The Bone Garden: A Novel

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