The Bone Garden: A Novel

Eighteen

— YOU WISHED to speak to me, Dr. Grenville? — said Norris.

Dr. Grenville gazed across his desk, and his face, backlit by the morning sun, gave away nothing. The blow is about to fall, thought Norris. For days he'd been tormented by the rumors, by innuendo. He'd heard whispers in the halls, had caught the glances of his fellow students. As he stood facing Grenville, he prepared to hear the inevitable. Better to know the answer now, he thought, than to suffer through days or weeks of whispers before the final blow.

— You have seen the latest article in the Daily Advertiser? — asked Grenville. — About the West End murders? —

— Yes, sir. — Why delay it any longer, he thought. Better to get it over with. He said, — I wish to know the truth, sir. Am I or am I not to be expelled from this college?'

— That's why you think I've called you here? —

— It is a reasonable assumption. Considering… —

— The rumors? Ah, yes, they are flying thick and furious. I've heard from the families of a number of our students. They're all concerned about the reputation of this college. Without our reputation, we are nothing. —

Norris said nothing, but dread had settled like a stone in his stomach.

— The parents of those students are also worried about the wellbeing of their sons. —

— And they think I am a threat. —

— You can understand why, can't you? —

Norris looked him straight in the eye. — All they have to convict me is circumstance. —

— Circumstance is a powerful voice. —

— A misleading voice. It drowns out the truth. This medical college prides itself on its scientific method. Isn't that method all about seeking answers based on facts, not hearsay? —

Grenville leaned back in his chair, but his gaze remained fixed on Norris. Displayed in the office was evidence of how highly Grenville valued the study of science. On his desk, a grotesquely deformed human skull sat beside a normal one. In a corner hung a dwarf's skeleton, and on the shelves of the bookcase were specimens preserved in jars of whiskey: a severed hand with six fingers. A nose half eroded by tumor. A newborn with a single Cyclops eye. All these were silent testament to his fascination with anatomical oddities.

— I'm not the only one who's seen the killer, — said Norris. — Rose Connolly has seen him, too. —

— A monster with black wings and a skull's face? —

— There is something evil at work on the West End. —

— Attributed by the Night Watch to the work of a butcher. —

— And that's the real charge against me, isn't it? That I'm the son of a farmer. If I were Edward Kingston or your own nephew Charles, or the son of any prominent gentleman, would I still be a suspect? Would there be any doubt of my innocence? —

After a silence, Grenville said: — Your point is well taken. —

— Yet it changes nothing. — Norris turned to leave. — Good day, Dr. Grenville. I see I have no future here. —

— Why would you not have a future here? Have I dismissed you from this school? —

Norris's hand was already on the doorknob. He turned back. — You said my presence was a problem. —

— It is indeed a problem, but it's one that I'll deal with. I'm fully aware that you face a number of disadvantages. Unlike so many of your classmates, you did not come straight from Harvard, or indeed from any college. You're self-taught, yet both doctors Sewall and Crouch are impressed by your skills. —

For a moment Norris could not speak. — I— I don't know how to thank you. —

— Don't thank me yet. Things may still change. —

— You won't regret this! — Again, Norris reached for the door.

— Mr. Marshall, there's one more thing. —

— Sir? —

— When was the last time you saw Dr. Berry? —

— Dr. Berry? — This was a completely unexpected question, and Norris paused, perplexed. — It was yesterday evening. As he was leaving the hospital. —

Grenville turned his troubled gaze to the window. — That was the last time I saw him, too, — he murmured.

— Though there has been much speculation as to its etiology, — said Dr. Chester Crouch, — the cause of puerperal fever remains open to debate. This is a most evil disease, which steals the lives of women just as they achieve their heart's desire, the gift of motherhood… — He stopped and stared.

So did everyone else, as Norris walked into the auditorium. Yes, the infamous Reaper had arrived. Did he terrify them? Were they all worried that he'd sit next to them, and his evil would rub off?

— Do find a seat, Mr. Marshall! — said Crouch.

— I'm trying to, sir. —

— Over here! — Wendell stood. — We've saved a seat for you, Norris. —

Acutely aware that he was being stared at, Norris squeezed his way up the row, past young men who seemed to flinch as he brushed past. He settled into the empty chair between Wendell and Charles. — Thank you both, — he whispered.

