Is there a Doctor in the house?

[michaeldr]

Every year in this part of the world [eastern Med] we hear about ‘West Nile Fever’

And every year we hear about a number of people dying from it

I am a layman on this [and other topics]

But looking around the web I understand that this disease was only identified during the inter-war years

My question for the medical professionals amongst us is this

Although unknown/unidentified/unrecognized at the time - 1915

Is it possible that this is what killed Rupert Brooke?

2 April 1915 – attack of Dysentery

9 April 1915 – On the transport ‘Grantully Castle’ Denis Browne records that as Brooke got better he developed a little sore on the right side of his upper lip; it may have been an infected insect bite. It swelled up for about two days and then went away.

20 April 1915 – Battalion on exhausting field day on Skyros. Brooke refused to be left behind, but went to bed early after dinner believing that the wine had made his lip swell up again

Swelling becomes acute

23 April 1915 – Brooke dies in the afternoon onboard the French hospital ship ‘Duguay-Trouin.’

[Details from IWM’s book ‘Rupert Brooke’s Death and Burial’ 1992]

Any professional medical comments will be most welcome

Regards

Michael D.R.

[HarryBettsMCDCM]

<::West Nile Fever::>

This Link might help you make up your minds???

[Robert Dunlop]

Very interesting thought. My first guess is that Brooke suffered the effects of a bacterial infection, most probably related to the dysentry. He does not appear to have had classical typhoid fever. There are related bacteria, however, that can cause dysentry and will spread in the blood stream to other parts of the body. This might explain the lesion that appeared on the lip - it may not have been an insect bite at all. If this were true, then Brooke was experiencing the effects of mild blood-poisoning. As his general condition deteriorated, he would become more succeptible to the effects on other organs, such as the kidneys and heart. The blood chemistry can become very deranged, causing sudden death.

If he did sustain an insect bite, then it most likely became infected with skin bacteria. This would explain the swelling too. The dysentry would have weakened his immune system, making him succumb to what was probably blood-poisoning from the skin infection in association with the previous effects of the dysentry.

It is doubtful that he died from the local effects of a skin infection in the face. These infections are rare and when they are severe enough to kill someone, they are very very nasty. I would have expected the description of his death/mode of dying to have been much more vivid. The sense I get is of someone whose body was gradually overcome by a more general problem.

Just some initial thoughts. If there are any more details forthcoming, this may help narrow the diagnosis.

Robert

[Kate Wills]

Len Sellers has advanced the theory that Brooke may have succumbed to a bite from a spider.

[aconnolly]

Michael

I agree with Robert.

The description of Brroke's illness(es) sounds in keeping with a bacterial infection. The dysentry could well have significantly weakened Brooke's ability to fight a second infection, or the dysentry itself may have been the cause. Or the dysentry may have been a "red herring" given the time between dysentry and death.

As Robert has decribes, the effects of dysentry on the body include the loss of huge quantities of fluid which itself can lead to kidney failure and loss of electrolyes (basically salts) which can lead to (sudden) heart failure. In addition, when the intestine is "diseased", the barrier that keeps bugs in our gut and out of our blood stream is disturbed, therefore in severe cases bacteria can enter the blood stream and cause blood poisoning. This in turn leads to worsening kidney and heart failure, plus lung troubles (fluid build-up) and decreasaed brain function. Under this scenario, it is unlikely someone would initially appear to make a full recovery only to rapidly die three weeks later.

The description sounds like Brooke had a moderate version of the dysentry, was coming right, then suffered a second and ultimately fatal infection. The lip issue is interesting. It may well have been the equivalent of what today is called a "cold sore" - comes up in times of physical ill-health, stress etc. However, the term "acute" is in the report. This suggests an abscess (boil). Whilst one acute abcess is unlikley to kill a young, generally fit man, Brooke would probably still have been recovering (at least metabolically) from the dysentry, so even a relatively innocuous lesion could have killed him.

Very interesting. I look forward to other opinions and more information. Somewhere I have read a report from a fellow officer who was with him when he died, but I'm damned if I can remember who/what.

Andrew

[aconnolly]

This link is to a Brooke web site. Seems to describe bacterial blood poisoning.

Andrew

http://www.rupertbrookeonskyros.com/

Edit: click on "Final days" - this refers to a diagnosis of a diplococcus infection - this is abacteria which if entering the blood stream can be rapidly fatal.

[Robert Dunlop]

Thanks for the link, Andrew. The description fits with a bacterial rather than viral cause of death. 'Cold sore' is a very good suggestion for the lip lesion, with secondary bacterial infection then causing the signs of inflammation. Another alternative is that the surface of the lip may have cracked, partly from dehydration and perhaps from sun damage (I note the mention of sunstroke).

