The Cole Trilogy: The Physician, Shaman, and Matters of Choice (151 page)

“As difficult as it is,” Jay said, “we mustn’t allow this war to end our friendship.”

“No. Of course not!” It might not end it, Rob J. thought, but their friendship already had been strained and spoiled. He was startled when Geiger, departing for home, embraced him like a lover. “I look upon your loved ones as my own,” Jay said. “There’s nothing I wouldn’t do to ensure their happiness.”

Next day Rob J. understood Jay’s farewell mood when Lillian, sitting dry-eyed in the Coles’ kitchen, told them her husband had left for the South at daybreak, to volunteer his services to the forces of the Confederacy.

It seemed to Rob J. the whole world had turned as somber as Confederate gray. Despite all he could do, Julia Blackmer, the minister’s wife, coughed herself to death just before the winter air turned thin and cold. In the churchyard the minister wept as he recited the prayers of interment, and as the first shovelful of dirt and stone fell with a thump on Julia’s pine box, Sarah squeezed Rob J.’s hand so hard it hurt. The members of Blackmer’s flock gathered to support their clergyman in the days that followed, and Sarah organized the women so that Mr. Blackmer never lacked for sympathetic company or a prepared meal. It appeared to Rob J. that the minister should have a little privacy in his grief, but Mr. Blackmer appeared grateful for the good works.

Before Christmas, Mother Miriam Ferocia confided to Rob J. that she’d received a letter from a firm of Frankfurt solicitors, telling her of the death of Ernst Brotknecht, her father. His will had arranged for the sale of the Frankfurt wagonworks and the carriage factory in München, and the letter said that a considerable sum of money was waiting for his daughter, known in her former life as Andrea Brotknecht.

Rob J. expressed his regrets about her father, whom she hadn’t seen in years. Then, “Good grief. Mother Miriam, you’re rich!”

“No,” she said calmly. She had promised to turn all worldly goods over to Holy Mother Church when she took the habit. She had already signed papers giving the inheritance into the jurisdiction of her archbishop.

Rob J. was irked. Over the years, hating to see the nuns suffer, he had made a series of small gifts to their community. He had observed the rigor of their lives, the severe rationing and the lack of anything that might be considered a luxury. “A little money would make such a difference to the sisters of your community. If you couldn’t accept for yourself, you might have thought of your nuns.”

But she wouldn’t allow him to draw her into his anger. “Poverty is an essential part of their lives,” she said, and nodded with infuriating Christian forbearance when he said good-bye too abruptly and rode away.

With Jason gone, a lot of warmth went out of Rob’s life. He might have continued to make music with Lillian, but the piano and the viola da gamba sounded strangely unsubstantial without the melodious cement of Jay’s violin, and they found excuses to avoid playing alone.

The first week of 1862, at a moment when Rob J. felt particularly discontented, he was happy to receive a letter from Harry Loomis in Boston, accompanied by the translation of a paper published in Vienna several years before by a Hungarian doctor named Ignaz Semmelweis. Semmelweis’ work, entitled
The Etiology, Concept, and Prophylaxis of Childbirth Fever
, essentially buttressed the work done in America by Oliver Wendell Holmes. At the Vienna General Hospital, Semmelweis had concluded that childbed fever, which killed twelve mothers out of one hundred, was contagious. Just as Holmes had done decades earlier, he had discovered that doctors themselves spread the disease by not cleaning their hands.

Harry Loomis wrote that he was becoming increasingly interested in ways of preventing infection in wounds and surgical incisions. He wondered whether Rob J. was aware of the research of Dr. Milton Akerson, who worked on these problems at the Hospital of the Mississippi Valley in Cairo, Illinois, which Harry believed was not too far distant from Holden’s Crossing.

Rob J. hadn’t heard of Dr. Akerson’s work, but at once he knew he wanted to visit Cairo and observe it. Opportunity didn’t arrive for several months. He rode through the snow and made his calls, but at last things turned quiet, just as the spring rains came. Mother Miriam assured him that she and her sisters would keep an eye on his patients, and Rob J. announced he was going to Cairo for a brief vacation. On April 9, a Wednesday, he
plodded Boss through the rich gumbo on the roads as far as Rock Island, where he boarded the horse in the stable; then, at dusk, he caught a ride on a log raft down the Mississippi. Throughout the night he floated downriver, reasonably snug under the roof of the raft shack, sleeping on the logs next to the cookstove. When he left the raft at Cairo next morning, he was stiff and it was still raining.

