The Cole Trilogy: The Physician, Shaman And Matters Of Choice Part 72

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 ill.u.s.trate 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. Ill.u.s.trating 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. G.o.dd.a.m.ned 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 a.s.sured 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 pa.s.sed 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 pa.s.sed 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 b.i.t.c.h; 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 Ma.s.sachusetts 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 cla.s.s 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 prost.i.tute 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 Ess.e.x 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 gla.s.s 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 d.i.c.kens 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 gla.s.s 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, Ma.s.sachusetts, physician named Whitney, a.s.sisted 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.

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 ma.s.sive 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 b.u.t.tressed 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 G.o.d-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 s.e.x, 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 cec.u.m 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; sc.r.a.ped 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 pa.s.sion. 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 s.e.xual 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 h.o.r.n.y. 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 ent.i.tled "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 moment, medicine claimed him.

From the start of his training he had what his Uncle Ra.n.a.ld, 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 G.o.d-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 s.h.i.t. 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 ma.s.s. 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 st.i.tches 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 a.s.sist. 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 longsh.o.r.eman'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 b.i.t.c.h."

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 st.i.tch the flaps. By this time, Peter Finn's eyes were gla.s.sy 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 "wh.o.r.edom 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 gla.s.s of ale at the Ess.e.x, 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 Cole'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, embarra.s.sed 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 b.r.e.a.s.t.s, 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.

Presently there was the small knock he had come to know. Meg Holland let herself into his room. She wasn't too thin, he noted as he smiled a greeting and began to unb.u.t.ton his shirt. But for once Meggy sat on the edge of the bed without moving.

When she spoke, it was in a hoa.r.s.e whisper, her tone even more than her words striking deep into his spirit. Her voice had a tight, dead quality, like the sound of dried leaves pushed by a breeze across hard, cold ground.

"Caught," she said.

6.

DREAMS.

"Right and proper," she told him.

He couldn't find the words to say to her. She'd been experienced when she came to him, he cautioned himself. How did he know the child was his? I always wore the sheath, he protested silently. But in fairness he knew he'd worn nothing the first few times, and again on the night when they'd tried the laughing gas.

He was conditioned by his training never to countenance abortion, and he was sensitive enough now to resist suggesting it, aware that her religion was the strongest part of her.

Finally he told her he would stand by her. He wasn't Stanley Finch.

She didn't appear tremendously buoyed by the declaration. He forced himself to take her into his arms and hold her. He wanted to be tender and comforting. It was the worst possible moment to perceive that her feline face within a few years would be decidedly bovine. Not the face of his dreams.

"You're a Protestant." It wasn't a question, for she knew the answer.

"I was so raised."

She was a plucky woman. Her eyes filled for the first time only when he told her he was uncertain about the existence of G.o.d.

"You charmer, you scoundrel! Lydia Parkman was favorably impressed by your company," Holmes told him next evening at the medical school, and beamed when Rob J. said he thought her an extremely pleasant woman. Holmes mentioned casually that Stephen Parkman, her father, was a Superior Court judge and an overseer of Harvard College. The family had begun as dealers in dried fish, eventually had become flour merchants, and now controlled the widespread and lucrative trade of barreled grocery staples.

"When do you intend to see her again?" Holmes asked.

"Soon, of that you can be certain," Rob J. said guiltily, unable to allow himself to think of it.

Holmes's ideas about medical hygiene had revolutionized the practice of medicine for Rob. Holmes told him two stories that b.u.t.tressed his theories. One concerned scrofula, a tubercular disease of the lymphatic glands and joints; in medieval Europe it was believed that scrofula could be cured by the touch of royal hands. The other tale dealt with the ancient superst.i.tious practice of washing and bandaging soldiers' wounds and then applying ointment-terrible unguents containing such ingredients as decaying flesh, human blood, and moss from the skull of an executed man-to the weapon that had inflicted the hurt. Both methods were successful and famous, Holmes said, because inadvertently they provided for the patient's cleanliness. In the first case, the scrofulous patients were washed completely and carefully lest the royal "healers" should be offended when it came time to touch them. In the second case, the weapon was smeared with foul stuff but the wounds of the soldiers, washed and then left alone, had a chance to heal without infection. The magic "secret ingredient" was hygiene.

It was difficult to maintain clinical cleanliness in District Eight. Rob J. took to carrying towels and brown soap in his bag and washed his hands and instruments many times a day, but the conditions of poverty combined to make the district a place in which it was easy to sicken and die.

He tried to fill his life and his mind with the daily medical struggle, but as he dwelt long and hard on his predicament, he wondered if he was bent on his own destruction. He had thrown away career and roots in Scotland by his involvement in politics, and now in America he had compounded his ruination by entangling himself in a disastrous pregnancy. Margaret Holland was facing the situation practically; she asked him questions about his means. Far from filling her with dismay, his annual income of $350 seemed comfortable to her. She asked about his people.

"My father is dead. My mother was failing badly when I left Scotland, and I'm certain that by now ... I have one brother, Herbert. He manages the family holding in Kilmarnock, raises sheep. He owns the property."

She nodded. "I've a brother, Timothy, lives in Belfast. He's a member of Young Ireland, always in trouble." Her own mother was dead; there were a father and four brothers in Ireland, but a fifth brother, Samuel, lived in the Fort Hill area of Boston. She asked timidly if she shouldn't tell her brother about Rob and ask Samuel to keep his eyes open for rooms for them, perhaps near his own flat.