What Killed Jane Austen?: And Other Medical Mysteries (12 page)

Though Cameron’s report did not even suggest suicide, the British media release stated that Rudolf Hess had hung himself.

In outrage, the Hess family insisted on a second autopsy. Still no gunshot wound, but this second report stated that the prisoner had received a savage blow to the back of his head.

Finally, 26 German pathologists took nearly one year to compose a third autopsy report, which supported probable strangulation. Scotland Yard spent six months investigating the death, but British authorities suppressed its report.

Dr Thomas concludes that the prisoner was far too frail and stiff to have possibly hung himself. Instead he was struck on the head and then strangled. Furthermore, Thomas says, British authorities have continued this deception (‘one of the most shameful crimes in history’) ever since.

There is independent support for his views.

Seventy-six members of the Royal College of Surgeons of Edinburgh unanimously agreed that the prisoner who died in Spandau in 1987 could not have been the real Rudolf Hess.

(GB)

For many people ‘the classics’ are books they feel they ought to read, but somehow never do. This is especially true of the modern classics by, among others, Kafka, Orwell, Camus and Auden. Often these books are so tortuous that after the first few pages a reader feels he or she has the drift and puts them away for another occasion. For some, remembered books are the ones they have never read.

The authors are well-known enough, however, and a number of these moderns have had interesting medical histories.

Take Franz Kafka (1883–1924), for instance. Besides being the stimulus for a new word in the language—‘kafkaesque’, meaning ‘man’s bewilderment in a nightmarish world’—medically he had two claims to fame.

A thin, stooped, introspective man, at the age of 34 Kafka concluded that his then persistent cough was psychosomatic in origin, being initiated and stimulated, he felt, for the sole purpose of putting to an end his insoluble internal struggles. Being the reflective, introspective person he was, Kafka seems to have thought it necessary to have an explanation for every bodily function. In fact the cause was much more mundane—he had tuberculosis and was to spend half of his remaining six years in sanatoriums.

However, it was not so much the symptoms produced by the bacillus at its common location, the lung, which are of interest, but the symptoms produced from another, fairly uncommon, area for which he is best remembered medically. The germ affected the writer’s larynx, and eventually left him speechless, parched and gaunt, a victim, he claimed, of a conspiracy of his own body.

Kafka’s second connection with medicine was to do with his work. He lived in Prague and worked at his day job at the Worker’s Accident Insurance Institute, where his task was to assess the degree of disability caused by workplace injuries.

He was there at a time when workers’ compensation was an emerging feature of industrial life, and quickly recognised that it did not always pay to get well quickly; a clean bill of health often meant being sent away empty handed. Limbs became a commodity to be haggled over, and at night Kafka returned home to write about those more seedy aspects of human nature he had seen during the day.

Kafka always felt that he should have won the Nobel Prize for Literature. When it became obvious that was not going to happen, in a fit of gallows humour he exclaimed: ‘At least I think I deserve the Nobel Prize for sputum.’

He was 40 when he died in 1924. Had he not succumbed then, a second fatal trap may have been sprung 20 years on, for his three sisters were gassed in a German concentration camp.

Another well-regarded modern writer was George Orwell (1903–50). He was born in Bengal, where his father was a minor civil-service official, and he grew up in an atmosphere of impoverished snobbery. Nonetheless, he was bright enough to win a scholarship to Eton.

Orwell was also to die of tuberculosis in a sanatorium. Furthermore, like Kafka, he had a laryngeal condition which affected his speech. It was not a chronic infection, however, but the result of a wound to the throat sustained during the Spanish Civil War. Thereafter he spoke in an odd, strained manner.

The Algerian writer Albert Camus (1913–60), who did manage to win the Nobel Prize for Literature, contracted tuberculosis at the age of 17. As a youth he rather fancied himself as a soccer player, but the disease cut short his promising sporting career. He had several flare-ups of the disease, but, as he lived on into the era of antibiotics, he survived with the aid of their use. In the end it did him little good for he died aged 46, not of a diseased chest, but of an automobile accident.

