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  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.

  Rob J. bought one. He expressed no color preference, but the ribbon was blue.

  “With care, one may serve you.” She explained that it could be used again and again if washed after each use, blown up, and powdered. When Rob left with his purchase, she bade him a cheerful good day and asked to be recommended to his colleagues and patients.

  Meggy hated the sheath. She was more appreciative of a gift Harry Loomis gave to Rob, telling him to have a wonderful time. It was a bottle containing a colorless liquid, nitrous oxide, called laughing gas by the medical students and young doctors who had taken to using it for entertainment. Rob poured some into a rag and he and Meggy sniffed it before making love. The experience was an unqualified success—never had their bodies seemed droller or the physical act more comically absurd.

  Beyond the pleasures of the bed there was nothing between them. When the act was slow, there was a little tenderness, and when it was furiously physical there was more desperation than passion. When they spoke, she tended either to gossip about the boardinghouse, which bored him, or to reminisce about the old country, which he avoided because memory caused him pain. There was no contact between their minds or souls. The chemical hilarity they shared a single time through the use of nitrous oxide was never approached again, for their sexual gaiety had been noisy; though the drunken Lem had been oblivious, they knew they had been lucky to go undetected. They laughed together only once more, when Meggy peevishly observed that the sheath must have come from a ram, and christened it Old Horny. He was troubled by the extent that he was using her. Observing that her petticoat was exceedingly darned, he bought her a new one, a guilt offering. It pleased her tremendously, and he sketched her in his journal reclining on his narrow bed, a plump girl with a smiling cat’s face.

  He saw many other things he’d have sketched if he’d had energy left over from medicine. He’d begun as an art student in Edinburgh, in rebellion from the Cole medical tradition, dreaming only of being a painter, for which the family had thought him touched. In his third year at the University of Edinburgh he was told he had artistic talent, but not enough. He was too literal. He lacked the vital imagination, the misty vision. “You have the flame but lack the heat,” his professor of portraiture had told him, not unkindly but too plainly. He was crushed, until two things happened. In the dusty archives of the university library he came across an anatomical drawing. It was very old, perhaps pre-Leonardo, a nude male figure that appeared cut away to reveal the organs and blood vessels. It was entitled “The Second Transparent Man,” and with a wonderful shock he saw it had been drawn by one of his ancestors, whose signature was legible, “Robert Jeffrey Cole, after the fashion of Robert Jeremy Cole.” It was evidence that at least several of his ancestors had been artists as well as medical men. And two days later he wandered into an operating theater and saw William Fergusson, a genius who performed surgery with absolute certainty at lightning speed to minimize the patient’s shock from the agonizing pain. For the first time, Rob J. understood the long line of Cole doctors, because the certainty came to him that the most glorious canvas could never be as precious as a single human life. In that mom
ent, medicine claimed him.

  From the start of his training he had what his Uncle Ranald, who was in general practice near Glasgow, called “the Cole gift”—the ability to tell, by holding a patient’s hands, whether he or she would live or die. It was a diagnostic sixth sense, part instinct, part input from inherited detectors no one could identify or understand, but it worked so long as it wasn’t blunted by the overuse of alcohol. For a physician it was a true gift, but now, transplanted to a distant land, it was one that ground Rob J.’s spirit, because District Eight had more than its share of people who were dying.