Robert

[michaeldr]

Many thanks to all for your interest in this question

And for the professional opinions supplied

For any non-Gallipoli Association readers of this thread and to amplify Kate’s reminder about Len Sellers' theory; In the Spring 2005, edition No.107 of the association’s journal, ‘The Gallipolian,’ Len told of one of his taped interviews with the late Joseph Murray, who at the time in question was Arthur (Oc) Asquith’s runner and had been sent to find Brooke.

“Brooke was on his bed pointing and touching his lip saying that he had been bitten. Joe said he made quite a fuss about it and was a nuisance. Suddenly, Joe saw near Rupert Brooke’s bed a large black spider. He didn’t like the look of it so killed it with his boot.”

If it was a spider then WNF can be ruled out as it is transmitted by mosquito. If it was blood poisoning then I think that it could equally have been either a spider or an insect. [e.g. people going caving in this part of the world are usually warned of the dangers of spider or tick bites.]

If I read your posts correctly the consensus is that the original diagnosis was correct and that WNF can be ruled out

Since raising this point I have done some further reading and think that the following will be of interest as it gives many more details – e.g. an abscess on the neck and pains in his back and chest. It is from a letter written by Denis Browne and addressed to Edward Marsh and was published by Len in his magazine ‘RND’ issue No.7, December 1998

“After a long day from 8 to 4 he came back to the ship rather tired. Our table in the saloon (Rupert, Oc, Patrick, Charles, Cleg & I always sat together) invited a party from the Franconia to dinner, but only Cherry & Kershaw came. Rupert was quiet & talked very little and went to bed early.

Next morning he staid in bed, feeling seedy I heard. Somehow I did not see him after dinner that night, when I looked in to ask how he was & to show him the Times cutting of Inge’s sermon with the quotation of his sonnet. He said he felt very bad & didn’t want the light on. ……………………….….He complained of a swelling on the left side of his upper lip. He was evidently not up to very much, & I left him.

Next morning (Thursday) he was worse. The Batt. Surgeon (McCracken) was not anxious about his lip, but was worried because he had pain in the chest & back. I looked in three times during the day, but he was dozing & I didn’t like to disturb him. At midday McCracken got really anxious & sent for the A.D.M.S. Gaskell, the D.A.D.M.S. Casement, & the Brigade S.M.O. Schlesinger (whom I recognised as a Guy’s man). They came over about 3 & consulted with McCracken & Goodale (the ship’s surgeon & a good bacteriologist), & the conclusion they arrived at was that he had practically no chance of getting over it: the diagnosis was acute blood-poisoning. They proposed operating by making an incision in an abscess which had formed on the left side of the neck & was pumping the infected blood from his lip all over his body. But before they could do this, we had the idea of getting him on a hospital ship. There was a French hospital ship, the Duguay-Trouin, in Skyros, & we asked them to take him in, as anything would have been better than the stuffy cabin he was in and there were, and there were no proper facilities on the Grantully Castle for nursing him…………………………………………………..

………..He was practically the only patient on the ship & the chief surgeon gave up his whole time to the case, & I believe hardly left him at all. Whether they made the incision in his neck on Thursday night I don’t know. Schlesinger said they would probably ‘irrigate’ the place with antiseptic. Oc & I left him about 6 when we could do nothing more……………………………………………………………………………………….

Next morning Oc & I went over in a steam pinnace soon after breakfast to see what we could do: and found him very much weaker, but not quite so bad as Schlesinger expected. I stayed on board till 2.30, but there was nothing to be done as he was quite unconscious……………………………………………At 2 o’clock the head surgeon told me he was sinking fast & I went off to the Franconia for the Chaplain for his mother’s sake……………………………………………………Oc had arrived at 2.30 & brought Schlesinger from the Royal George. He confirmed the change & told me that it was simply a matter of time……………………………………At 4 o’clock he became weaker & at 4.46 he died.”

Thanks again for your interest

Michael D.R.

[Robert Dunlop]

Thanks Michael. This adds a lot. Robert

[michaeldr]

"This adds a lot. Robert"

No problem Robert – I think that we were very lucky to have had such a keen observer present. I take it that the abscess on the neck, and the chest and back pains only reinforce the opinion about blood poisoning?

Off on a tangent and forgive me if I have mentioned this before

But like the late, great Frank Muir, I am a collector of ill considered trifles

A lady, who was the widow of an officer killed on Gallipoli, also died from blood poisoning following an insect bite. She had by then re-married and her death caused a famous general the blackest day of his life.

Betty Carver was the widow of Captain Oswald Armitage Carver, 1/2nd (E. Lancs) Royal Engineers. (D o W 7th June 1915) She was later married for ten years to Bernard L. Montgomery before she died in October 1937

Michael D.R.

