodenal ulcer, growths on the lungs and brain, measles, and consumption. Three more conditions this time.
 
SPOILER ALERT!! Contains extracts from the book and plot reveals.
 
 Bert Davies - Stomach flu

One of the characters, Bert Davies, gets offered a chance to do some moonlighting on a Saturday when he was supposed to be at work.

Jack’s dad knew a man contracted to demolish a row of dilapidated cottages in the Pier District where they were clearing slums. His workforce had succumbed to stomach flu, and the job had stalled. Desperate to meet his deadline, the contractor recruited labourers from the dockworkers’ line-up with the promise of a bonus, if they finished by the weekend. Jack recruited Bert.

The workers’ illness inspired the lie Bert planned to tell when he returned to work on Monday—stomach problems.
 
Gastroenteritis was common in the early twentieth century, caused either by a virus or bacteria. Both types of intestinal infection were commonly known as stomach flu. The symptoms of gastroenteritis are a watery diarrhoea, abdominal cramps, nausea or vomiting, and sometimes fever. The most common way to develop stomach flu was through contact with an infected person or by consuming contaminated food or water. It could be very unpleasant, but usually cleared up by itself within a week. Unfortunately, it spread very easily.

Stomach flu was common in summer and was believed to be brought on by heat. Treatments included castor oil, opium, brandy and hot baths. Soapsuds enemas were used to purge the intestines. The importance of restoring fluids and salt was largely unrecognised until the middle of the 20th century.
 
Since early times, diarrhoea has been associated with cowardice. In military conflicts, soldiers suffering from it were considered ‘gutless’, whereas diarrhoea-free soldiers had the ‘guts’ to keep fighting.
 
The saying ‘an apple a day keeps the doctor away’ has some validity when it comes to diarrhoea. During WW1, it was discovered that prisoners of war in a German camp who ate apples scrounged from a nearby orchard rid their systems of diarrhoea more quickly than the other prisoners. Research has proved it is the pectin in apples which has this effect.1

Paul Cezanne, (Aix-en-Provence, 1878-1887)

WW1 hospital ward

Jack Hill – Brain fever
 
Whilst not a sufferer of this illness himself, Jack suffers the consequence of an outbreak of brain fever at the naval training barracks at HMS Pembroke, Chatham in 1917.
 
Jack walked into the drill shed with his kitbag, searching for a place to kip. Close to nine hundred seamen, all trades and ranks, slept in crowded conditions in that hall. Some were there because the authorities had quarantined one barrack following an outbreak of brain fever.
 
Brain fever was the term used for any acute cerebral infection accompanied by fever. In this case it was epidemic cerebrospinal meningitis, otherwise known as spotted fever, caused by the meningococcus bacteria, Neisseria meningitidis. The bacteria produce inflammation of the meninges, or membranes, of both the brain and the spinal cord. It is highly infectious and often fatal, 50% if untreated.

​The symptoms of the disease are flu-like and include fever, headache and a stiff neck. Sufferers may go on to develop nausea, vomiting, sensitivity to light, a rash, and confusion.2

The bacteria are spread via secretions from the throat and respiratory tract. ‘Smoking, close and prolonged contact – such as kissing, sneezing or coughing on someone, or living in close quarters with a carrier – facilitates the spread of the disease’.3 It’s easy to see how a crowded barracks would be an ideal breeding ground for it.

Nowadays meningitis is treated with antibiotics and there are vaccinations against some forms of the disease. These were not available during WW1. Instead, patients were given emetics to induce vomiting, quinine wine, and the ubiquitous treatment of bloodletting. ‘It was believed that reducing the amount of fluid in the body by bloodletting and vomiting would relieve the pressure of inflammation.’4  From the late 19th century, lumbar punctures were also used to drain off excess fluid for the purpose of reducing pressure. Can’t have been fun without anaesthetic.

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Meningitis lumbar puncture, early 20th century (Wickiwand)

By the beginning of the 20th century immune serums were being developed using antibodies from animals injected with the meningitis bacteria. Injecting horse antiserum into the spinal fluid was the first effective treatment against meningitis and saved many lives during WW1. By mid-century this treatment was no longer recommended and penicillin was commonly used, heralding the start of the antibiotic era. Aren’t you grateful to be living in the 21st century?