  The God-cursed district, as he had come to think of it, dominated his existence. The Irish had arrived with the greatest expectations. In the old country a laborer’s daily wage was sixpence, when there was work. In Boston there was less unemployment and workers earned more, but they were worked fifteen hours a day, seven days a week. They paid high rents for their slums, they paid more for their food, and here there was no little garden, no tiny patch for growing mealy bog apples, no cow for milk, no pig for bacon. The district haunted him with its poverty and filth and its needs that should have paralyzed him but instead stimulated him to work like a tumblebug attempting to move a mountain of sheep shit. Sundays should have been his to use as a brief time of recovery from the numbing work of the terrible week. Sunday mornings, even Meg got a few hours off to allow her to go to mass. But each Sunday found Rob J. back in the district, freed from the necessity of conforming to the schedule dictated by the appointment slips, able to donate hours that were his, hours he didn’t have to steal. It took him no time at all to establish a real, if mostly unpaid, Sunday practice, for everywhere he looked there was illness, injury, disease. Word spread very quickly of the physician who was able and willing to converse in the Erse, the ancient Gaelic language shared by the Scots and the Irish. When they heard him uttering the sounds of their old home, even the bitterest and foulest tempered brightened and beamed. Beannacht De ort, dochtuir oig—Bless you, young doctor!—they called after him in the streets. One person told another about the lad of a doctor who “had the tongue,” and soon he was speaking the Erse every day. But if he was adored on Fort Hill, he was less than popular in the office of the Boston Dispensary, for all manner of unexpected patients began to appear there with prescriptions from Dr. Robert J. Cole for medications and crutches and even for food prescribed to treat malnourishment.

  “What is happening? What? They are not on the list of those referred by donors for treatment,” Mr. Wilson complained.

  “They’re the ones in District Eight who need our help most.”

  “Nevertheless. The tail must not be allowed to wag the dog. If you are to remain with the dispensary, Dr. Cole, you must obey its rules,” Mr. Wilson told him severely.

  One of the Sunday patients was Peter Finn of Half Moon Place, who suffered a tear in the calf of his right leg when a crate fell from a wagon while he was picking up half a day’s wages on the wharves. The laceration, bandaged with a dirty rag, was swollen and painful by the time he showed it to the doctor. Rob washed and sewed together the ragged lips of flesh, but corruption began at once, and the very next day he was forced to remove the stitches and place a drain in the wound. The infection proceeded at a terrifying rate, and within a few days the Gift told him that if he was to save Peter Finn’s life, the leg must be taken.

  It was on a Tuesday, and the matter couldn’t be put off until Sunday, so he was back to stealing time from the dispensary. Not only was he forced to use one of the precious blank treatment slips given him by Holmes, he had to give his own scarce and hard-earned money to Rose Finn so she could go to a tenement saloon for the jug of poteen that was as necessary to the operation as the knife.

  Joseph Finn, Peter’s brother, and Michael Bodie, his brother-in-law, reluctantly agreed to assist. Rob J. waited until Peter was stuporous with morphia-laced whiskey and laid out on the kitchen table like a sacrifice. But at the first cut of the scalpel the longshoreman’s eyes bugged in disbelief, the cords in his neck stood out, and his great scream was an accusation that made Joseph Finn turn pale and Bodie stand useless and trembling. Rob had strapped the offending leg to the table, but with Peter thrashing and bellowing like an agonized beast, he shouted to the two men, “Hold him! Hold him down, now!”

  He cut as he had been taught by Fergusson, truly and swiftly. The cries ceased as he sliced through flesh and muscle, but the grinding of the man’s teeth was more terrible than screams. When he severed the femoral artery the bright blood leapt, and he tried to take Bodie’s hand and show him how to stem the arterial fountain. But the brother-in-law lurched away.

  “Come back. Oh, you son of a bitch.”

  But Bodie was running down the stairs, weeping. Rob tried to work as if he had six hands. His own size and strength enabled him to help Joseph pin the thrashing Peter to the table, while at the same time he somehow found the dexterity to pinch off the slippery end of the artery, damming the blood. But when he let go to reach for his saw, the hemorrhaging began anew.

  “Show me what to do.” Rose Finn had slipped next to him. Her face was the color of flour paste but she was able to grasp the artery end and control the bleeding. Rob J. sawed through the bone, made a few quick cuts, and the leg dropped free. Now he was able to tie the artery and trim and stitch the flaps. By this time, Peter Finn’s eyes were glassy with shock and his only sound was raw, ragged breathing.

  Rob carried away the leg, wrapped in a threadbare stained towel, to be studied later in the dissection room. He was dull with fatigue, more from his awareness of Peter Finn’s martyrdom than because of the exertion of the amputation. He could do nothing about his bloodied clothes, but at a public tap on Broad Street he washed the blood from his hands and arms before going on to his next patient, a woman of twenty-two he knew to be dying of the consumption.

