The Way of All Flesh

by Ambrose Parry

  ‘Barley sugar,’ she answered.

  Whatever fortitude had guided Sarah’s vital intervention quickly deserted her once the danger had passed, and she found herself suddenly tremulous and unsteady on her feet in the aftermath. At the professor’s bidding, she was escorted to his study, where she was furnished with a strong cup of tea. Mrs Lyndsay had great faith in its restorative powers, but as Sarah sat on the couch and slowly sipped, she reflected that perhaps simply enjoying the peace and time to drink it was the brew’s most efficacious property. The pounding in her chest gradually subsided and her breathing, which had been for a while rapid and shallow, returned to its usual rate and depth.

  There was a gentle rap at the door and Dr Simpson entered.

  ‘How are you feeling now, Sarah?’ he asked.

  ‘Much better, thank you, sir.’

  ‘I must congratulate you. You showed great presence of mind in dealing with that situation. You saved that wee fellow’s life, and no mistake. I am immensely proud of you. But I am also most curious as to just how you knew what to do.’

  Sarah cleared her throat. ‘Buchan’s Domestic Medicine, sir. We didn’t have a great many books at home, only that one and the Bible. As a result, I must have read it through a number of times.’

  ‘Indeed?’ asked Dr Simpson, smiling. Something about her answer appeared to have amused him. She felt that she ought to explain further.

  ‘My grandmother was the village howdie. A midwife and a healer. That is probably why I developed an interest in such matters. I know a little about herbal remedies. What she taught me.’

  Dr Simpson smiled again. ‘Hence your efforts in cultivating a little herb garden at the back of the house. I hope you’re not planning to go into competition with me as a healer.’

  ‘No, sir,’ she answered bashfully.

  ‘My grandfather too was a healer of some repute,’ Dr Simpson told her. ‘Mainly of livestock but he set a few bones in his time. He was, however, prone to indulging in country superstitions. He once buried a cow alive in an attempt to halt the progression of cattle plague, the image of which stayed with my father and haunted him to his dying day.

  ‘Fortunately, there is no place in modern medicine for such nonsense. Health and disease is not a straightforward business. It would seem that the more we know, the more there is to know. Always be suspicious of those who claim to have simple answers to complex problems. Beware the foul waters of quackery.’

  Sarah had heard similar speeches before and was well aware of the less-than-scrupulous travelling salesmen with their cure-all mixtures. While it was certainly true that country folk could still be a little credulous, being far removed as they were from great seats of learning, Sarah understood that when there was a dearth of knowledge and education, people – no matter their origins – were inclined to believe just about anything communicated to them with sufficient confidence and authority. However, Sarah also knew from personal experience that when all hope was lost, when all else had failed, people were willing to try almost anything to save those that they loved.

  ‘Surely botanicals cannot be considered quackery?’

  ‘Most definitely not,’ the doctor replied. ‘Nature has provided us with many useful remedies, but it is chemistry that will unlock her secrets. As a result of chemistry, we now know that it is quinine in Jesuit’s bark that makes it useful in tertian fever and morphine that gives the opium poppy its power.’

  Dr Simpson went to his bookcase and began searching the spines.

  ‘I have the most informative book on the subject: Outlines of Chemistry, for the Use of Students, by my colleague Professor William Gregory. Would you be interested in learning more about it?’

  Sarah smiled, put down her teacup and held out her hand.

  Twelve

  Raven entered the lecture theatre alongside the professor, loaded down by a stack of notes which Simpson typically ignored. The lecture room was full and the students unusually attentive. Raven had been on those same benches in the preceding two years, and it had been Simpson’s passion and clarity on his subject that had drawn him towards the field of midwifery.

  On this occasion the lecture was about the parturient with a contracted pelvis. As always the professor was a warm and engaging speaker, seldom taking his audience’s attention for granted, and illustrating his points through reference to relevant clinical examples. These were detailed in the case notes Raven had looked out and hefted into the room at Simpson’s request, but he never had need to refer to them.

