The Cole Trilogy: The Physician, Shaman, and Matters of Choice (101 page)

Rob J. tried to keep the relief from his voice as he assured Dr. Holmes it was. They turned down the lamps together, saying good night at the bottom of the stairs and going separate ways. He was giddily conscious of the notes in his pocket. As he passed Allen’s Bakery, a man was removing
trays of pastries from the window, closing for the night, and Rob J. went in and bought two blackberry tarts, a celebration.

He intended to eat them in his room, but in the house on Spring Street the maid was still up, finishing the dishwashing, and he turned into the kitchen and held out the pastries. “One is yours, if you help me steal some milk.”

She smiled. “Needn’t whisper. She’s asleep.” She pointed toward Mrs. Burton’s room on the second floor. “Nothin wakes her once she sleeps.” She dried her hands and fetched the milk can and two clean cups. They both enjoyed the conspiracy of the theft. Her name was Margaret Holland, she told him; everyone called her Meg. When they finished their treat, a milky trace remained in the corner of her full mouth, and he reached across the table and with a steady surgeon’s fingertip obliterated the evidence.

4

THE ANATOMY LESSON

Almost at once he saw the terrible flaw in the system used by the dispensary. The names on the tickets he was given each morning didn’t belong to the sickest people in the Fort Hill neighborhood. The health-care plan was unfair and undemocratic; treatment tickets were divided among the wealthy donors to the charity, who passed them out to whomever they pleased, most of the time to their own servants as rewards. Frequently Rob J. had to search out a tenement to care for someone with a minor complaint, while just down the hall an unemployed pauper lay dying of medical neglect. The oath he’d taken when he had become a physician forbade him to leave the desperately ill patient untreated, yet if he was to keep his job, he had to turn in a large number of tickets and report that he had treated the patients whose names were on them.

One evening at the medical school he discussed the problem with Dr. Holmes. “When I was with the dispensary I collected treatment tickets from my family’s friends who donated money,” the professor said. “I’ll collect tickets from them again, and give them to you.”

Rob J. was grateful, but his spirits didn’t rise. He knew he wouldn’t be
able to collect enough blank treatment tickets to care for all the needy patients in District Eight. That would require an army of physicians.

The brightest part of his day often happened when he returned to Spring Street late in the evening and spent a few minutes eating contraband leftovers with Meg Holland. He fell into the habit of bringing her small bribes, a pocketful of roasted chestnuts, a piece of maple sugar, some yellow pippins. The Irish girl told him the gossip of the house: how Mr. Stanley Finch, second-floor front, bragged—bragged!—he’d got a girl in the family way in Gardner and run off; how Mrs. Burton could be unpredictably very nice or a holy bitch; how the hired man, Lemuel Raskin, who had the room adjoining Rob J.’s, had a powerful thirst.

When Rob had been there a week, she mentioned ever so casually that whenever Lem was given half a pint of brandy he swallowed it all at once and thereupon couldn’t be awakened.

Rob J. made Lemuel a gift of brandy the following evening.

It was hard to wait, and more than once he told himself he was a fool, that the girl had just been prattling. The old house had a variety of nighttime noises, random squeaking of boards, Lem’s guttural snoring, mysterious poppings in the wood siding. Finally there was the smallest sound at the door, really only the suggestion of a knock, and when he opened it, Margaret Holland slipped into his cubby carrying the faint odors of womanhood and dishwater, and whispered it would be a cool night and held out her excuse, a threadbare extra blanket.

Barely three weeks after the dissection of the youth’s cadaver, the Tremont Medical School was sent another bonanza, the body of a young woman who had died in prison of puerperal fever after birthing a child. That evening Dr. Holmes was held up at the Massachusetts General and Dr. David Storer of the Lying-in served as professor. Prior to Rob J.’s dissection, Dr. Storer insisted upon giving the docent’s hands the closest of inspections. “No hangnails or breaks in the skin?”

“No, sir,” he said a bit resentfully, unable to see a reason for the interest in his hands.

When the anatomy lesson was over, Storer told the class to move to the other side of the room, where he would demonstrate how to conduct internal examinations of patients who were pregnant or had female problems. “You may find the modest New England woman will shy away from such examination
or even forbid it,” he said. “Yet it’s your responsibility to gain her confidence in order to help her.”

Dr. Storer was accompanied by a heavy woman in an advanced stage of pregnancy, perhaps a prostitute hired for the demonstration. Professor Holmes arrived while Rob J. was cleaning the dissection area and setting it in order. When he finished, he started to join the students who were examining the woman, but an agitated Dr. Holmes suddenly barred his way. “No, no!” the professor said. “You must scrub yourself and leave here. At once, Dr. Cole! Go to the Essex Tavern and wait there while I gather together some notes and papers.”

Rob did so, mystified and annoyed. The tavern was just around the corner from the school. He ordered ale because he was nervous, although it occurred to him that perhaps he was being fired as docent and shouldn’t spend the money. He had time to finish only half a glass before a second-year student named Harry Loomis appeared bearing two notebooks and several reprints of medical articles.

“The poet sent these.”

“Who?”

“Don’t you know? He’s Boston’s laureate. When Dickens visited America, it was Oliver Wendell Holmes who was asked to write lines welcoming him. But you needn’t worry, he’s a better doctor than he is a poet. Capital lecturer, isn’t he?” Loomis cheerfully signaled for a glass of ale of his own. “Although a bit dotty about washing one’s hands. Thinks dirt causes infection in wounds!”

