“The boy almost certainly died of morphia toxicity. You know that as well as I, father. If it wasn’t the laudanum, it must have been something else. Perhaps something Dr. Frias prescribed.”
“That is a leap, not a conclusion. I advise you to leave the matter as it is. No one will blame you for the boy’s death. Even his mother will come to see that you acted appropriately.”
“I can’t leave it, father. I have to at least try to find the truth.”
“Why? The boy cannot come back. It will make no difference.”
“I’m not sure. Maybe I need to prove to myself that it wasn’t my fault. Maybe I have to find a way not to feel Mildred Anschutz looking at me the way Isobel’s parents did. I just know that I need to. Can you spare me this morning?”
Abel shook his head in resignation. “You never could be dissuaded when you were determined to do something. I suppose that’s why you’re such a good doctor.” He thought for a moment. “I suppose I can ask Pierre Gaspard to help out. He lives only three blocks away, and he loathes retirement. Did you plan on making a condolence call?”
“I thought I should wait until tomorrow. Seeing how Mrs. Anschutz feels.”
“Probably wise. Let me go with you.”
“No, father. I should do it alone.” Noah stood to leave. “Have you forgiven yourself, father? For Viola Mangino? Have you come to accept that it was not your fault?”
“Her dying? Yes, I have.”
“No. I meant the forceps delivery.”
“Oh, you thought . . . no, Noah. I didn’t perform the delivery.”
“But . . .”
“Oh no, son. That wasn’t me. Arnold Frias delivered Viola Mangino.”
FIVE
DAY 2. THURSDAY, 9/21—9 A.M.
The pediatric ward was the pride of the sprawling Brooklyn Hospital. Endowed by the dowagers of the Ladies’ League, the vast, high-ceilinged room was on the third floor, facing south, so the children could enjoy a light and airy environment. Twenty-four beds lined the walls, twelve on each side, with ample space between. The floors were polished tile, the windows large, and the walls painted a bright off-white. The room smelled of disinfectant and talc. Four nurses were on duty, either sitting at bedside or scurrying between patients.
Each of the beds was occupied. Although the room held both boys and girls, curtains had been set between the beds and could be pulled shut for privacy. The patients ranged in age from two or three to early teens. Some were talking to one another, a few others were attended by visitors sitting in chairs pulled next to the beds, but most of them lay quietly alone. The dowagers could not provide caring relatives, so many children of the poor would receive no visitors for their entire stay. Some would be abandoned permanently by families who could not bear the burden of a convalescing child, then sent to orphanages when they were well enough to be discharged. There, most would languish and molder. Many would die.
Noah stepped inside through the swinging double doors to the sound of dry coughing. Respiratory ailments abounded. More children died from non-tubercular pulmonary infection than from any other cause. He could see just from tone, color, and posture that at least six of the children were gravely ill. Others seemed to be convalescing well. A boy, one of the older patients, was sitting up in bed reading a battered copy of Huckleberry Finn.
Alan De Kuyper stood at a bed at the far end of the ward with four younger doctors, three men and a woman. Morning rounds. He was attending a scrawny, pallid, twitchy boy of six or seven. De Kuyper was in his early thirties, a gangly man with robin’s-egg-blue eyes, an unlined face, and hair gone prematurely gray. He grinned when he saw Noah walking his way.
“Couldn’t wait until tonight to see me?” he asked, then turned his attention back to his patient. “All right, Anson. We’re going to play a game. You’re going to tell these doctors what’s bothering you, and they’re going to try to guess what’s making you sick.”
“I don’ wanna play no game,” the boy replied.
“No game? Do you want breakfast instead?”
“Not hungry.”
“Would you like to get up and play, then?”
“Too tired.”
De Kuyper continued to question the boy, eliciting that he suffered from headaches, bad teeth, and that he had difficulty holding things or walking because of weakness in his hands and feet. “Well, Anson,” he said, finally. “I’m sorry you won’t play with us. We’ll leave you alone now.”
“Yeah,” grunted the boy.
De Kuyper led the doctors to the aisle, out of earshot of the patient. “Well?” he asked.