  When they were at home in their own neighborhoods, the Irish lived miserably. Outside their own neighborhoods, they were calumnized. Rob J. saw posters in the streets: “All Catholics and all persons who favor the Catholic Church are vile impostors, liars, villains, and cowardly cutthroats. A TRUE AMERICAN.”

  Once a week he attended a medical lecture in the second-floor amphitheater at the Athenaeum, in its sprawling quarters that had been made by joining two mansions on Pearl Street. Sometimes after the talk he sat in the library and read the Boston Evening Transcript, which reflected the hatred that twisted the society. Distinguished clergymen like Reverend Lyman Beecher, minister of the Hanover Street Congregational Church, wrote article after article about the “whoredom of Babylon” and the “foul beast of Roman Catholicism.” Political parties glorified the native-born and wrote of “dirty, ignorant Irish and German immigrants.”

  When he read the national news to learn about America, he saw that it was an acquisitive country, grabbing land with both hands. Recently it had annexed Texas, acquired the Oregon Territory through a treaty with Great Britain, and gone to war with Mexico over California and the southwestern portion of the American continent. The frontier was the Mississippi River, dividing civilization from the wilderness into which the Plains Indians had been pushed. Rob J. was fascinated with Indians, having devoured James Fenimore Cooper’s novels throughout his boyhood. He read whatever material the Athenaeum had on Indians, then turned to the poetry of Oliver Wendell Holmes. He liked it, especially the portrait of the tough old survivor in “The Last Leaf,” but Harry Loomis was right: Holmes was a better doctor than he was a poet. He was a superlative doctor.

  Harry and Rob took to ending their long days with a glass of ale at the Essex, and often Holmes joined them. It was evident that Harry was the professor’s favorite student, and Rob found it hard not to envy him. The Loomis family was well-connected; when the time came, Harry would receive the proper hospital appointments to ensure him a satisfying medical career in Boston. One evening over their drink, Holmes remarked that while doing some library work he had come upon reference to both Cole’s Goiter and C
ole’s Malignant Cholera. His curiosity whetted, he had searched the literature and found ample evidence of the Cole family’s contributions to medicine, including Cole’s Gout, and Cole’s and Palmer’s Syndrome, a malady in which edema was accompanied by heavy sweats and stertorous respirations. “Furthermore,” he said, “I found that more than a dozen Coles have been professors of medicine in either Edinburgh or Glasgow. All kinfolk of yours?”

  Rob J. grinned, embarrassed but pleased. “All kinfolk. But most of the Coles down through the centuries have been simple country physicians in the lowland hills, like my father.” He said nothing about the Cole Gift; it wasn’t something one discussed with other doctors, who would think him either unhinged or a liar.

  “Is your father there still?” Holmes asked.

  “No, no. Killed by runaway horses when I was twelve.”

  “Ah.” That was the moment when Holmes, despite the relatively small difference in their ages, determined to fill a father’s role in gaining Rob admission to the charmed circle of Boston families through an advantageous marriage.

  Soon after that, twice Rob accepted invitations to the Holmes house on Montgomery Street, where he glimpsed a life-style similar to the one that once he had thought possible for himself in Edinburgh. On the first occasion, Amelia, the professor’s vivacious, matchmaking wife, introduced him to Paula Storrow, whose family was old and rich but who was a lumpish and painfully stupid woman. But at the second dinner his partner was Lydia Parkman. She was too slender and lacked any sign of breasts, but beneath her smooth walnut-brown hair her face and eyes radiated a wry and mischievous humor, and they spent the evening engaged in a teasing but farranging conversation. She knew some things about Indians, but they talked mostly about music, for she played the harpsichord.

  That night, when Rob came back to the house on Spring Street, he sat on his bed beneath the eaves and contemplated what it might be like to spend his life in Boston, colleague as well as friend to Harry Loomis and Oliver Wendell Holmes, married to a hostess who presided over a witty table.