  Looking at the packed theatre and comparing it to some of the sparsely attended meanderings he had sat through in the same venue, Raven considered how much the professor would make from the fees of this class alone. By his calculations it was a significant amount. Perhaps one day he might lecture here himself, or in the short term at least, now that he had been over the course, he could offer personal tuition to some of the rich students lining the benches. These were pleasant enough daydreams, but even if they were to come to fruition, it would not be soon enough for Flint.

  Towards the end of the lecture a messenger appeared at the door, sweaty and breathless from running, and clutching a soiled piece of paper. Raven intercepted him in the corridor outside before he could disrupt the doctor’s concluding remarks.

  ‘The professor is urgently requested to attend at a house in the Grassmarket, sir,’ he panted, thrusting the paper into Raven’s hand.

  ‘By whom?’ Raven asked, opening the note, the penmanship of which was illegible.

  ‘By the doctor who is already there.’

  ‘And did he write this with his feet?’

  ‘No, his left hand. He was using his right to stop the bleeding.’

  The doctor’s carriage sped them through the narrow streets, avoiding carts, barrows and the odd heedless pedestrian seemingly intent upon self-murder. The dog would have loved this, thought Raven, though he was not sorry that on this occasion the beast had been left at home.

  They pulled up outside a building on the south side of the Grassmarket and were directed by the messenger to an upper apartment. Simpson for once was panting due to the urgency of his ascent, unable to spare the breath to again observe ‘always the top’.

  Inside they found a young woman in labour, deathly pale and covered in a sheen of perspiration. Standing useless against the wall was a terrified-looking midwife who had some hours ago realised she was out of her depth.

  In this, she was not alone.

  The young doctor who had written the left-handed note looked besieged by his circumstances, crouching at the foot of the bed, blood spattering his face and his clothes. He had clearly been there for some time, and looked up with a bright expression of relief upon seeing Simpson, betraying that he had not been sure the professor would respond.

  Raven took hold of the woman’s wrist while Simpson shed his coat. Her pulse was rapid and thready. With the professor stepping in to intervene, the young doctor moved aside and climbed to his feet. He was shorter than Raven and slight of build, with something boyish about his countenance. He was expensively tailored, however, the clothes sitting elegantly upon his neat frame even as blood and sweat stuck the shirt to his chest.

  ‘Tell me what we have here,’ Simpson bade him.

  Raven had expected an anxious voice befitting the circumstances and his physical stature, but the young doctor explained the details of the case in a calm, clear register, his account as lucid as his note had been illegible.

  ‘Liquor amnii discharged early, ineffectual pains, two doses of ergot of rye given. There was considerable vomiting after the first dose, and after the second the patient said that she felt “something give” inside. The infant’s head remained high, and so I employed long forceps but to no avail. Considerable haemorrhage followed the attempt at delivery, whereupon I dispatched my urgent note requesting your assistance.’

  Raven was impressed as much by this display of professional detachment as by the contents of his descriptio
n. He knew well enough how flustered one could become in the face of mounting trauma, sufficient that the maelstrom inside his head could pour out as babble from his mouth.

  ‘Name?’ Simpson asked.

  ‘Beattie, sir. Dr John Beattie.’

  ‘Of the patient,’ he clarified.

  ‘Oh. Williams, I think. Or was it Williamson. I can’t quite recall. It has been a long day.’

  Dr Simpson examined the patient, looked at Raven and beckoned him closer. His face was grim.

  ‘The infant’s head is at the upper aperture of the pelvis and is fairly wedged there,’ he whispered. ‘It is not sufficiently far down in the pelvis for a forceps delivery to have any chance of success and I am worried that the uterus itself might have ruptured. We must deliver the infant without delay – it is the mother’s only chance of survival.’