None of the four responded.
“Review the symptoms. Irritability, hyperactivity, fatigue, loss of appetite, weakness in the extremities, excessive tooth decay . . .”
Still nothing.
De Kuyper sighed deeply. “I’ll give you a hint.” He bunched his fingers and poked them back and forth toward his open mouth. The four glanced about at one another, but none spoke.
He rolled his eyes heavenward. “Children are known to put anything and everything into their mouths, are they not?”
“I’ve got it,” the woman said, raising her hand as if she were still in class. She was reedy and dark, in her early twenties. “Lead toxicity.”
“Very good, Dr. Bertelli. And the treatment?”
“Remove the source of the problem.”
“Correct,” De Kuyper replied. “Easier said than done though. But we’ll have a talk with the boy’s parents and tell them to repaint their apartment and keep a cleaner house. I’m certain they will run right off and do so.”
He excused himself and gestured to Noah to walk to the end of the ward.
“Dolts,” he muttered. “Anyone can get into medical school these days.”
“They can’t be that bad,” Noah replied.
“Not like you, old man.” De Kuyper clapped Noah on the shoulder. “Actually, they just started. Bertelli’s the best. One of the others will be all right, another fair. As for the fourth . . . let’s just hope he decides to give up medicine and become a banker.”
“Your brother Jamie is a banker.”
“Precisely. So, what brings you to my atelier?”
Noah described Willard Anschutz’s symptoms, both during his initial visit with the boy and then immediately before he died.
“I’m sorry, old man. Sounds ghastly. My God, I hate to lose patients. It’s as if every child is entitled to a life and when one dies, I’ve denied it to them. Can’t dwell on it though. If I did, I’d have to leave the profession.”
Noah nodded in mock agreement. This from a man Noah had once found weeping in a closet when one of his patients died of a seizure. “The mother thinks I’m responsible,” he said.
“From two drops of laudanum. Ridiculous.”
“I thought so, too. But what else could have done it?”
“Was the boy taking patent medicines?”
“I asked and was told categorically by his mother he wasn’t. It’s a good family. Anschutz. Wurster’s niece. The father’s an army officer, off slaughtering Filipinos. But I’m convinced the mother was telling the truth.”
“Very well. Let’s look elsewhere then. You say both pupils were dilated when you first observed the boy?”
“Yes.”
“That would eliminate a brain tumor. Could be a strain of encephalitis, I suppose, although the set of symptoms on your first visit work against it. Might be something new. We live near the waterfront, after all. Perhaps an unknown bacillus has been brought ashore from Africa or Asia. One which mimics morphia and only affects the young. You should ask Jacobi.”
Jacobi, the oracle. Alan’s mentor. In 1861, he had become the first man in America to establish pediatrics as a separate discipline.
“I thought Jacobi doesn’t see anybody.”
“An exaggeration. Most stories about Jacobi are. He’s sarcastic, domineering, a socialist, and a Jew. A man to emulate, except for the Jew part. He’s still
a revolutionary under the surface, I expect. Although he never talks about it, you know of course that he came to America as a stowaway on a freighter after he escaped from prison in Germany? He was under a death sentence for radical activities.”
“Yes. I believe you have mentioned that.”
Alan chuckled. “Yes, I suppose I have. In any event, he has no patience for fools or anyone who would waste his time, another of his traits I admire. But he’ll be happy to see you if I make an introduction.”
“I’d be grateful. He’s still at Columbia?”
“Absolutely. Still teaching. At seventy. Amazing fellow. If there is an obscure ailment from which the Anschutz boy died, Jacobi will know it.”
Noah reached into his vest and removed the envelope. He held it open to show Alan the small, blue tablet. “Have you ever seen one of these before?”
De Kuyper shook his head. “That doesn’t mean much, of course. There are thousands of different medications floating about. The boy was taking these?”
“His mother claimed he had stopped two weeks ago.”
“Are they a morphiate?”
“The mother assures me they are not.”
“But you suspect otherwise. Quite right. Who prescribed them?”
“Frias.”
