by Carol Baxter
• • •
That Tuesday afternoon, Dr Marshall received word that Mrs Collins had visited the surgery while he was out and had left a message saying that her husband was no better. His curiosity was piqued. While the message suggested that her husband was no worse—a promising sign, of sorts—it also indicated that the second medication had failed to take effect. Was his latest diagnosis also incorrect? Perhaps he should visit Collins again and check on his condition, if only to alleviate his own concerns.
The following day, just as he was about to leave for Botany, he received a visit from his brother-in-law, Dr Thomas Martin. Also Irish-born, Martin had joined Marshall’s Elizabeth Street practice on his arrival in Sydney and had worked there until a few months previously, when he established his own practice in College Street.
‘I’m just off to visit a patient,’ Marshall apologised. Then, as Martin might have previously attended the man, he mentioned his name: Michael Peter Collins.
Martin said that he knew Collins and his wife, having attended their dead baby and Mrs Collins’ first husband while working at Marshall’s surgery. He began to describe his encounters with the family, one story that segued into a second. When he had finished, he left his brother-in-law alone to absorb the significance of his tale.
Before commencing his journey, Marshall decided to collect one last item for his medical bag—just in case.
Chapter 2
Where there is mystery, it is generally expected there must also be evil.
Lord Byron, Fragment of a Novel
Was Thomas Martin truly saying what Marshall thought? Had they both missed something vital? As the thoughts buzzed around Marshall’s mind, the steam-driven tram carried him south to Botany, where he alighted around four o’clock that Wednesday afternoon. Finding Collins in bed looking no worse than before, he asked how he felt.
‘The diarrhoea and straining have ceased,’ Collins replied, ‘and my motions are natural but the vomiting continues. I still have a slight pain over the stomach, although it is not very severe.’
Marshall reached down and pressed lightly on Collins’ stomach. No reaction—a good sign. He made the usual examination, noticing only one new symptom: conjunctivitis, an inflammation of the eyelid covering. Otherwise, Collins’ general condition seemed satisfactory and his symptoms consistent with the second diagnosis. There was still no cause for alarm.
While examining Collins, he had sidestepped a chamber-pot sitting on the floor near the bed. It contained foul-smelling vomit of an unpleasant greenish hue. He pointed to the pot and asked Collins: ‘Did you vomit that?’ Receiving confirmation, Marshall poured the lumpy liquid into the empty eight-ounce medicine bottle he had returned to his surgery to collect. He sealed it and slipped it inside his medical bag.
Glancing around the room, he saw a liquid-filled lemonade bottle sitting on an upturned box that served as a bedside table. He asked Collins if he knew what it contained. ‘Brandy,’ was the response. Continuing to look around the room, he spotted an empty bottle on the dressing table. Just what he needed. He poured some brandy into the bottle and tucked it into his medical bag. He then said that Collins would need to void some urine so it could be tested for kidney disease. Another empty bottle on the dressing table could be used for its storage—once it had been washed.
Marshall took the empty bottle to the kitchen, which lay at the back of the house behind the sitting room. Finding Mrs Collins there, he asked her to wash it, explaining that he would need to test a sample of Collins’ urine as his condition wasn’t improving.
While he waited, he wrote a prescription for a mixture that should relieve Collins’ pain and vomiting. Among other ingredients, it contained bismuth subnitrate—a medical preparation widely used to treat gastric complaints—hydrocyanic acid (cyanide) to relieve coughing and gastric pain, and morphine hydrochloride for general pain relief.
As Mrs Collins washed and dried the bottle, she said: ‘The powders you ordered before did not stop the vomiting. Will the new powders stop the vomiting at once or are they for the disease?’
‘Not directly,’ he replied.
‘Could you give me something to stop the vomiting directly?’
‘I will try.’
While they were talking, he noticed a three-quarters-full medicine bottle sitting on a kitchen shelf. ‘Is that the medicine I prescribed first?’ he asked. When she confirmed that it was, he put the bottle into his pocket.
