​In the dim light, the poor woman lying in the enormous bed looked shrunken. Her gauntness emphasised her sharp features, softened only by the frills of her night-bonnet. A storybook illustration of a witch sprang into Sarah’s mind. Although supported by pillows, it appeared the effort of keeping her head upright exhausted Mrs Kesby and she kept closing her eyes.

She has called Sarah to her room to offer her a compromise. She will agree to her marrying Edwin – an unsuitable match in her eyes – on condition Sarah waits for a year:

It may have been Mrs Kesby’s common sense which made her accept the futility of further efforts to change Sarah’s mind. More likely, she had registered the imminent end to her span on this earth and death’s shadow lent her a clemency little in evidence during her hale and hearty years. The headaches which plagued her for several months worsened in frequency and intensity. Before the year ended, she was dead from a growth on the brain.

Mrs Kesby has been suffering from a brain tumour. Her symptoms apparent in the story are headaches, loss of balance, and fatigue. In 1898 there was little effective treatment for cancer other than surgical removal of the tumour. This was commonly attempted in cases where the tumour was visible, in breast cancers for example, but in the absence of CT scans, operating on a brain tumour was precarious to say the least. Nevertheless, it was attempted and ‘The first practical treatise on intracranial tumors was published in 1888 by Byrom Bramwell (1847 – 1931), an English surgeon who specialised in surgery for brain tumors.’ 1
 
Radiotherapy was developed too late for Mrs Kesby as X-rays were only discovered by Roentgen in 1896 and not used for cancer diagnosis or treatment until three years after that. All that was available to Mrs Kesby were adjustments to her diet and the ubiquitous bloodletting.

​Winnie Hill - Measles

When Sarah goes to her sister-in-law Elsie’s house to tell her she has gone into labour, she notices Elsie’s little girl, Winnie, is looking unwell:
 
Six-year-old Winnie sucked her thumb, staring at Sarah with glazed eyes.
 
The next day, Ed hears from his brother-in-law, Alf, that Winnie has the measles:
They shook hands. “How’re things?”
“Not bad, though Winnie’s come down with the measles, so Elsie’s busy. She won’t be goin’ round yours to help with the newborn, I’m afraid.”
“Crikey! Sorry to hear that. Hope poor Winnie gets over it soon.” Ed frowned in concern for Alf’s wife and daughter and his own. He had been relying on Elsie to help Sarah find her feet with the baby. “Hope the others don’t catch it.”

In 1900 when this conversation takes place, germ theory was still in its infancy, but thanks to the work of Louis Pasteur and Joseph Lister, most people knew that diseases like measles were infectious. British patent applications in 1900  included devices for avoiding infection from the communion chalice and the telephone. 2 Hence, Alf’s decision to send the other children away to prevent them catching it. But by no means everyone understood the mechanics of infection as this cartoon from 1915 indicates:

Measles was common and most people survived it, but it could have unpleasant side effects ranging from mild, such as diarrhoea and ear infections, to serious such as blindness, encephalitis and pneumonia leading to death. One of the treatments at this time was for the patient to stay in a darkened room as it was thought, erroneously, that light would increase the likelihood of blindness. Children lay in darkened rooms for two or three weeks until the infection had passed, a practice which continued well into the 20th century. I remember my mother telling me about her experience of this, and she was born in 1923.

Nowadays immunisation helps keep the incidence of measles down, although outbreaks of the disease occur in populations where the uptake of vaccinations is low. Measles is a virus and there are no antiviral drugs to treat patients once they’ve contracted the disease.

Edwin Marsh - Consumption

The first sign of this disease in Sarah’s husband, Ed, is a cough:
 
Ed’s coughing fit marred the walk to the park. He’d had a lingering cough for three weeks and couldn’t seem to shift it. Half way up Park Avenue he convulsed in a spasm lasting minutes, bringing up phlegm which he spat into a drain. As soon as they reached the park, he sat down on a bench close to the entrance.
            “You lot go and explore. I’m gonna sit here and catch my breath. I’ll wander along later and find you.”
            “Are you sure, Ed? We can wait with you.” Sarah tried to keep the anxiety out of her voice: the coughing fit had unsettled her. She would make certain they talked about it when they got home. Ed had to see a doctor.
 
The coughing is followed by a fever:
 
In the night, she awoke to find Ed trembling next to her. He had thrown off the covers and was exuding heat like a furnace, dampening the sheets with sweat.
“What is it, Ed? What’s the matter.”
“Don’t know. I can’t stop shivering. Must’ve got a fever.”
Sarah fetched a flannel wrung out with cold water to soothe his brow and lay awake worrying until he stopped shaking and fell back asleep.

