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  Rob J. knew what Dr. Storer wasn’t saying: some of the local graduates had the help of family prestige and connections, just as in Edinburgh he had enjoyed the advantage of being one of the medical Coles.

  “I would try another city, perhaps Providence or New Haven,” Dr. Storer said, and Rob J. muttered his thanks and took his leave. But a moment later, Storer came hurrying after him. “There is a remote possibility,” he said. “You must talk with Dr. Walter Aldrich.”

  The physician’s office was in his home, a well-kept white frame house on the south side of the meadowlike green they called the Common. It was visiting hours, and Rob J. waited a long time. Dr. Aldrich proved to be portly, with a full gray beard that failed to hide a mouth like a slash. He listened as Rob J. spoke, interrupting now and again with a question. “University Hospital in Edinburgh? Under the surgeon William Fergusson? Why would you leave an assistantship like that?”

  “I’d have been transported to Australia if I hadn’t fled.” He was aware his only hope was in the truth. “I wrote a pamphlet that led to an industrial riot against the English crown, which for years has been bleeding Scotland. There was fighting, and people were killed.”

  “Plainly spoken,” Dr. Aldrich said, nodding. “A man must struggle for his country’s welfare. My father and my grandfather each fought the English.” He regarded Rob J. quizzically. “There is an opening. With a charity that sends physicians to visit the city’s indigent.”

  It sounded like a grubby, inauspicious job; Dr. Aldrich said most visiting physicians were paid fifty dollars a year and were happy to receive the experience, and Rob asked himself what a doctor from Edinburgh could learn about medicine in a provincial slum.

  “If you’ll join the Boston Dispensary, I’ll arrange for you to assist evenings as docent in the anatomy laboratory of the Tremont Medical School. That will bring you another two hundred and fifty dollars a year.”

  “I doubt I can exist on three hundred dollars, sir. I have almost no funds.”

  “I have nothing else to offer. Actually, the annual income would be three hundred and fifty dollars. The work is in District Eight, for which the dispensary’s board of governors recently voted to pay the visiting physician one hundred dollars instead of fifty.”

  “Why does District Eight pay twice as much as other areas?”

  Now it was Dr. Aldrich who chose candor. “It is where the Irish live,” he said in a tone as thin and bloodless as his lips.

  Next morning Rob J. climbed creaking stairs at 109 Washington Street and entered the cramped apothecary’s shop that was the Boston Dispensary’s only office. It was already crowded with physicians awaiting their daily assignments. Charles K. Wilson, the manager, was brusquely efficient when Rob’s turn came. “So. New doctor for District Eight, is it? Well, the neighborhood’s been unattended. These await you,” he said, handing over a wad of slips, each bearing a name and address.

  Wilson explained the rules and described the eighth district. Broad Street ran between the ocean docks and the looming bulk of Fort Hill. When the city was new, the neighborhood was formed by merchants who built large residences in order to be near their warehouses and waterfront businesses. In time, they moved on to other, finer streets, and the houses were occupied by working-class Yankees, then in turn by poorer native tenants as the structures were subdivided; and finally by the Irish immigrants who came pouring from the holds of ships. By then the huge houses were run-down and in disrepair, subdivided and subrented at unfair weekly rates. Warehouses were converted into hives of tiny rooms without a single source of light or air, and living space was so scarce that beside and behind every existing structure there had risen ugly, leaning shacks. The result was a vicious slum in which as many as twelve people lived in a single room—wives, husbands, brothers, sisters, and children, sometimes all sleeping in the same bed.

  Following Wilson’s directions, he found District Eight. The stink of Broad Street, the miasma given off by too few toilets used by too many people, was the smell of poverty, the same in every city in the world. Something within him, tired of being a stranger, welcomed the Irish faces because they shared his Celticness. His first ticket was made out to Patrick Geoghegan of Half Moon Place; the address might as well have been on the sun, for almost immediately he became lost in the maze of alleys and unsigned private ways that ran off Broad Street. Finally he gave a dirty-faced boy a penny to lead him into a tiny crowded court. Inquiries sent him to an upper story of a neighboring house, where he made his way through rooms inhabited by two other families to reach the tiny quarters of the Geoghegans. A woman sat and searched a child’s scalp by candlelight.

  “Patrick Geoghegan?”

  Rob J. had to repeat the name before he won a hoarse whisper. “Me Da … dead these five days, of brain fever.”