Cairo was in awful shape, fields flooded and many of the streets underwater. He made a careful toilet at an inn that also sold him a poor breakfast, then found the hospital. Dr. Akerson was a swarthy, bespectacled little man whose heavy mustaches continued across his cheeks to join his hair at his ears, after the regrettable fashion made popular by Ambrose Burnside, whose brigade had made the first attack against the Confederates at Bull Run.

Dr. Akerson greeted Rob politely and was detectably pleased to hear that his work had gained the attention of colleagues as far away as Boston. The air in his wards was sharp with the odor of hydrochloric acid, which was the agent he believed could fight the infections that so often brought death to the wounded. Rob J. noted that the smell of what Akerson called the “disinfectant” masked some of the disagreeable odors of the ward, but he found it irritating to his nose and his eyes.

He soon saw that the Cairo surgeon had no miraculous cure.

“At times, there definitely seems to be a benefit from treating the wounds with hydrochloric acid. At other times …” Dr. Akerson shrugged. “Nothing seems to work.”

He had experimented with spraying hydrochloric acid into the air of the operating room and the wards, he told Rob, but had discontinued that practice because the fumes made it difficult to see and breathe. Now he contented himself with saturating dressings in the acid and placing them directly on the wounds. He said he believed that gangrene and other infections were caused by pus corpuscles floating in the air as dust, and that the acid-soaked dressings kept these contaminants from the wounds.

An orderly came by bearing a tray laden with the dressings, and one fell from the tray onto the floor. Dr. Akerson picked it up, brushed some dirt from it with his hand, and showed it to Rob. It was an ordinary dressing, made from a cotton rag soaked with hydrochloric. When Rob returned it to Dr. Akerson, the surgeon sighed and put it back on the tray to be used. “A pity we can’t determine why sometimes it works and sometimes it doesn’t,” Akerson said.

Their visit was interrupted by a young physician who informed Dr.
Akerson that Mr. Robert Francis, a representative of the United States Sanitary Commission, had asked to see him on “most urgent business.”

As Akerson walked Rob J. to the door, they found Mr. Francis waiting anxiously in the corridor. Rob J. knew and approved of the Sanitary Commission, civilian organization established to raise funds and recruit personnel to care for the wounded. Now, speaking hurriedly, Mr. Francis told them there had been a desperate two-day battle at Pittsburg Landing, Tennessee, thirty miles north of Corinth, Mississippi. “There are terrible casualties, many times worse than Bull Run. We’ve gathered volunteers to serve as nurses, but we’re frantically short of physicians.”

Dr. Akerson looked pained. “The war has taken most of our doctors. There is no one who could leave here.”

Rob J. spoke at once. “I’m a physician, Mr. Francis. I’m able to go.”

With three other physicians gathered from nearby towns, and fifteen assorted civilians who never had nursed anyone before, Rob J. boarded the river packet
City of Louisiana
at noon and steamed down the wet murk that covered the Ohio River. At five
P.M
. they reached Paducah, Kentucky, and entered the Tennessee River. It was a long 230 miles down the Tennessee. In the dark of night, unseen and unseeing, they passed Fort Henry, which Ulysses S. Grant had captured only a month before. All the next day they chugged past river towns, laden wharves, more flooded fields. It was almost dark again when they reached Pittsburg Landing at five
P.M.

Rob J. counted twenty-four steamships there, including two gunboats. When the medical party disembarked, they found the bank and the bluffs had been trodden into mud by a Yankee retreat on Sunday, and they sank halfway to their knees. Rob J. was detailed to go onto the
War Hawk
, a ship that was laden with 406 wounded soldiers. They were almost finished loading when he boarded, and they got under way without delay. A grim first officer told Rob J. quietly that the enormously high battle casualties had taxed the hospital facilities in communities throughout Tennessee. The
War Hawk
would have to carry its passengers 658 miles, up the Tennessee River to the Ohio, and up the Ohio River to Cincinnati.

Wounded men had been set down on every surface—below, in the officers’ and passengers’ cabins, and all over the open decks under the unceasing rain. Rob J. and an army medical officer from Pennsylvania named Jim Sprague were the only doctors. All the supplies had been dumped in one of the
staterooms, and the voyage wasn’t two hours old when Rob J. saw that medicinal brandy was being stolen. The military commander of the ship was a young first lieutenant named Crittendon, his eyes still dazed from combat. Rob convinced him that the supplies needed an armed guard, which began at once.