  As Simpson began fishing about inside his bag, Raven wondered what implement might be in there that could succeed where the forceps had failed. Simpson withdrew what Raven recognised as a perforator, and immediately he understood what was about to happen. He should have known already, but his faith in the professor as some kind of miracle-worker had caused him to misread the possibilities. He was going to perform a procedure known as a craniotomy.

  Simpson took the bottle of ether from his bag. At least she wouldn’t have to be awake during this.

  ‘She shouldn’t need much,’ he said, looking at Raven.

  ‘Mrs Williamson won’t be having any of that,’ the midwife objected. ‘We’re of the same church and the minister says it’s not right to use it.’

  Raven looked at her in confusion and disbelief.

  She responded by thrusting a pamphlet at him, a diatribe penned by one Reverend Malachy Grissom.

  Raven glanced at it and then looked to Simpson, who responded with a weary expression. He had clearly encountered this form of resistance before.

  ‘The primeval curse,’ he said by way of explanation. ‘Genesis. “In sorrow thou shalt bring forth children.” Some consider it to be anti-scriptural to remove the pain associated with labour.’

  Raven thought that this sounded like needless stupidity, a description that fitted many words and deeds he had witnessed on the part of churchmen. Why a so-called man of God would deny a woman pain relief, especially given what was about to happen, made no sense to him.

  ‘Perhaps Mrs Williamson should be permitted to make that decision for herself,’ Raven suggested, earning himself a scolding look from the midwife.

  The woman herself could not be persuaded, however.

  ‘I’ll not risk eternal damnation for the sake of delivering a child,’ she replied weakly.

  The midwife nodded with undisguised satisfaction, her eyes fixed on Raven, and so Dr Simpson proceeded without the aid of a soporific.

  For once Raven was grateful for the sheet that was shrouding the woman’s legs and genital area. He knew what was happening, he had seen it before and he had no desire to see it again today. He could more or less recite Dr Simpson’s lecture on the subject anyway:

  Many children can be brought into the world by the use of forceps and turning, but there are cases where the infant’s head is too large and the maternal passages too small to admit the delivery of the child alive without bringing the life of the mother into the most imminent danger. In such circumstances, we can save the life of the mother by sacrificing that of her pregnancy. By opening the head of the infant by means of perforating instruments, we can remove the contents of the cranium and then break down the vault of the skull, bringing away the fragments until only the base of the cranium and the bones of the face remain to be extracted by means of the crochet.

  Even in her weakened state, Mrs Williamson writhed a great deal as the various instruments were inserted to break down the infant’s head and haul it out. Raven felt turmoil watching her and thinking of the tiny life that was being snuffed out before it had a chance to take a single breath. This was the thing that most caused him to fear he was not made of the right stuff to be a doctor. He knew for sure it was why he couldn’t be a surgeon. His mother always said he had the devil in him, but she simply meant he had a keen sense of mischief, the imp of the perverse. The human in him had a tendency to feel other people’s pain too keenly.

  After the infant was delivered – what was left of it – the placenta followed without delay, but the uterus would not contract. The patient continued to bleed despite the binder tightly wound round her abdomen. Raven knew this was a serious complication. He also knew there was nothing more they could do.

  The cleaning and tidying away of instruments was performed in near silence. Dr Simpson spoke to the midwife, giving instructions that she should see to her patient’s every comfort, vowing to return later in the day to check on her progress.

  He shook his head as he left the room.

  Thirteen

  The medical men, all of them now dishevelled and blood-spattered, emerged onto the Grassmarket, which was busy with carters and street-traders going about their business. It seemed incredible that the rest of the world could carry on as if nothing had happened: small-scale horror and tragedy swallowed up by the day-to-day affairs of the city.

  Simpson suggested that they repair to a local hostelry for a restorative to raise their spirits, nominating an establishment he had frequented as a medical student.

  Baxter’s tavern sat rather incongruously beside Cranston’s Teetotal Coffee House, which Raven noted with some satisfaction had little in the way of customers. Given the nature of the afternoon’s proceedings, he had no doubt which he would rather patronise but did have his concerns regarding who he might see in the alehouse, or more pertinently who might see him.