But of this small group of modern writers it is the poet, and one of the angry young men of literature of the 1930s, W.H. Auden (1907–73), who perhaps has the most interesting medical history.

He was born in York, where his father was a general practitioner (well-off enough to employ a coachman, two maids and a cook—those were the days). The year after Auden was born the family moved to Birmingham, where his father had been appointed to a post at the university’s medical school.

Auden felt destined to be a poet from the age of 15, and his undergraduate days at Christ Church, Oxford, cemented his early aspirations.

Photographs taken in his youth show his rather florid face, thick lips and large hands and feet. Apparently he was clumsy in his movements, rather grubby in his personal habits and lived in an apartment which was to be avoided by the fastidious. He was described by Alan Bennett as: ‘scattering his ash as liberally as he did his aperçus. If one wanted to entertain Auden, the first requirement was a good carpet sweeper’.

He was a professed homosexual and his long-time lover was Chester Kallman, an undistinguished young poet who apparently, as Bennett succinctly has it, ‘went down on posterity but not to it’.

With Auden’s heavy features and thick digits, at first glance he had the appearance of an acromegalic. Acromegaly is an uncommon malady caused by a pituitary disorder. Often the first signs of the disease are when the sufferer notices that his hats have become too small and dentures ill fitting.

In Auden’s case, it was not until later in life, when he developed his famous creased, gouged and rumpled face, that the true diagnosis became apparent. He suffered not from acromegaly but from the rare Touraine-Solente-Golé syndrome, also known as pachydermoperiostosis. It is a very rare syndrome, but oddly enough it seems Racine, a towering French poet and dramatist of the 17th century, was similarly affected.

The condition apparently mainly attacks males and is an inherited developmental defect. It is characterised by clubbing of the fingers and toes, coarsening of the features, a rather lugubrious expression, oiliness of the skin and marked furrowing of the scalp. (The features can indeed be confused with acromegaly, however in that condition the facial skeleton, the jaw and skull as a whole are enlarged.)

There is no therapy. It is not fatal, and progresses for five to ten years before becoming stable.

The ailment had no effect on Auden’s capacity for work, and he lived to the age of 66, dying in Vienna in 1973.

His face, while not his fortune, was a constant source of wonderment to the public. After painting Auden’s portrait, the renowned artist David Hockney surely had the final say when he remarked: ‘I kept thinking, if his face looks like this, what must his balls look like?’

(JL)

Thus wrote Byron on the Duchess of Richmond’s ball held on 15 June 1815, a function graced by the Duke of Wellington himself, no less, as well as ‘a thousand hearts beating happily when Youth and Pleasure met to chase the glowing hours with flying-feet’, to quote the poet. It was then, just when ‘joy was unconfined’ that ‘was heard the cannon’s opening roar’ of the Battle of Waterloo.

It all happened a long time ago, when medical care of the casualties of war was quite different from that practised today. Sterility, antibiotics, anaesthetics and rapid evacuation are the norm for the 20th century. But what was it like then?

On 1 March 1815 Napoleon had landed near Antibes in the South of France, having escaped from Elba four days earlier. Thus began the drama of the Hundred Days which reached its climax in Belgium, in the countryside just outside Brussels, near the hamlet of Waterloo.

During those three months the former Emperor had managed to gather around him 115,000 of France’s finest troops, and on the very day of the Duchess’s ball he quietly slipped over the river Sambre in the north east of that country, and, although he did not know it at the time, into military folklore. His plan was to drive a wedge between the 102,000 Anglo-Dutch-Belgium troops under Wellington and the 140,000 approaching Prussians under Marshal Blücher. Initially there was success and the Prussians were driven back to within 40 kilometres of Brussels.

Over the next three days several bloody battles were fought, culminating in the final showdown at Waterloo on 18 June. Many valorous stories are told of the brief campaign, but when the cannon fire had stopped and the smoke cleared, the chilling and sombre fact remained that all told there had been 102,000 fatal casualties including 47,000 at Waterloo itself. These latter were about equally divided between the two forces.