[squirrel]

Thanks for a most interesting thread.

Infected insect bites can cause fairly rapid blood poisoning as the insect in question cuts through the skin directly in to a blood vessel to feed.

Most, bed bugs are one exception, inject an anti coagulant to allow them to feed, and the wound though relatively small, takes time to dry and a scab to form.

Any pathogen that the insect is carrying on the exterior, or it's feeding apparatus can be introduced to the wound.

Spiders don't feed by drawing blood but they do introduce venom which also prevents clotting and a scab forming leaving the wound open to infection.

[Robert Dunlop]

I take it that the abscess on the neck, and the chest and back pains only reinforce the opinion about blood poisoning?

Yes Michael. I must say that the sudden formation of an 'abscess' in the neck arising from a lesion on the upper lip strikes me as unusual. It was on the same side as the original lesion, which fits. I would have expected the infection to have spread into the rest of face, for example the check, as well. 'Abscess' typically implies a deep-seated bacterial infection that takes time to develop. Swollen lymph nodes can develop very quickly, especially with the usual cause of a sudden-onset superficial skin infection.

The chest and back pains raise interesting possibilities. They may be non-specific pains from feeling unwell with blood-poisoning, though these are usually muscle-type aches and pains in the rest of the body - like having a bad case of the 'flu. They could imply other sites of infection, or swollen lymph nodes, deep within the chest.

Irrespective of the above musings, the story fits with blood-poisoning in someone who was already weakened.

Robert

[michaeldr]

Thanks again Robert

and to all the Pals for your valued contributions

Michael D.R.

[Myrtle]

Michael

In Christoper's Hassall's biography of Rupert Brook, he mentions a letter that was sent to Rugby by McCracken the battalion surgeon. McCracken wrote that Dr Goodale, the bacterioligist serving as a junior medical officer on board the Grantully Castle, identified the cause of the swelling down the right hand side of Brook's face and neck, as the germ "Diplococcus, morphologically resembling Pneumococcus".

There is also an explanation of how generally Rupert Brook had a very low immune system, "the coral poisoning at Tahiti had expended it to danger point." All the doctors agreed that the swelling of Brook's lip was caused by a mosquito bite.

Myrtle

[Myrtle]

Michael

Just in case you don't have these details. The cause of death was entered as "Oedeme malin et septicemie foudroyante," (Malignant oedema and overwhelming septicaemia).

Myrtle

[michaeldr]

Myrtle,

Many thanks for those details

I seem to recollect reading about the coral poisoning

however I had not taken onboard how serious it was

I must go back and re-read

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Re post 10 above

In another thread the ever inventive Kate has called a tangent-to-a-tangent

‘A tangle’

And indeed that’s what I appear to be in

The UK’s Saturday papers land here on Monday morning

So this evening I am struggling with the Weekend FT’s Polymath set by Gozo

when I come across the clue to 1 Down

‘Shakespear’s “snapper-up of unconsidered trifles”

[oh dear, my memory again]

My apologies to late Frank Muir who I am confident got the quote right the first time

For those still interested and who have got this far in the tangle

The line is from ‘The Winter’s Tale’ Act IV. Scene 3

“Bohemia. A road near the Shepherd’s cottage”

Autolycus has just been singing

And concludes with the monologue during which he declares

“My father nam’d me Autolycus; who, being, as I am, litter’d under Mercury, was likewise a snapper-up of unconsidered trifles.”

Regards

Michael D.R.

[Robert Dunlop]

...swelling down the right hand side of Brook's face and neck...

Myrtle. Thank you for this extra information. This is more like what I was expecting. I had not come across the French term 'Oedème malin' before. It relates to rapid swelling on the face, often involving the eyes and/or lips. There is a really nasty condition called Ludwig's angina (http://adam.about.com/encyclopedia/001047.htm) that illustrates just how 'malignant' swelling can be in the head and neck. This is not what Brookes had but it makes the point. The speed of onset and the inflammatory reaction fits with the type of bug described.

Robert

[Myrtle]

Michael/Robert

For your information there is also mention of another officer who earlier in the voyage had been troubled with the same kind of swelling on the lip as Brook, however after a poultice or two this officer's infection had cleared up in three days. This appears to indicate that Rupert Brook's condition was complicated by his weaker immune system.

When on the French ship the French surgeons cauterized the infected area and attempted to establish a focal abscess in the thigh, to draw off the bacteria concentrated in the neck. The British doctors were impressed with the French Fleet Surgeons "up-to-date methods" in carrying out this particular operation.

Myrtle

[Robert Dunlop]

A powerful reminder of the helplessness of the pre-antibiotic era. Robert