The Last Jew (34 page)

The other examiner, Calca, was a smiling, hearty man with red hair and a small, sharp beard. He wore a tunic encrusted with dried and clotted blood, pus, and mucus. Nuño already had disdainfully described the tunic to Yonah as 'the man's boastful advertisement of his trade,' and had warned Yonah that Calca had read Galen and little else, so that most of his questions would come from Galen.

The four of them sat at the table. Yonah told himself that two and a half decades before, Nuño Fierro had sat in this room and taken his examination, and several decades before that, Gabriel ben Nissim Sporanis had done so too, in a time when a physician could announce that he was a Jew.

Each examiner would have two rounds of questioning, and Montenegro went first, his due as the senior physician. 'If you please, Señor Callicó. I would like you to speak to us about the advantages and the disadvantages of prescribing theriac as an antidote against fevers.'

'I shall begin with the disadvantages,' Yonah said, 'for they are few and can quickly be dealt with. The medication is complex to assemble, containing up to seventy constituent herbs, and therefore it is difficult to compound and expensive to buy. Its chief advantage is that it is a proven and effective agent against fevers, intestinal ailments, and even some kinds of poisonings.' He could feel himself unwind as he moved easily from point to point, trying to make his exposition complete without being excessive. Montenegro appeared to be satisfied. 'My second question deals with the differences between quartan and tertian fevers.'

'Tertian fevers appear every third day, counting the day of occurrence as the first day. Quartan fevers appear every four days. These fevers are most likely to occur where the climate is warm and moist, and often are accompanied by chills, sweats, and great weakness.'

'Quickly and briefly answered. To cure hemorrhoids, would you remove them by knife?'

'Only if nothing else would help. Often the pain and unpleasantness can be controlled by a healthful diet that avoids sharp, salty, or very sweet foods. If there is copious bleeding, styptic medication can be applied. If they swell but do not bleed, they may be lanced or drained with leeches.'

Montenegro nodded and sat back, indicating that it was Pedro de Calca's turn.

Calca stroked his red beard. 'Speak to us, please, of the Galenic system of humoral pathology,' he said, and settled back in his chair.

Yonah was ready and he drew a breath. 'It originated as a few ideas expressed by the Hippocratic school and was modified by other early medical philosophers, especially Aristotle. Galen molded their ideas into a theory that said all things are composed of four elements -- fire, earth, air, and water -- producing the four qualities of hot, cold, dry, and wet. When food and drink are taken into the body, they are cooked by natural heat and transformed into four humors, blood, phlegm, yellow bile, and black bile. Air corresponds to blood, which is wet and hot, water to phlegm, which is wet and cold, fire to yellow bile, which is dry and hot, and earth to black bile, which is dry and cold.

'Galen wrote that a portion of these substances is carried by the blood to nourish the various organs of the body, while the rest is excreted as waste. He said that the proportions in which the qualities are combined in the body are very important. An ideal mixture of qualities produces a person in a state of well-being. Too much or too little of a humor upsets the balance, resulting in illness.'

Calca played with his beard again: stroke, stroke. 'Tell us about innate heat and the pneuma.'

'Hippocrates and Aristotle, and then Galen, wrote that the heat within the body is the substance of life. This internal heat is nourished by the pneuma, a spirit which is formed in the purest blood of the liver and carried by the veins. Yet it cannot be seen. It--'

'How do you know it cannot be seen?' Calca interrupted, and Yonah felt Nuño's warning knee press hard against his own.

Because thus far we have dissected the veins and the organs of three cadavers, and Nuño has shown me only tissue and blood and pointed out that we were unable to see anything that might be called the pneuma. He was a fool; Calca would realize that the only one who could know such a thing was someone who had opened a body and witnessed it. For a moment, terror seized his vocal cords.

'It is ... something I have read.'

'Where have you read this, Señor Callicó? For it seems to me I have never heard whether the pneuma can be seen or cannot be seen.'