Rob J. hadn’t brought his own medical bag with him from Holden’s Crossing. There was a surgical kit with the supplies, and he asked that the engineering officer sharpen several of the instruments. He had no desire to use them. “Travel’s a rough shock to wounded men,” he told Sprague. “I think whenever it’s possible, we should postpone surgery until we can get these people to hospitals.”

Sprague agreed. “I’m not much for cutting,” he said. He hung back, letting Rob J. make the decisions. Rob decided Sprague wasn’t much for doctoring either, but he put him in charge of dressing wounds and seeing that the patients received soup and bread.

Rob saw almost at once that some of the men had been badly mangled and required amputation without delay.

The volunteer nurses were eager but green—bookkeepers, teachers, liverymen—all facing blood and pain and kinds of tragedy they had never imagined. Rob gathered several around him to help with the amputations, and set the rest to work under Dr. Sprague, bandaging wounds, changing dressings, bringing water to the thirsty, and sheltering those on deck from the chill rain with whatever blankets and coats could be found.

Rob J. would have liked to go to each of the wounded men in turn, but there wasn’t opportunity to do that. Instead, he went to a patient whenever a nurse told him there was a man who was “bad.” In theory, none of those who’d been placed on the
War Hawk
should have been so “bad” that they couldn’t survive the trip, but several died almost at once.

Rob J. ordered everyone removed from the second mate’s cabin and began to amputate there by the light of four lanterns. That night he took fourteen limbs. Many on board had been amputated before they were placed on the boat, and he examined some of these men, saddened by the poor quality of some of the surgery. A man named Peters, nineteen years old, had lost his right leg at the knee, his left leg at the hip, and all of his right arm. Sometime during the night he began to bleed from his left leg stump, or perhaps he’d been bleeding when brought aboard. He was the first to be discovered dead.

“Poppa, I tried,” wept a soldier with long yellow hair and a hole in his
back in which his spine gleamed white as a trout’s bones. “I tried hard.”

“Yes, you did. You’re a good son,” Rob J. told him, stroking his head.

Some screamed, some wrapped themselves in silence like armor, some wept and babbled. Slowly Rob J. puzzled the battle out of small pieces of their individual pain. Grant had been at Pittsburg Landing with forty-two thousand troops, waiting for General Don Carlos Buell’s forces to join up with him. Beauregard and Albert Johnston decided they could defeat Grant before Buell got there, and forty thousand Confederates fell on the bivouacked Union troops. Grant’s line was pushed back on both the left and the right, but the center, manned by soldiers from Iowa and Illinois, held through the most savage kind of fighting.

The rebels had taken many prisoners on Sunday. The bulk of the Union force was driven back all the way to the river, into the very water, their backs to the bluff that prevented them from further retreat. But Monday morning, when the Confederates would have mopped up, boats emerged from the morning mist, carrying twenty thousand reinforcements from Buell, and the battle was turned. At the end of that savage day of fighting, the Southerners retreated to Corinth. By nightfall, as far as the eye could see from the Shiloh Church on the battlefield, dead bodies covered the ground. And some of the injured were picked up and placed aboard boats.

In the morning the
War Hawk
slipped past forests bright with new leaves and thick with mistletoe, and greening fields, and now and then a peach orchard alight with blossom, but Rob J. didn’t notice.

The boat captain’s plan had been to pull into a river town morning and evening in order to take on wood. At the same time, the volunteers were to go ashore and forage whatever water and food they could obtain for their patients. But Rob J. and Dr. Sprague had prevailed upon the boat captain to make a stop each noon as well, and sometimes in the middle of the afternoon, because they found it was easy to run out of water. The afflicted thirsted.

To Rob J.’s despair, the volunteers couldn’t begin to maintain hygiene. Many of the soldiers had had dysentery before being hurt. Men defecated and urinated where they lay, and it was impossible to clean them. There were no changes of clothing, and their wastes caked on their bodies as they lay in the cold rain. The nurses spent most of their time distributing hot soup. On the second afternoon, when the rain stopped and a strong sun came out, Rob J. greeted the warmth with great relief. But with the steam that
rose from the decks and the people came a magnification of the enormous smell that gripped the
War Hawk
. The stench became almost palpable. Sometimes when the boat stopped, patriotic civilians came aboard with blankets, water, and food. They blinked, their eyes watered, and they always hurried away without delay. Rob J. found himself wishing that he had a supply of Dr. Akerson’s hydrochloric acid.