  It was what the people of Scotland, too, called any high fever that preceded death. “I’m sorry for your trouble, madam,” he said quietly, but she didn’t even look up.

  Downstairs he stood and gazed. He knew every country had streets like this, reserved for the existence of injustice so crushing it creates its own sights and sounds and odors: a whey-faced child seated on a stoop gnawing a bare bacon rind like a dog with a bone; three unmatched shoes worn beyond all repair, adorning the littered dirt lane; a drunken male voice making a hymn of a maudlin song about the green hills of a fled land; curses shouted as passionately as prayers; the smell of boiled cabbage dampened by the stink, everywhere, of overflowed drains and many kinds of dirt. He was familiar with the poor neighborhoods of Edinburgh and Paisley, and with the stone row houses of a dozen towns where adults and children left home before daybreak, plodding to the cotton factories and woolen mills, not to drag themselves home until well after night had fallen again, pedestrians only of the dark. The irony of his situation struck him: he had fled Scotland because he’d fought the forces that formed slums such as this, and now in a new country his nose was being rubbed in it.

  His next ticket was for Martin O’Hara of Humphrey Place, a shed-and-shanty area cut into the slope of Fort Hill and reached by means of a fifty-foot wooden stairway so steep as to be virtually a ladder. Alongside the stairway was a wooden open gutter down which the raw wastes of Humphrey Place oozed and flowed, dropping to add to the troubles of Half Moon Place. Despite the misery of his surroundings, he climbed quickly, becoming acquainted with his practice.

  It was exhausting work, yet at the end of the afternoon he could look forward only to a meager, worried meal and an evening at his second job. Neither job would provide him with money for a month, and the funds he had left wouldn’t pay for many dinners.

  The dissection laboratory and classroom of the Tremont Medical School was a single large room over Thomas Metcalfe’s apothecary shop at 35 Tremont Place. It was run by a group of Harvard-trained professors who, disturbed by the rambling medical education offered by their alma mater, had designed a controlled three-year program of courses they believed would make better doctors.

  The professor of pathology under whom he would work as dissection docent proved to be a short, bandy-legged man about ten years older than himself. His nod was perfunctory. “I am Holmes. Are you an experienced docent, Dr. Cole?”

  “No. I’ve never been a docent. But I’m experienced at surgery and dissection.”

  Professor Holmes’s cool nod said: We shall see. He outlined briefly the preparations to be completed before his lecture. Except for a few details, it was a routine with which Rob J. was familiar. He and Fergusson had done autopsies every morning before going on rounds, for research and for the practice that enabled them to maintain their speed when operating on the living. Now he removed the sheet from the skinny cadaver of a youth, then donned a long gray dissection apron and laid out the instruments as the class began to arrive.

  There were only seven medical students. Dr. Holmes stood at a lectern to one side of the dissection table. “When I studied anatomy in Paris,” he began, “any student could buy a whole bod
y for only fifty sous at a place that sold them each day at high noon. But today cadavers for study are in short supply. This one, a boy of sixteen who died this morning of a congestion of the lungs, comes to us from the State Board of Charities. You will do no dissecting this evening. At a future class the body will be divided among you, two of you getting an arm for study, two a leg, the rest of you sharing the trunk.”

  As Dr. Holmes described what the docent was doing, Rob J. opened the boy’s chest and began to remove the organs and weigh them, announcing each weight in a clear voice so the professor could record it. After that, his duties consisted of pointing to various sites in the body to illustrate something the professor was saying. Holmes had a halting delivery and a high voice, but Rob J. quickly saw that the students considered his lectures a treat. He wasn’t afraid of salty language. Illustrating how the arm moves, he delivered a ferocious uppercut at the air. While explaining the mechanics of the leg, he did a high kick, and to show how the hips worked, a belly dance. The students ate it up. At the end of the lecture they crowded around Dr. Holmes with questions. As the professor answered them, he watched his new docent place the cadaver and the anatomical specimens in the pickling tank, wash down the table, and then wash and dry the instruments and put them away. Rob J. was scrubbing his own hands and arms when the last student left.

  “You were quite adequate.”

  Why not, he wanted to say, since it was a job a bright student could have done? Instead, he found himself asking meekly if advance payment was possible.

  “I’m told you work for the dispensary. I worked for the dispensary myself once. Goddamned hard work and guaranteed penury, but instructional.” Holmes took two five-dollar notes from his purse. “Is the first halfmonth’s salary sufficient?”

  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.