— We were afraid you might not be coming at all, — said Charles. — You should have heard the rumors this morning. They were saying— —

— Are you gentlemen quite finished with your conversation? — Crouch demanded, and Charles flushed. — Now. If you will allow me to continue. — Crouch cleared his throat and began once again to pace the stage. — We are, at this moment, experiencing an epidemic in our lying-in ward, and I fear there are more cases to come. So we shall devote this morning's program to the subject of puerperal fever, otherwise known as childbed fever. It strikes a woman in the bloom of her youth, at precisely the time when she has the most to live for. Though her child might be safely delivered, and even thriving, the new mother still faces danger. It may manifest during labor, or the symptoms may develop hours, even days after the delivery. First, she feels a chill, sometimes so violent that her shaking will rattle the bed. This is followed inevitably by a fever that causes the skin to flush, the heart to race. But the true torment is the pain. It begins in the pelvic area and progresses to excruciating tenderness as the abdomen swells. Just to touch it, even a mere stroke of the skin, can induce screams of agony. There is often a bloody discharge, too, of a most foul and malodorous nature. The clothes, the bedsheets, indeed, even the entire sickroom may reek of the stench. You cannot imagine the mortifying distress of a gentlewoman, accustomed to the most scrupulous hygiene, who now finds the mere whiff of her body so repellent. But the worst is yet to come. —

Crouch paused, and the audience was utterly silent, their attention riveted.

— The pulse grows more rapid, — Crouch continued. — A fog clouds the mentation so that the patient sometimes does not know the day or the hour, or she mumbles incoherently. Often there is intractable vomiting, of indescribably foul matter. Respirations become labored. The pulse grows irregular. At which point, there is little left to offer except morphine and wine. Because death inevitably follows. — He stopped and looked around the room. — In the months to come, you yourselves will see it, touch it, smell it. Some claim it's a contagion like smallpox. But if this is so, why does it not spread to the women in attendance, or to women who are not pregnant? Others say it is a miasma, an epidemic state of the air. Indeed, what other explanation might there be to account for the thousands of women dead of this illness in France? In Hungary? In England?

— Here, too, we are seeing many more of them. At our latest meeting of the Boston Society for Medical Improvement, my colleagues cited alarming numbers. One doctor has lost five patients in quick succession. And I have lost seven, in this month alone. —

Wendell leaned forward, frowning. — My God, — he murmured. — It truly is an epidemic. —

— It has become such a terrifying prospect that many expectant mothers, in their ignorance, choose not to come to the hospital. But the hospital is where they can expect far superior conditions than in the filthy tenements, where no doctor attends them. —

Abruptly Wendell stood. — A question, sir. If I may? —

Crouch glanced up. — Yes, Mr. Holmes? —

— Is there also such an epidemic in the tenements? Among the Irish in South Boston? —

— Not yet. —

— But so many of them live in filth. Their diet is inadequate, their conditions in every way appalling. Under those conditions, shouldn't there be many such deaths? —

— The poor have a different constitution. They're made of sturdier stock. —

— I've heard that women who suddenly give birth in the street or in the fields seldom come down with the fever. Is that also because of a stronger constitution? —

— That is my theory. I'll speak more of this in the weeks to come. — He paused. — But now we move on to Dr. Sewall's anatomical presentation. His specimen today is, I regret to say, one of my own patients, a young woman who perished from the very illness I have just described. I now call on Dr. Sewall to demonstrate the anatomical findings. —

As Dr. Crouch sat down, Dr. Sewall climbed to the stage, his massive girth creaking heavily on the steps.

— What you have just heard, — said Sewall, — is the classic description of childbed fever. Now you shall see the pathology of this disease. — He paused and gazed around the auditorium at the rows of students. — Mr. Lackaway! Will you come down here and assist me? —

— Sir? —

— You have yet to volunteer for any anatomical demonstration. Here is your chance. —

— I don't think I'm the best choice— —

Edward, who was sitting behind Charles, said: — Oh, go on, Charlie. — He gave him a clap on the shoulder. — I promise, someone will catch you this time when you faint. —

— I'm waiting, Mr. Lackaway, — said Sewall.

Swallowing hard, Charles stood and reluctantly made his way down to the stage.

Sewall's assistant rolled out the cadaver from the wing and removed the drape. Charles recoiled, staring at the young woman. Black hair cascaded from the table, and one arm, white and slim, dangled over the side.