After collecting the urine sample, he explained to them both that Collins was to have a half-ounce of the newly prescribed medicine every four hours. Mrs Collins was to let him know the next day how her husband fared. He then asked for his fee.
Mrs Collins said bluntly, ‘I cannot give it.’
Marshall had heard this response many times before—usually after he had provided the requested treatment, of course. Impecunious patients were a hazard of the medical profession. For obvious reasons, the ailing often had difficulty earning the money they needed to pay for a doctor’s treatment. Most tried to reimburse him once they were back in funds. Some didn’t, and the bad debts accumulated. The doctor therefore told Mrs Collins that if her husband’s condition worsened she should take him to the Coast Hospital at Little Bay as it was too far for him to come again. She made no reply.
• • •
Under the circumstances, Marshall was surprised to see Mrs Collins at his surgery the following day. Admittedly, he had asked her to report back—but that was before she had been unable to pay the fee.
‘The medicine did not stop the vomiting,’ she said. ‘Collins was very bad last night and I thought he was unconscious. I thought he was going to die. And his throat is very sore.’
‘Continue the mixture,’ the doctor recommended, ‘and have him gargle with alum and water.’ He knew that the medicine he’d prescribed should ease the irritation and inhibit the vomiting—in ordinary cases, that was—so he was surprised that Collins still wasn’t improving. All the more reason for him to test the collected samples.
‘I cannot come again until you find my fee,’ he warned. ‘I advise you to send him to the hospital.’
‘I am well known about Botany,’ she reassured him. ‘It will be all right.’
• • •
George Marshall’s first opportunity to test the samples came the next day, Friday, at the dispensary of his cousin, Dr Hezlett Hamilton Marshall. Sydney had taken pride in the achievements of this colonial-born doctor, with the newspapers reporting in 1885 that young Hamilton had passed his second set of examinations for Edinburgh University’s Bachelor of Medicine degree, gaining four first-class honours. Back in Sydney, Hamilton had taken over his late father’s Liverpool Street surgery where George once worked. There in its little laboratory, surrounded by a rainbow of different-shaped glass carboys filled with herbs and chemicals, they would conduct their chemical investigation.
Only one test interested George Marshall. Although he hadn’t mentioned it to the Collinses, he wanted to know if any of the samples showed traces of a certain sparkling white crystal, one that had long been nicknamed ‘the inheritance maker’. Officially, it was labelled ‘arsenious acid’; however, to the humble denizens of this century-old colony, the crystals had a shorter, more ominous name: arsenic.
The Reinsch test would serve his purpose. Chemists had used the simple procedure for half a century to detect arsenic and other heavy metals. It shouldn’t be long before he had some answers.
As his cousin gathered the testing equipment, Marshall lifted the bottle of Collins’ vomited matter from his medicine bag. He took out a small sample, about half an ounce, and tipped it into a glass test tube, adding enough water to cover the sample. Picking up a bottle of hydrochloric acid, he poured the required amount into the test tube and stirred the mixture. The acid would dissolve the vomit. He boiled the liquid over a Bunsen burner for some time, then picked up a strip of bright copper foil and inserted it into the test tube.
The test’s
inventor, the German chemist Hugo Reinsch, had determined that heat applied to the test-tube contents would convert the solid substance into a vapour. On cooling, the vapour would condense again into a solid state without becoming a liquid—that is, it would ‘sublime’ as a grey-to-black metallic coating on the foil. If such a discolouration appeared on the foil, it would signify the presence of arsenic.
Marshall pulled the copper foil from the test tube. He and his cousin peered at the foil. There was indeed a slight discolouration. But was it enough for them to be certain that arsenic was present? They conferred and peered again and conferred once more. They decided that it wasn’t.
Perhaps they would obtain more definitive results from one of the other samples. They performed the same test on Collins’ urine and also on the contents of the other bottles collected from his house. Again they found nothing noteworthy. Afterwards, they put all but the urine bottle on the top shelf of the dispensary and left them there for safe keeping.