“Ah! Dr. Dollars.” He gestured toward the pill. “Let me have this tested for you.”
“I’d like to do it myself.”
“Of course. The laboratory will be empty this time of day. Have you used Herold’s Manual of Legal Medicine?”
“No.”
“There’s a copy on the front shelf. It’s outstanding. If you’re going to run a test, follow Herold’s methodology.” Alan put a finger to his chin. “And why don’t I fetch you tonight? You shouldn’t be forced to enter the lion’s den alone. I’ll be by at 6:30.”
“I hope eventually I won’t need an honor guard to go to your parents’ house.”
“Give it twenty years.” Alan paused. “However the test comes out, you didn’t have anything to do with the boy’s death.”
“How can you be so sure?”
“I wouldn’t introduce my sister to an imbecile.”
“I’m greatly relieved.” When Noah turned to leave, a man who had been sitting at the bedside of a young boy rose to leave as well. Noah held the door as the man passed through. He was sharp-featured and light-haired, in his mid-twenties, clean-shaven, and wearing wire-frame spectacles that framed a prominent, aquiline nose. Behind the lenses lay a pair of quick, attentive eyes. He nodded in thanks but eyed Noah strangely, as if Noah were an acquaintance that he could not quite place.
The light-haired man paused after he walked by, holding the door open and gazing back into the ward. He allowed Noah to pass him and make his way down the hall. As Noah reached the staircase, he looked back, but the man was gone.
SIX
DAY 2. THURSDAY, 9/21—9:45 A.M.
The laboratory was in the basement, accessible only through a staircase at the rear of the lobby. As Noah walked toward it, he heard his name called.
He turned to see a tall, bearded man, wide as a doorway, snowy hair peaked like the back of Melville’s whale. A gold watch chain lay across his mountainous abdomen like a garland.
Frias. Walking with him was another man whom Noah did not know, also broad and bearded, but shorter.
Arnold Frias was on him in three steps, speaking before Noah could open his mouth. “Whitestone! I’m pleased to have run into you.” He managed to find a deft balance between bonhomie and condolence. “I spoke with Mildred, of course. Dreadful tragedy. Appalling. I know how crushed you must feel. But don’t blame yourself, my boy. One cannot practice medicine without such occurrences. But when it is a child . . .”
“Thank you, Dr. Frias. How is Mrs. Anschutz?”
“Beside herself, as you might expect. Willard was such an effervescent lad. He brought joy to everyone. But we cannot anticipate the Lord’s plan. Sometimes the best of us are taken far too soon.”
“I was planning on waiting until tomorrow to see her.”
“I think you might consider waiting a bit longer than that. I’m loath to bear bad tidings, but, unjust as it may be . . .” Frias left the obvious unsaid, then seemed to remember he was not alone. He cleared his throat before making introductions. “By the way, do you know Martin Smith?”
“I don’t believe so.”
Smith extended his hand. He had a powerful grip. His eyes were gray and his expression even, like a man giving nothing away at a game of cards.
“We’ve got to be off.” Frias forced an ingratiating smile. “I’m giving Martin a tour of the hospital.” After a few steps, however, he excused himself and walked back to Noah. This time, he spoke more softly. “I believe you took something last night that belonged to Mrs. Anschutz. I would like it back.”
Noah shrugged, then hoped the gesture hadn’t appeared as stiff as it felt. “I’m sorry, Dr. Frias, but I don’t have it anymore. There seemed no need to keep it.”
“You discarded it?”
“Yes, I’m afraid so. Mrs. Anschutz certainly had no further need of it, and I don’t like keeping unknown medications about.”
Frias considered for a moment whether to press, then glanced over his shoulder at Martin Smith waiting across the hall. “Very well.” His face fell into a mien of professional compassion. “Once again, Whitestone, my sympathies.”