  Entering at the professor’s back, he scanned the room from the doorway, ready for a sharp departure. Simpson seemed to be on friendly terms with both proprietor and clientele. He ordered a round of Edinburgh ales, which he took an age to bring across due to how many conversations he struck up between the gantry and their table. Raven drank deeply, thirstier than he realised and in need of the comforts alcohol could offer.

  Beattie seemed altogether less traumatised by the outcome of the case. Perhaps this was because he had been a participant throughout rather than merely an impotent witness, and perhaps his greater experience of such things had inured him to the emotional effluent. He seemed unperturbed by the spit and sawdust of the pub, despite his expensive outfit suggesting he might be used to more salubrious surroundings. There was an awkwardness about his gait in keeping with a pronounced quickness to all his physical movements that reminded Raven of a small bird: fleet but restless, as though wary of predators.

  Up close and in clearer light, Raven enjoyed a closer appreciation of his boyish visage, which revealed the man to be not so youthful as he first appeared. Initially he believed he had encountered another prodigy like James Duncan (though hopefully not such an obnoxious one), but he could now see the lines around his eyes, suggesting Beattie might be in his late twenties.

  Simpson asked Beattie a little about his background, beginning with the seemingly inevitable question regarding his father’s occupation.

  ‘My father is dead, sir,’ Beattie replied. ‘Indeed, I lost both my parents when I was twelve. However, I am fortunate in having a benefactor in the form of my uncle, a Mr Charles Latimer, who is a man of some property in Canaan Lands on the Morningside.’

  Raven hoped Beattie’s uncle wore his largesse more lightly than Miserly Malcolm, who turned every penny spent on his nephew into a token of his sister’s failure and poor judgment in her choice of matrimonial partner.

  ‘You don’t sound as though you hail from these parts,’ Simpson suggested.

  ‘No. I was schooled in the south of England, but my mother grew up here. I attended university in Edinburgh to be closer to my uncle, who has become frailer over the years.’

  In the manner peculiar to all medical men, Simpson ignored all reference to finance and property and asked for detai
ls regarding the uncle’s debility.

  ‘He suffers from a severe form of rheumatism which causes him much pain. He has tried all manner of therapies in his attempts to find relief. He most recently embarked upon a trip to Austria to try a water treatment promoted by a fellow named Priessnitz. Runs a therapeutic establishment somewhere in the mountains.’

  ‘Did your uncle find any of this helpful?’

  ‘He found his pain to be somewhat improved but his spirits more so. It makes me think that there may be something in it – cold baths, simple diet and the withdrawal of all internal medicines. His response to these therapies – and more pertinently the sum he paid for them – leads me to envisage that there might be a lucrative market for hydropathic treatments.’

  Simpson rubbed his chin, fixing Beattie with a thoughtful gaze.

  ‘It could perhaps be argued that it was the withdrawal of his usual medicaments which resulted in his improvement, and not the regular soaking with cold water. We are perhaps too ready to dose our patients with powerful purges and bleed them to the point of depletion, don’t you think? My friend and colleague Dr George Keith is a great believer in Nature’s Method and the idea of masterly inactivity on the part of the physician.’

  ‘Primum non nocere,’ nodded Beattie in agreement.

  Do no harm: the Hippocratic injunction.

  Simpson took a gulp from his ale by way of toasting the sentiment, draining the last of it.

  ‘Forgive me, Dr Beattie, I have just spied a good friend at another table. But before I go, let me say I have very much enjoyed meeting you this afternoon. You must come to dinner at Queen Street.’

  ‘I would be honoured,’ Beattie replied with a quiet grace.

  Raven could only imagine how he might have spluttered his response had someone so feted extended such an offer. This together with his fine garb suggested it was not the first time Beattie had been invited to dine in estimable company.

  They watched the professor stride across the tavern and loudly hail a fellow on the other side of the room.