George Marshall took the urine bottle back to his own surgery so he could conduct the necessary kidney-function tests. He tested the urine’s albumin levels—increased levels indicated kidney damage—but the results were normal. He tested the urine’s specific gravity and found that it too fell within the normal range. Clearly, his patient was not suffering from kidney disease. He poured the urine into a clean eight-ounce medicine bottle and stashed it away safely.
Having found no evidence of arsenic poisoning, his suspicions were allayed. Even so, he remained curious about the case. He decided to visit Collins once more to see how he was faring.
• • •
No one answered the door when he arrived at the Collins house around four that afternoon. Again he knocked and waited . . . and again. When Mrs Collins eventually opened the door, she said, ‘Oh, it’s the doctor. I had not expected you.’ She welcomed him inside.
In the bedroom, he saw Collins leaning over the side of the bed as if he were about to vomit. He mused, ‘It is strange that he is still vomiting.’ Past experience had shown that his medicine usually suppressed the urge.
‘I have just given him a vomiting powder I got from Waterloo,’ Mrs Collins said.
Surprised, he queried, ‘Why did you give him that?’
‘I thought you weren’t coming again and I didn’t know what to do. A man told me Mick was suffering from biliousness and a vomit would do him good.’
Mick’s friend Arthur Hamill had visited earlier in the day and had initially suggested a drink of hot beer and egg to sweat out Mick’s cold. She’d prepared it for him but he hadn’t liked it. When Hamill and his wife returned later in the day, they had suggested the vomiting powder.
As Louisa handed a liquid-filled glass to her husband, she explained to the doctor that she was giving him hot water to encourage vomiting.
Marshall didn’t object. While perplexed that she should trust such unprofessional medical advice, he knew that the vomiting powder was unlikely to cause any harm. He waited until Collins had drunk the water before asking about his symptoms. Collins complained again of pain and of his continued inability to sleep. Marshall questioned him about his diarrhoea and learnt that the pendulum had swung the other way, to constipation.
He conducted another physical examination. Collins’ pulse was still strong, that of a healthy man. His appearance remained satisfactory, little different to two days previously—certainly no worse. However, the continued eye inflammation led Marshall to ask Mrs Collins about it.
‘The retching and vomiting have made his eyes sore,’ she explained.
Marshall knew that the retching itself would not have caused conjunctivitis. It was, however, a symptom of a variety of other medical conditions, some that were of particular concern.
He wrote out another prescription, one containing five grains of calomel and two grains of powdered ginger. It would act as a purgative to relieve Collins’ constipation.
By this time, the vomiting powder was taking effect. Collins spewed a large quantity of dark green matter into the chamber-pot—an ideal specimen, Marshall realised. He told Collins and his wife that he would need to collect a sample so he could conduct further tests. Helpfully, Mrs Collins went out to the kitchen and returned with a small cup. He didn’t need it, though. Despite his failure to detect arsenic in the earlier samples, he still had a niggling concern. Moreover, he hadn’t forgotten his brother-in-law’s tales about his encounters with the family, so he had brought along another clean bottle.
‘As you are not improving, you would be far better off in hospital,’ Marshall told Collins in his wife’s presence.
Collins made no reply.
After taking leave of his patient, Marshall paused at the front door to urge Collins’ wife to heed his advice.
‘People always die when sent to hospital,’ she replied matter-of-factly. ‘If he is going to die, it is better for him to die at home.’
Marshall had often encountered this attitude to hospital care. The public had known that hospitals were dangerous places long before Ignaz Semmelweis recognised the deadliness of a doctor’s unwashed hands—made even more deadly when an earlier patient was an autopsied corpse. Unfortunately, with the arrogance of rank and conservatism, many doctors had dismissed Semmelweis’s simple antiseptic solution and had continued with their unwashed practices. It would be a long time before the public lost its fear of hospitals.