The question is: if Byron could thus verbalise the country’s collective sorrow over the dead, how did the army deal with the daunting problem on the spot of those only marginally better off, the wounded? In a word: ingloriously. In deed and in fact, they had met their Waterloo.

The British Army medical department of the era fell into two categories, those who staffed hospitals, a phalanx of top medical brass led in this instance by Dr John Grant, who was headquartered in Brussels—and those attached to regiments, who were, indeed, at the cutting edge, in more ways than one.

For the Waterloo offensive there were 52 staff surgeons who were distributed among general hospitals at Ostend, Ghent and Bruges as well as Brussels.

In the field the theory was that each battalion of 600 men was allocated one regimental surgeon and two assistant surgeons. In fact, of the 40 battalions, only 22 had this complement. All told there were 36 regimental medical officers and 69 assistant surgeons in the action of June 1815. A veritable thin red line, with sleeves up and eyes down as the foot sloggers went pouring forth ‘with impetuous speed, and swiftly forming in the ranks of war’, to quote Byron again.

Assistant surgeons were unqualified apprentices and usually inexperienced in battle conditions The medical field station, such as it was, was often within cannon-shot range of the battle itself and established in a farmhouse or barn. It was expected to move with the action, leaving the more seriously wounded in the care of the local inhabitants. As the war had already ravished their land, a wounded pillager in their midst must have raised mixed feelings in the unwilling hosts. In the Waterloo campaign, however, most Belgians were generous, caring and unstinting in their efforts to aid the injured, after all they were actually on the side of the allies. Nonetheless, some went onto the field of battle when the combatants had departed and stripped the bodies of any marketable bric-a-brac. Moreover, to further that grisly end, they were not above dispatching a few of the badly wounded.

Between the front and the base hospital there were no intermediate units, but to overcome this deficiency, the authorities supplied each battalion of 600 with one sprung cart, some blankets and 12 stretchers. Brussels is about 19 kilometres from Waterloo, and in the end it proved to be a long and halting walk for many.

No operating instruments were provided, as each surgeon was required to bring along his own boxed set. These included items such as bullet forceps to grope for missiles, a punch to knock out teeth, a pair of strong flippers for trimming the ends of protruding bones and a probang. This later was a flexible strip of whalebone for rummaging about down the throat to clear the passages.

(Since this surgically gung-ho era, of course, such boxed sets of surgeons instruments have become collectors’ items; so much so, in fact, that many extra assortments were manufactured to satisfy the ghoulish curiosity and morbid interest of the amateur collector. One seen now in mint condition probably never saw the inside of a field operating theatre or drew blood in the line of duty.)

The overwhelming size of their task at Waterloo concentrated the minds of the surgeons wonderfully, and the whiff of cordite and press of numbers rapidly overcame any hesitancy due to lack of formal qualifications or dexterity. For his pains, a Regimental Medical Officer was paid 10 shillings a day and in seniority ranked below the youngest ensign in the regiment.

Apart from three defended farms, the battle itself was fought over open country with little cover. This facilitated artillery fire and mass deployment of troops. As a consequence there were three modes of injury.

First, heavy macerating wounds from 6, 9 or 12 pound round shot. The allies had smaller cannon, but the French had the more deadly 12-pounder. The cannon fire was liable to produce violent effects up to about 1,000 metres, and a well-directed shot was capable of killing a dozen or more men in line. A ricochet could be just as lethal. Fortunately, the formalities that June day had been preceded by heavy rain, and the wet ground reduced the chance of ricochet.

Second, injuries from low-velocity lead musket fire. This was effective up to about 30 to 40 metres and the shot frequently fragmented on contact with bone. Over 250 metres it was little more than a nuisance, so muskets could only effectively be used at close quarters, which added a psychological dimension. Multiple shot exploding out of canisters was particularly effective against massed infantry.