Yonah paused. 'It was not in Avicenna or in Galen that I read it,' he said, as though trying to recall. 'I believe it was in Teodorico Borgognoni.'

Calca looked at him.

'Quite so,' said Miguel de Montenegro. 'That is it. I recall reading it in Teodorico Borgognoni myself,' and Nuño Fierro nodded in agreement.

Calca nodded as well. 'Borgognoni, of course.'

As his second round of questioning, Montenegro asked Yonah to compare the treatment of a fractured bone with the treatment of a dislocation. They listened to his answer without comment and then Montenegro asked him to list the factors necessary for health.

'Uncontaminated air, food and drink, sleep to rest the body's forces and wakefulness to make the senses active, moderate physical exercise to expel residues and impurities, elimination of wastes, and sufficient joy to make the body prosperous.'

'Tell us how disease is spread during epidemic,' Calca said.

'Poisonous miasmas are formed by decaying corpses or the fetid waters of swamps. Warm, moist air charged with corruption gives off noxious odors that, if breathed in by healthy persons, may infect and sicken their bodies. During epidemics, the healthy should be encouraged to flee, going far enough so that miasmas cannot be carried to them on the wind.'

There followed quick strokes of the red beard and a rapid series of questions about urine: 'What does urine signify when it is somewhat yellow?'

'It contains a measure of bile.'

'And when the urine is the color of fire?'

'It contains a great deal of bile.'

'Dark red piss?'

'In one who has not been eating saffron, it contains blood.'

'If the urine is seen to contain sediment?'

'It indicates internal weakness of the patient. If the sediment looks like bran and has a bad odor, it indicates that there is ulceration within the ducts. If the sediment has decomposed blood, it marks a phlegmonous tumor.'

'If one sees sand in the urine?' Calca asked.

'It reveals a calculus or stone.'

There was a silence.

'I am satisfied,' Calca said.

'I am satisfied also. A fine candidate who reflects his teacher,' Montenegro said, and proceeded to take down from a shelf the great leather-bound municipal volume. He recorded in it the names of the examiners and the nominator, as well as the intelligence that Señor Ramón Callicó of Saragossa had been examined and duly accepted and licensed as a physician on the seventeenth day of October, Anno Domini 1506.

On the way home teacher and pupil lolled in their saddles and chortled like children or drunkards.

'I believe I read it in Teodorico Borgognoni! I believe I read it in Teodorico Borgognoni!' Nuño mocked him.

'But Señor Montenegro ... Why did he support me?'

'Miguel de Montenegro is a good and celebrated Catholic, the favorite physician of the Church and a man who is called upon to travel far and wide when a bishop or cardinal suffers illness. Yet he is a true medical scientist who makes up his own mind about what is science and what is sin. He and I dissected together several times when we were younger. I am sure he perceived at once why you could attest so confidently regarding the appearance of something internal to the body.'

'I am grateful to him, and fortunate.'

'Yes, you are fortunate, but you performed in a manner that does you great credit.'

'I was most fortunate in my teacher, Maestro,' he said.

'You should refer to me as your maestro no longer, for now we are colleagues, Nuño said, but Yonah shook his head.

'Two men will always have my gratitude, he said. 'Both of them are Fierro. And each will ever be maestro to me.'

31

A Hard Day's Work

Only a few weeks after the examination Nuño turned over a number of their patients to him. Day by day, Yonah felt more like a physician and less like an apprentice.

Late in February Nuño told him that an annual gathering of the physicians of Aragon would be held in Saragossa. 'It will be good for you to go to the gathering, and to meet your colleagues,' he told Yonah, and both of them arranged their schedules so they might attend.

When they reached the inn they found seven other physicians drinking wine and eating garlicky roasted duck. Both Pedro de Calca and Miguel de Montenegro greeted them, and Nuño derived obvious pleasure in introducing Yonah to the other five, practitioners from the outer edges of the district. When they were finished eating, Calca gave a talk on the role of the pulse in illness. Yonah thought it was ill prepared and was troubled that one of the men who had so recently examined him could present so poor a lecture. Yet when Calca finished, the other physicians stamped their feet in apparent approval, and when he asked if anyone there had a question, no man ventured to rise.