When Frias was gone, Noah made his way downstairs. He signed in with the attendant at the desk, then set himself up at station. The laboratory, as Alan had predicted, was empty. The space was large and open, with small windows near the ceiling that peeked over the grass of the hospital’s back lawn. The room was divided into thirds by work tables, each containing four stations with sink, microscope, burner, and the other tools of the medical researcher’s trade. At the near wall, flanking the door on either side, were large shelved cases. One held manuals, journals, and records of previous analyses, the other, behind glass doors, a cornucopia of chemicals that could be used to perform every conceivable pathological, cytological, or histological analysis.
Noah scanned the bookshelves and withdrew the volume to which Alan had referred, Justin Herold’s Manual of Legal Medicine. Fifteen years ago, Herold had been appointed coroner’s physician for New York City at age twenty-four, the youngest man ever to hold the post. Last year, back in private practice, he had published his guide for “practitioners and students of medicine and law.”
Part I of the tome was dedicated to toxicology. Chapter 10 was entitled, “Opium and Morphine.” Checking for appropriate tests on page 96, Noah found the following:
Tests: “Opium itself has no direct chemical test. But, as every watery solution contains the meconate of morphine, well-marked reactions are used to distinguish the alkaloid of opium, morphine, and its peculiar acid, meconic.
I. Morphine—The important tests for this alkaloid are the nitric acid, ferric chloride, sulphomolybdic acid, and iodic acid.
The details of the four tests followed. Since none was certain to be accurate and each had occasions where a positive result might be caused by a compound other than a morphiate, proper procedure dictated that each of the four tests be conducted on the substance. But Noah had only one small tablet. He had been taught in medical school to employ a sufficient quantity of an unknown to ensure a fair result, and so, conducting four separate tests would exhaust the material at hand. Even if a test were positive, he would need to retain at least half the tablet so that it might be tested independently to confirm his findings.
Forced, therefore, to choose one, perhaps two of the tests, he opted for the sulphomolybdic acid test, also known as Froehde’s test. It seemed most likely to produce a result unique to morphine. Herold’s instructions read as follows:
This reagent is prepared by dissolving five or six grains of molybdate of sodium or ammonium in two drachms of strong sulphuric acid. If morphine is treated with this acid, it strikes a beautiful violet color, changi
ng to green, and finally to a sapphire-blue.
Noah gathered the necessary chemicals. When the reagent was set, he ground one-quarter of the tablet with mortar and pestle, and placed the resulting powder in a test dish. As he prepared to treat the powder with the reagent, he found himself growing excited. If the mixture struck violet, his suspicion that Dr. Frias had prescribed a morphiate for Willard would be confirmed. Although the mystery of how the drug had lingered in the child’s system would remain, it might well have been the cause of the boy’s death. Perhaps the tablet contained some new formulation with an extended half-life.
Noah drew four drops of sulphomolybdic acid into a dropper’s neck. He held the instrument over the powdered tablet, unable at first to will himself to the squeeze the bulb. Finally, he did and the reagent dropped into the dish. Noah waited.
Nothing.
No violet at all. If anything, the original blue faded. Noah added more of the reagent. Still no reaction. Noah stared at the mixture in the dish and then at the impotent reagent, as if each had intentionally conspired against him. He reread the instructions, but he had performed the test properly. There could be no doubt. No morphia had been in the sample.
But perhaps the section of the tablet he examined contained only inert matter and the morphia resided in a section he had not tested. Yes. That might be. Unlikely, but far from impossible. He had sufficient material for one, perhaps two more experiments. Should he repeat the sulphomolybdic acid test? Or attempt one of the other three?
Noah chose the nitric acid test.
With morphine and its salts concentrated nitric acid produces a rich orange-red, slowly fading to yellow, or sometimes a brownish-yellow color, which upon standing strikes a light yellow. Nitric acid also produces a reddish color with other organic substances, but these are not crystalline. It strikes a deep-red color with brucine, which upon the addition of stannous chloride is changed to a bright purple; no such change is produced in the case of morphine.
Once again, failure. The powder did not strike red at all. Whatever was in the tablet, it was not a morphiate. No explanation had been provided for Willard Anschutz’s apparent morphia toxicity. But if the tablet was harmless, why was Frias so hot about it? Noah dropped the remaining half back into the envelope.
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