Terrence Holt: In the Valley of the Kings: Stories

No one, at the time, had any empirical reason for suspecting such, but in every account, even the first, I trace an instinctive recognition that it was the word itself that carried the contagion. It was several months, of course, before the means of transmission was identified, through the work of the Centers for Disease Control and Prevention in Atlanta and Lucerne, and ultimately the heroic sacrifice of the interdisciplinary team at the École des Hautes Études en Sciènces Sociales in Paris. So how do we find, in this first written record, the prudence that spared until a later date so many lives? And how do we balance that seeming prudence with the other inescapable fact about the word: that as the end approached, all seemed seized — as was Tabitha herself — with an impulse to speak. It was as if the word struggled to speak itself, as if in answer to some drive to propagate that would not be denied.

The elucidation of the mechanism was complicated by the discovery that mere speech was harmless, as was hearing: it was the eye through which the plague entered, and the eye alone. The hand that wrote, so long as the person behind it did not look, was spared (with the notorious exception of the blind, who took the illness in Braille, and broke out before they died in portentous boils). But to see the word in print (ink or video, it did not matter) was to sicken, and invariably to die.

Experimental studies were hampered, of course, by a number of complicating factors, not least of which was the obvious difficulty in conducting tests on other than human subjects. A late attempt was made, by some accounts, to incorporate the word into the ideogrammatic code taught to chimpanzees at the Yerkes National Primate Center; results were fragmentary, the experiment ending prematurely with the incapacitation of the staff. One significant datum did emerge from all studies, however: illiteracy was no defense. Even those incapable of deciphering the dialogue from comic strips were found to be susceptible. The only exceptions were those functioning, for whatever reason, below the mental age of thirty months.

But all of this knowledge came later. Although this most important aspect of the disease did ultimately receive full measure of publicity, in the case of Tabitha Van Order the initial reports were mute. Indeed, were it not owing to the early curiosity of one researcher in virology at a nearby university, the epidemiological particulars of this first case might have passed almost entirely unrecorded. This virologist, one Taylor Salomon, happened to have been a patient on the same floor as the child, incapacitated with a pneumonia contracted while at work in her laboratory. On the day that Tabitha gave up the ghost in a room four doors down from hers, Professor Salomon was sitting up in bed for the first time in two weeks, taking some clear broth and attempting to organize notes from her research.

The attempt was futile, owing to the extreme weakness that had kept her semiconscious for the previous two weeks, and was disrupted forever by the unearthly cry that heralded Tabitha’s demise. Professor Salomon was fortunate in this, however: her own illness had kept her from visiting the child’s room, or even glimpsing her mottled face through the open door before the marks had faded entirely away. And the research project that had hospitalized Professor Salomon soon faded from her thoughts as well, supplanted by a new question as soon as the nurse appeared, visibly shaken, in answer to the professor’s call.

The nurse could report the sequel of the child’s cry, but not its meaning; she could only echo, with the distracted air that had come to typify the medical staff in the last hours of Tabitha’s life, the helpless distress of her colleagues at finding their patient so unaccountably dead. To Salomon’s more pertinent questions about the disease’s course and etiology, the nurse could only wring her hands and look back over her shoulder, as if she harbored a guilty secret. Her curiosity piqued, Dr. Salomon managed to rise from her bed and stumble down the hall before the orderlies arrived to wheel the body away. The marks had apparently disappeared no more than five minutes before her arrival.

Luck was with her again, in that her appearance in the room was followed almost immediately by that of the medical examiner. The examiner, already irritated at the interruption of lunch, was inclined to order Salomon from the room, and her recitation of her credentials did nothing, at first, to soothe him. But being in no mood to take up the investigation himself, even in his irritation he was no match for Salomon’s persistence, and in the end he agreed to provide the samples she required. In an additional example of the good fortune that marked so much of Salomon’s involvement with the case, the M.E.’s cooperative attitude was not shared by the hospital staff, which refused to release the child’s chart to anyone but the M.E., citing doctor-patient confidentiality. But the samples, Salomon felt, would prove more valuable than any M.D.’s scribble, and she was content with the oral recitation of the child’s history she eventually wrung from the nurses. The samples, iced and isolated according to protocols, waited another two weeks before Salomon was able to return to her lab, where she found, of course, nothing. The blood, nerve tissue, and other fragments of Tabitha’s clay were apparently those of a healthy five-year-old girl, and nothing an extremely well-funded laboratory could bring to bear on them was able to add anything to the story.

Stymied in the laboratory, Salomon turned to a colleague in epidemiology, and, swearing him to secrecy initiated field studies of the child’s home, school, and other haunts. The season was late spring; the child’s back yard abutted on a swamp: insect traps were set and their prey examined (at this point the impromptu task force expanded to include an entomologist). Once again, nothing significant appeared.

Time was running out for Salomon and her hope of scoring a coup. Five weeks after Tabitha’s admission to the hospital, the child’s mother, the triage nurse, four orderlies, the emergency-room physician’s assistant, three floor nurses and two doctors were admitted with livid bruises on the palms of their hands, cheeks, jaws, and (most plainly) foreheads.

In this first wave of cases, the disease exhibited additional symptoms, not observed (or not reported) in the case of Tabitha Van Order. In the triage nurse, onset was marked by a vague dreaminess that overtook her at work one morning. By lunchtime, she was incapable of entering insurance information correctly on her forms, and by midafternoon she had wandered from her desk. She was found on one of the high floors of the hospital, staring out a window at the lake, where a sailboat regatta was in progress. It was only at this point that the marks on her face were noticed. At about this time (the precise time is unavailable, owing to the nurse’s absence from her desk), Julia Van Order arrived at the emergency room, brought in by a neighbor who had found her laughing uncontrollably in the street outside her home. The third symptom, glossolalia, was observed in two of the orderlies and one physician, who were admitted over the course of the evening. By midnight, there were twelve patients on the floor.

Recognizing an incipient epidemic, the chief of infectious disease imposed strict quarantine that evening. Staff on the floor were issued the customary isolation gear, and strict contact precautions were imposed. Who could blame the man for not issuing blindfolds? Such measures were in fact tried, much later, but by then, of course, it was much too late. He failed as well to confiscate pens.

Professor Salomon, on hearing of these new admissions, realized that her time was running out, and did the only thing left to her. After one visit to the hospital, during which she conducted interviews with those of the victims able to respond, she wrote up as full a description of the disease as she could, took her best guess (which turned out, in the end, to be wrong) as to its cause, sealed the four closely-printed pages in a dated envelope, and sent it, with a cover letter, to the New England Journal of Medicine. It was not at that time the policy of the New England Journal to accept so-called plis cachetés, the practice having fallen into disrepute over a generation earlier, and Salomon’s contribution might have been returned unopened had it not been for yet another fortuitous circumstance.