Charles Kemp – Poliomyelitis

Charles suffered from polio as a child. It left him with a withered leg. He mentions it in the first conversation he has with Jane, his future wife.
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Lost in her thoughts, she realised the man next to her had spoken.
“Oh, I’m sorry, sir. I didn’t catch what you said. I was absorbed in watching the dancing.”
He smiled. “That’s all right. I said if I could dance, I would ask you to take a turn with me, but I can’t, I’m afraid—gammy leg.” He knocked his leg with his cane.
“Oh, dear. Is it a war injury?”
“Sadly not.” A faint blush shaded his cheeks. “I’d have something to be proud of, if it were. No, a childhood disease left me with a withered leg.”
Jane noticed a metal calliper extending below his trousers and underneath his shoe. Unsure how to respond, she smiled.
 
            Unlike Charles’s previous girlfriend, Emma, Jane is not repulsed by his disability. She sees his withered limb for the first time on their wedding night.

“Would you like to see my leg, Jane?”
From her reaction, she had not expected that question. Without waiting for an answer, he rolled up his pyjama trouser leg to display the withered limb, his calf not much thicker than the bone within it, the foot misshapen and turned inwards. As Jane stared, he studied her face, and noted sadness and sympathy, not the revulsion he had seen in Emma’s expression.
“Oh, you poor thing,” she said. “It must have been awful for you, especially as a young child. When did it happen?”
“I contracted the disease when I was nine.”

Poliomyelitis is a highly contagious virus specific to humans. It is passed on through contact with faecal matter in contaminated food or water and invades the nervous system where it destroys nerve cells which control the muscles, especially the legs, causing paralysis. Death occurs in five to ten percent of cases when the disease reaches the respiratory system. It mainly affects children. There is no cure. It can only be prevented by immunisation but that had not been developed at the time Charles contracted the disease in 1903.
 
Although it is an ancient disease, outbreaks were relatively rare in the West until the late 19th century. Michael Underwood, a paediatrician in London, was the first to describe the disease in June 1894, but the first large-scale epidemic occurred in the United States in 1916.
There were no effective treatments, but a diverse range was attempted: baths using almond meal or oxygenated water, poultices of chamomile, slippery elm, arnica or mustard, doses of caffeine, quinine, radium water, and even chloride of gold.5

​In the 1950s an apparatus known as an ‘iron lung’ was invented to help polio victims whose breathing muscles had been affected. The patient was sealed inside the machine and air was pumped out of the casing, reducing pressure and making the chest rise to fill the lungs. When air was allowed back in, the lungs emptied.

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Children in an iron lung, 1950, before the advent of a vaccine.

It is not surprising that the vaccine, developed in 1955, was welcomed as a medical miracle. The injection was replaced in 1962 by a sugar cube vaccine. I have a vivid memory of eating my pink sugar cube, no doubt one of my more pleasant visits to the doctor’s surgery.
 
Thankfully polio has almost been eradicated worldwide. In 2015 there were only seventy-four reported cases, and in 2020 the WHO classified the disease as endemic only in Afghanistan and Pakistan.

In the USA, this cardboard placard was placed in windows of residences where patients were quarantined due to poliomyelitis. Violating the quarantine order or removing the placard was punishable by a fine of up to US$100 in 1909 (equivalent to $2,846 in 2019).Wikipedia

​That's all for now. Stay healthy! Next blog: the Spanish Flu.

​References:
1The History of Acute Infectious Diarrhoea Management by Z.H.McMahan and H.L.Dupont
2 CDC – centers for disease control and prevention
3 WHO
4The History of Meningitis: Causes, Treatments and Vaccines – Confederation of Meningitis Organisations
5 A Monograph on the Epidemic of Poliomyelitis (Infantile Paralysis) in New York City in 1916 by John Haven Emerson
 
Sources:
The Independent newspaper
Britannica
Wikipedia
The history of polio, Action Medical research blog, October 2016.