Tess Gerritsen - The Bone Garden - A Novel

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.