Loomis also had brought a note scrawled on the back of an overdue laudanum bill from the drug house of Weeks & Potter:
Dr. Cole, read these before returning to the Tremont Med Schl tomorrow night. Without fail, pls. sinc yrs, Holmes

He began to read almost as soon as he got back to his room at Mrs. Burton’s, at first somewhat resentfully, and then with growing interest. The facts had been told by Holmes in a paper published in the
New England Quarterly Journal of Medicine
and abstracted in the
American Journal of the Medical Sciences
. At first they were familiar to Rob J. because they precisely paralleled what he knew was happening in Scotland—a large percentage of pregnant women sickening with extremely high temperatures that quickly led to a condition of general infection and then to death.

But Dr. Holmes’s paper related that a Newton, Massachusetts, physician named Whitney, assisted by two medical students, had undertaken a postmortem examination of a woman who had died of puerperal fever. Dr. Whitney had had a hangnail on one finger, and one of the medical students had had a small raw scar from a burn on his hand. Neither man had felt that his injury was more than an unimportant nuisance, but within a few days the doctor’s arm began to tingle. Halfway up his arm was a red spot the size of a pea, from which a fine red line extended to the hangnail. The arm rapidly swelled to twice its normal size, and he developed a very high fever and had uncontrollable vomiting. Meanwhile, the student with the burned hand also became febrile; within a few days his condition deteriorated rapidly. He turned purple, his belly became very swollen, and finally he died. Dr. Whitney came very close to death, but slowly improved and eventually recovered. The second medical student, who had had no cuts or sores on his hands when they had done the autopsy, developed no serious symptoms.

The case was reported, and Boston doctors discussed the apparent connection between open sores and infection with puerperal fever, but gained few insights. However, several months later, a physician in the town of Lynn had examined a case of puerperal fever while he had open sores on his hands, and within a few days he was dead of massive infection. At a meeting of the Boston Society for Medical Improvement, an interesting question had been raised. What if the dead doctor had not had any sores on his hands? Even if he hadn’t become infected, wouldn’t he have carried the infectious material around with him, spreading disaster whenever he happened to touch another patient’s wounds or sores, or the raw womb of a new mother?

Oliver Wendell Holmes hadn’t been able to get the question out of his mind. For weeks he had researched the subject, visiting libraries, consulting his own records, and begging case histories from doctors who had obstetric practices. Like a man working an intricate picture puzzle, he brought together a conclusive collection of evidence that covered a century of medical practice on two continents. The cases had appeared sporadically and unnoticed in the medical literature. It was only when they were sought out and brought together that they buttressed one another and made a startling and horrifying argument: puerperal fever was caused by doctors, nurses, midwives, and hospital attendants who, after touching a contagious patient, went on to examine uncontaminated women and doomed them to a feverish death.

Puerperal fever was a pestilence caused by the medical profession,
Holmes wrote. Once a doctor realized this, it must be considered a crime—murder—for him to infect a woman.

Rob read the papers twice and then lay there stunned.

He yearned to be able to scoff, but Holmes’s case histories and statistics weren’t vulnerable to anyone with an open mind. How could this runty New World doctor know more than Sir William Fergusson? On occasion Rob had helped Sir William perform autopsies on patients who had died of puerperal fever. Subsequently they had examined pregnant women. And now he forced himself to remember the women who had died following the examinations.

It seemed that, after all, these provincials had things to teach him about the art and science of medicine.

He got up to trim the lamp so he could read the material still another time, but there was a scratching at the door and Margaret Holland slipped into the room. She was shy about taking off her clothes, but there was no place to go for privacy in the small room, and anyway, he was already undressing too. She folded her things and removed her crucifix. Her body was plump but muscular. Rob kneaded the indentations her whalebone stays had left in her flesh and was progressing to more rousing caresses when he stopped, struck by a sudden terrifying thought.

Leaving her in the bed, he got up and splashed water into the washbowl. While the girl stared as though he had taken leave of his senses, he soaped and scrubbed his hands. Again. Again. And again. Then he dried them and returned to the bed and resumed their love play. Soon, despite herself, Margaret Holland began to giggle.

“You are the strangest young gentleman I have ever met,” she whispered into his ear.

5

THE GOD-CURSED DISTRICT

At night when he returned to his room he was so tired that he was able to play the viola da gamba only infrequently. His bowing was rusty but the music was a balm, unfortunately denied him because Lem Raskin soon hammered
on the wall to tell him to be quiet. He couldn’t afford to feed Lem whiskey in order to provide for music as well as sex, so music suffered. A journal in the medical-school library recommended that following intercourse a woman who didn’t wish to become a mother should douche with an infusion of alum and white-oak bark, but he was certain Meggy couldn’t be depended upon to douche regularly. Harry Loomis took it very seriously when Rob J. sought his advice, sending him to a neat gray house on the south side of Cornhill. Mrs. Cynthia Worth was white-haired and matronly. She smiled and nodded at Harry’s name. “I give good price to medical folk.”

Her product was made from the intestinal cecum of sheep, a natural cavity of gut, open at one end and thus admirably suited for conversion by Mrs. Worth. She was as prideful about holding up her wares as if she managed a fish market and they were sea creatures with eyes bejeweled in freshness. Rob J. drew a breath when he heard their price, but Mrs. Worth was unperturbed. “The labor is considerable,” she said. She described how the ceca had to be soaked for hours in water; turned inside out; macerated again in a weak alkaline solution that was changed every twelve hours; scraped carefully until they were free of mucous membrane, leaving the peritoneal and muscular coats exposed to a vapor of burning brimstone; washed in soap and water; blown up and dried; cut on the open ends to lengths of eight inches; and furnished with red or blue ribbons so they could be tied shut, offering protection. Most gentlemen purchased by threes, she said, as they were cheapest that way.