— This should be amusing, — said Edward, leaning forward to murmur in Wendell's ear. — How long do you think before he keels over? Shall we wager? —

— That isn't funny, Edward. —

— Not yet it isn't. —

On stage, Sewall uncovered his tray of instruments. He chose a knife and handed it to Charles, who looked at it as if he'd never seen a blade before. — This will not be a complete autopsy. We'll focus only on the pathology of this particular disease. You've been working on a cadaver all week, so by now you should be comfortable with dissection. —

Edward murmured, — I give him ten seconds before he hits the ground. —

— Hush, — said Wendell.

Charles approached the body. Even from where he sat, Norris could see Charles's hand shaking.

— The abdomen, — said Sewall. — Make your cut. —

Charles pressed the knife to the skin. The whole audience seemed to hold their breath as he hesitated. Grimacing, he made a slice down the belly, but his cut was so shallow the skin did not even part.

— You'll have to be bolder than that, — said Sewall.

— I— I'm afraid I'll damage something important. —

— You haven't even penetrated to the subcutaneous fat. Cut deeper. —

Charles paused, gathering up his nerve. Again he sliced. Again it was too shallow, a stuttering incision that left large gaps of the abdominal wall intact.

— You'll have her shredded by the time you finally get into the cavity, — said Sewall.

— I don't want to cut through the bowel. —

— Look, you've already penetrated here, above the umbilicus. Poke a finger through and control your incision. —

Though the room was not warm, Charles raised his sleeve to his forehead and wiped away sweat. Then, using one hand to stretch the belly wall taut, he sliced a third time. Pink loops slithered out, dripping bloody fluid onto the stage. He kept cutting, and his knife opened an ever-widening gap through which bowel spilled free. The putrid smell that rose from the cavity made him turn away, his face pale with nausea.

— Watch it. You've nicked the bowel! — barked Sewall.

Charles flinched, and his knife fell from his hand and thudded to the stage. — I've cut myself, — he whimpered. — My finger. —

Sewall gave an exasperated sigh. — Oh, go on, then. Sit down. I'll finish the demonstration myself. —

Flushing with humiliation, Charles slunk off the stage and returned to his seat beside Norris.

— You all right, Charlie? — whispered Wendell.

— I was a disaster. —

From behind, a hand clapped him on the shoulder. — Look on the bright side, — said Edward. — At least this time, you didn't faint. —

— Mr. Kingston! — boomed Dr. Sewall from the stage. — Would you care to share your comments with the rest of the class? —

— No, sir. —

— Then kindly pay attention. This young woman nobly offered up her body for the benefit of future generations. The least you can do is pay her the respect of your silence. — Dr. Sewall refocused on the cadaver, whose abdomen now gaped open. — You see, revealed here, the peritoneal membrane, and its appearance is quite abnormal. It is dull. In a healthy young soldier, killed quickly in combat, the membranes are bright and glistening. But in cases of childbed fever, the peritoneum lacks luster and there are pockets of pale and creamy fluid, foul smelling enough to turn the stomachs of even the most seasoned anatomist. I have seen bellies where the organs are drowning in this muck, and the intestines have numerous patches of hemorrhage. We cannot explain the reason for these changes. Indeed, as you've heard from Dr. Crouch, the theories for the cause of childbed fever are legion. Is it related to erysipelas or typhus? Is it an accident or merely providence, as Dr. Meigs in Philadelphia believes? I am no more than an anatomist. I can only show you what I have laid bare with my knife. By offering up her mortal remains for study, this subject has bestowed the gift of knowledge to every one of you. —

Hardly a gift, thought Norris. Dr. Sewall always sang the praises of the unfortunate subjects who crossed his table. He pronounced them noble and generous, as though they had willingly offered themselves to be publicly hacked open and disemboweled. But this woman was no volunteer; she was a charity case, her body unclaimed by either family or friends. Sewall's praise was an unasked-for honor that almost certainly would have horrified her.

Dr. Sewall had split open the chest, and now he lifted out a lung for the audience to inspect. Only days ago, such a mutilation of the torso had shocked this group of medical students. Now these same men sat silent and unperturbed. No one looked away; no one lowered his head. They'd been introduced to the sights of the anatomy lab. They knew its smells, that unique mingling of decay and carbolic acid, and each had held the dissecting knife in his own hands. Glancing at his classmates, Norris saw a range of expressions from boredom to fierce concentration. Only a few weeks of medical study had stiffened their spines and steadied their stomachs so they could watch without disgust as Sewall excavated the heart and remaining lung from the chest. We've surrendered our sense of horror, thought Norris. It was the first step, a necessary step in their training.

There would be worse to come.