‘I see no reason to suppose he will die,’ he reassured her. ‘On the contrary, I think he will get better if he is well looked after. People are well-treated in hospitals.’
She didn’t argue but nor did she look convinced.
‘I will not and cannot call again,’ he added firmly, having failed yet again to get his fee. ‘Let me know tomorrow what you will do.’
He left the house, hoping she would take his advice and send her husband to the hospital. Meanwhile, he would undertake more tests on the new vomit sample.
• • •
The press continued to discuss possible threats from abroad even though concerns were easing about the cause of the cable ruptures. It was as if Australia had only now noticed its isolation, its vulnerability. The Sydney Morning Herald wryly observed that, when the country had been tied to grandmama’s apron strings—that is, Britain—its people had been happy to thumb their noses at ‘nasty, big boy Johnny’, whichever country had had that honour at the time. Now that these apron strings had been cut, its citizens were wondering if Johnny was prowling nearby with the intention of whopping them at his leisure.
The Herald also opened the public’s eyes to a potential threat that no one had reccognised. A derelict, bottom-up ship had recently been found anchored in front of New South Wales’ chief coal port, Newcastle. What if this ship had been a Trojan horse with its entrails crammed with Russians—or, worse, Chinese? Thankfully, the government had at last recognised the danger and was planning to blow it up.
Some reminded the community that the press’s alarmism was nothing more than fanciful nonsense. There were no threats from abroad, no bogeymen using stealth to attack and destroy. Clearly, even among adults, imaginations could run rife when confronted by the seemingly inexplicable.
Chapter 3
It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm.
Florence Nightingale, Notes on Hospitals
Send Mick to the hospital? Not likely. Everyone knew that you might as well plan a funeral service as admit a loved one to the hospital—particularly the Little Bay hospital. It was the ‘fever hospital’, accepting patients with horrid diseases like smallpox and tuberculosis, diphtheria and scarlet fever. What hope had a sick person there? No, Louisa decided, she wouldn’t send him to the hospital. But what could she do to help him? He was getting worse.
Mick had fallen ill while at work two weeks previously, on Saturday, 23 June. Since mid-April, he had been working for Botany fellmongers Elliott & Geddes, mainly as a carter in rece
nt weeks. He would drive a lorry to either Glebe Island or Rookwood where he would load the ‘green skins’ of freshly slaughtered sheep then drive them back to the wool-washing site at Springvale, Botany. There the wool would be pulled off and dried and the skins prepared for leather-making.
That particular Saturday, he had been rostered to collect skins from Rookwood. Around three am, he had eaten bread and butter before heading off with his partner John Walker—the carters usually worked in pairs—to harness their teams and drive to Rookwood. He later said that, during the journey, his stomach had begun to churn, causing him to retch a couple of times. When they reached Rookwood, he had dashed into the bushes to vomit. He told Walker that he was too sick to load the skins, that Walker would have to do the work for him. He had managed to drive his own lorry back to Springvale, but since then his illness had prevented him from returning to work.
This meant that they were already short a fortnight of his £2 5s weekly wages. How could she pay the doctor when she had little income and limited savings? They no longer housed boarders, although her middle boys—Arthur and Frederick—added to the family’s coffers. Arthur worked at the Botany glassworks and Fred at the wool-washers, but they were paid only a fraction of adults’ wages. At least her two eldest sons weren’t a financial burden: Herbert, now aged twenty-one, had moved to the Newcastle district four years earlier, before his own father died, while Reuben had recently joined him there. She still had three young mouths to feed, though: May, Edwin, and her youngest, Charles, aged five. Meanwhile, the cost of Mick’s medical treatment had cut into their savings, and it hadn’t helped him, anyway. Reluctantly, she sent Fred to Mick’s boss, Mr Geddes, to ask for money to pay the doctor. It was a matter of pride to her that she always paid her bills, later if not sooner, no matter the circumstances. But she hated having to beg. Still, it was necessary in this instance. She wanted the very best treatment for her ailing husband.