Yonah had been amazed to hear Calca state that there were three types of pulse: strong, weak and bounding. Dare I contradict? Yonah wondered, painfully aware how new a physician he was. Yet he could not resist, and he lifted his hand.

'Señor Callicó?' Calca said, in evident amusement.

'I would like to add ... to point out ... that Avicenna wrote that there are nine kinds of pulse. The first, an even, ample signal of healthy equilibrium. A steady pulse that is stronger still, signaling power in the heart. A weak pulse that is just the opposite, denoting a weak force. And varieties of weakness -- a long and a short, a narrow and a full, a superficial and a deep.'

He saw with dismay that Calca was scowling at him. Next to him he could feel Nuño struggling to his feet.

'How good that we have at our meeting both a new physician fresh from book studies and an excellent and seasoned practitioner who well knows that in the daily treatment of folk, the rules of our art are made simpler by experience and hard-gained wisdom.' There were a few chuckles and a resumed stamping of feet while Calca smiled, mollified. Yonah could feel the blood risen to his face as he took his seat.

After they had arrived home, his complaint burst from him. 'How could you speak in such a manner, when you knew well that Calca was wrong and I was right?'

'Because Calca is precisely the kind of man who might go to the Inquisition and charge a rival with heresy if he is sufficiently provoked, which every physician who was there fully understood,' Nuño said. 'I pray the day may come in our Spain when a physician may disagree with impunity and safely argue in public, but now is not that day, nor shall it arrive tomorrow.'

At once Yonah understood that he had been a fool, and presently he muttered his thanks and an apology. Nuño didn't make light of the incident. 'You came to me aware of the dangers that exist for you from religion. You must also be vigilant against aspects of our profession that might bring catastrophe.'

He grinned suddenly at Yonah. 'Besides, you were not completely accurate in your remarks. In the translated pages of the Canon you have given to me, Avicenna said there are ten different kinds of pulse -- and then listed only nine! He also wrote that subtle differences in the pulse are useful only to skillful physicians. You will discover that this description fits only a few of the men with whom we have broken bread this day.'

Three weeks later, Nuño had a severe attack. He had been in the process of climbing the stairs to his room when a grinding pain in his chest struck him a wild and sudden blow that left him weak and gasping, so that he had to sit in order to avoid a nasty fall. Yonah had been out seeing patients and was in the barn, unsaddling the gray Arab, when a distraught Reyna opened the door. 'He is badly taken,' she said, and Yonah hurried into the house with her. Between them they managed to get Nuño into bed where, in a drenching sweat, he gasped out signs as if he were standing over a patient and lecturing to Yonah.

'Pain is ... dull, not ... sharp. But ... pronounced. Very pronounced ...'

When Yonah checked the pulse, it was so irregular it frightened him. It seemed to beat in fits and starts, to no rhythm he could perceive. He gave Nuño sips of camphor in apple liquor against the pain, which persisted strongly nevertheless for almost four hours. In the evening it lifted and then was gone, leaving Nuño lying abed with no strength at all.

But he was calm, and able to speak. He bade Reyna to kill a hen and make a broth for his dinner that day, and then he fell into a deep sleep. For a time Yonah watched him, realizing too well the limitations of the physician, because he wanted to do anything that would make Nuño well but had not the slightest idea what to do.

Within three days Nuño was able to make his way slowly down the stairs with Yonah's help, to sit during the day in his chair. For ten more days Yonah held on to hope for him, but by the end of the second week it was clear he had met with serious trouble. His chest was congested and his legs had begun to swell. At first Yonah tried raising his head and chest at night, propping him up in bed against several pillows. But soon both the swelling and the breathing grew worse, and day or night, Nuño refused to be moved from his chair by the fire. At night Yonah lay on the floor a few feet away from him, listening to the bubbling respirations of the seated man.