Ed is suffering from tuberculosis commonly referred to as TB. The symptoms are a cough lasting more than three weeks which produces phlegm, sometimes with blood in it, fever, chills, night sweats, loss of appetite and weight loss, fatigue, sometimes swellings in the neck. Ed displays many of these symptoms:
Trembling and sweating from one of his night fevers, Pa’s voice shook, and he struggled to catch his breath. The handkerchief he clasped was speckled red. Jane wished she could help. She would trade everything she owned to make him better.

“It’s Jane, Pa. Annie’s in the cellar with Ma and the others. They’re all right, just scared. It was a loud bang.” 
     You can say that again.” Pa struggled to sit up and Jane propped pillows behind him, noticing the hard glitter of his eyes in the darkness.

And:
 
Bert had met him before and remembered him as a young, lively, athletic man. The change in his appearance shocked him: he had lost weight and muscle tone, looking gaunt and wasted. He must be mid- to late-thirties, yet looked older than Jack’s dad in his forties.

TB was widespread in the 19th and early 20th centuries, especially amongst the urban poor whose diets and unsanitary living conditions undermined their immune systems. ‘Causing as much as one-quarter of all deaths in Europe, arising with particular frequency among young adults between the ages of 18 and 35, and bringing on a lingering, melancholy decline characterized by loss of body weight, skin pallor, and sunken yet luminous eyes, tuberculosis was enshrined in literature as the “captain of death”, the slow killer of youth, promise, and genius.’ 3
 
Famous people who died of TB in the 19th and 20th centuries include Keats, Chopin, the Brontë sisters, Chekhov, Modigliani and Kafka.
 
It is caused by a bacterium, mycobacterium tuberculosis, identified in 1882 by the German physician, Robert Koch, for which he received a Nobel prize. It is not highly contagious and most people’s immune systems can overcome it. But in some people the bacteria lie dormant for years without the infected person showing symptoms of the disease.

​
Immunization was developed by 1921 but only became widespread after World War 2. In the early 1900s when Ed was suffering from this disease treatment options were limited. It was believed that fresh air was of benefit and sufferers were encouraged to rest and take the air in sanatoria located in the mountains or by the sea – a feasible course of treatment for the wealthy but not for the likes of Ed. He eventually succumbs to TB and dies aged forty:

Two weeks after Armistice Day, Pa neared his end. He surprised the doctor by lingering so long after so protracted an illness. At least he realised the war was over. For the final hours he slipped into unconsciousness, Jane took turns with Annie and Ma to hold his hand, listening to the gurgling breathing, as though his lungs were liquefying.
Ma smoothed the hair from his forehead. “Look how curly black his hair still is, Jane. Hardly any grey.” She ran her fingertips along the side of his face, tracing his jawbone in a loving caress. “We must give him another shave this evening. See how badly we did it before.”
Jane moved closer to study Pa’s gaunt, muscle-wasted face. Patches of tattered beard grew where the pockets of sunken flesh were too slack for the razor. The sight made her tearful.

Nowadays TB is treated by antibiotics and is only fatal if left untreated.

That’s this dose of medical facts done with, but there’s more to come next time. Thanks for reading.
 
Sources:
1. A note from history: Landmarks in history of cancer, parts 4 and 5 by Steven I. Hajdu MD and Farbod Darvishian MD, American Cancer Society Journals, 2013.
2. Health & Medicine in the 19th Century by Jan Marsh, Victoria and Albert Museum website.
3. Tuberculosis through history by the editors of Encyclopaedia Britannica.
​4. History of Cancer, Ancient and Modern Treatment Methods Akulapalli Sudhakar Journal of Cancer Science & Therapy, Vol.1 Issue 2
5. Wikipedia

A surgical operation to remove a malignant tumour from a man's left breast and armpit in a Dublin drawing room, 1817. Watercolour, 1817. [Power, Robert F. Credit: Wellcome Collection.]

For George, opiates to dull the pain were the only treatment. He dies a couple of months after this final meeting with his daughter and granddaughter in February 1920.

Enough of this gruesome topic for the time being - more characters and their illnesses in the next blog. Good health to you all!

Adrienne.
 
Footnote: 1. Emily Baumrin, William Corbett, and Amita Kulkarni, Dartmouth Medical School, 2010

Sources:
1.The Attempt to Understand Puerperal Fever in the Eighteenth and Early Nineteenth Centuries by Christine Hallett PhD.
2. Childbed fever: A Nineteenth-Century Mystery by Christa Colyer School of Science University of Ontario Institute of Technology
3. A comprehensive history of cancer treatment by Nigel Hawkes.