Comes a Time for Burning

by Steven F Havill

  Every gas lamp on the clinic’s first floor was blazing, the light pouring into the mud of Gamble Street. An oil lantern burned out in the barn, and Thomas could see the outline of one of the ambulances and the slightly stooped, slow-paced figure of Howard Deaton.

  “Dr. Hardy is in your office, Dr. Parks,” Adelaide Crowell said as he stepped through the clinic’s front door. The nurse had appeared from the dispensary, and headed for the stairway without another word.

  The door of his office was open, and the gas lamps burned high both there and in the small laboratory. That room, added during the clinic’s renovation the past winter, was nothing more than a small addition with a bay window looking out on the empty field beside the clinic. Despite the dispensary’s modest size, six gas sconces flared, shadows like a kaleidoscope about the room.

  Dr. Lucius Hardy was in the process of screwing the door closures shut on the gas-fired incubator, and he turned as Thomas entered.

  “Good morning,” he said, but without his usual good humor. He glanced over at the small wall clock. “Rather an unpleasant interlude, and I find myself all thumbs in a strange dispensary. I spend so much time searching for things that I trip over myself.”

  He beckoned. “Come with me, will you?” He left the tiny room. Thomas followed as Hardy strode through the waiting room and then took the stairway up to the women’s ward two steps at a time.

  A single patient rested in the first bed on the right. In the back of the ward, the door to little Matilda Snyder’s room was closed, but Thomas could see a faint sliver of light as if the gas light had been turned to its lowest flicker.

  “This is Miss Lucy Levine,” Hardy said. He stood by the woman’s bedside, the tips of his fingers in his vest pockets. “She is twenty-three years old, and until only recently, in excellent health.”

  Nurse Crowell waited off to one side, her hands wrapped in her apron. Her gaze flitted from Miss Levine, who appeared ready to roll herself into a ball, to the two physicians.

  “I know Miss Levine,” Thomas said, but he was ready to argue that the patient in the bed could not be the bouncy, ebullient young lady with a comical cackle that reminded Thomas of a turkey’s call. He had seen her from time to time at the Clarissa Hotel and at the clinic, including less than a month ago when he had extracted an abscessed molar for her. Although the young woman’s eyes watched him in a singularly unfocused way, there was little life there. Her cheek bones stood out from a sunken face, her eyes dry and hollow. Thomas touched the back of his hand to her face and felt the cool, dry skin. He had expected to feel the rages of an interior furnace of infection, and was startled at the chill.

  “What was her temperature the last time you checked, Miss Crowell?”

  “Ninety-four degrees, doctor. That was at two on the clock.”

  “Ninety-four? You’re certain?”

  “Indeed so.”

  Miss Levine jerked, a feeble hiccough that recurred several times in rapid succession. An unintelligible murmur passed her lips. Thomas lifted away the light blanket, hesitated, then pulled it entirely off the narrow bed. The linen was foul over the rubber pad, but fresh elsewhere. Mrs. Crowell had been attentive, trying her best to keep up with the evacuations. She now used towels as one would diaper an infant.

  The patient’s legs worked feebly, and Thomas knelt to listen to the shrunken chest with his stethoscope. Even Lucy’s breasts, normally so buxom and enticing for her logger clientele, were shriveled in on themselves, as if sucked to desiccation from within. Thomas closed his eyes and concentrated, hearing a laboring heart beat with a feeble second stroke. He tried to rest his hand on her abdomen, but the woman uttered a cry so piteous, so heart-rending, that Thomas flinched. Her gut was hard and he could see every striation between the muscles, the skin drum-tight and dusky.

  What had been the body of a healthy, robust young woman now lay as a pathetic creature, all the life shrunken out of her.

  Thomas was about to ask Nurse Crowell to remove the bedding when the patient evacuated again, so violently that it caught Thomas by surprise.

  The nurse moved quickly with towels, and Thomas stood back, stunned. Perhaps two quarts of light straw colored fluid issued from the now frail body, looking as if someone had upended a cauldron of rice water.

  “She looses fluid faster than it can replaced,” Hardy said. “We’re seeing dehydration to the point of desiccation. Look there,” and he touched the corner of a listless eye. “She has not a tear remaining.”

  “She is able to hold water given by mouth?” Thomas could see that, although Lucy might be so ill that she couldn’t bear to speak, she was hearing the conversation, and the fear in her eyes stabbed his heart. “Anything at all?”

  “Not a drop,” Mrs. Crowell said. A robust, determined woman with the heavy foot tread of a laborer, her face was grim. “The poor thing wastes before our eyes,” she whispered. Thomas saw the pan on the next table, the black tubing and bulb coiled in the solution. He nodded at it, and Mrs. Crowell said, “Twice now, at least four liters. So little good.”

  “My God. Food poisoning, you think?” he asked, turning to Hardy. Bad fish could be lethal, he knew, but he had never seen a case as violent as this. “How did she come to us? To your attention, Lucius?”

  “A friend of hers came to the clinic, and Mrs. Crowell roused Howard. He went and fetched the girl in the ambulance. And a good thing he did, too. That’s been nearly three hours ago, now.” He turned his back to the bed and lowered his voice. “We are losing ground, Thomas.”

  “You should have called me earlier. She is alone in this? No others are ill?”

  “Apparently not, and frankly, that surprises me.” Hardy turned and regarded the girl. “She managed to tell me that she was taken ill the night before.” He consulted his watch. “Some thirty hours.”

  “Poisoned shell fish?” Thomas said, meaning it more as a thought than to be expressed aloud. Hardy inclined his head in skepticism, and Thomas answered for himself. “I see no respiratory spasms, and no paralysis. What else do we know that attacks so suddenly, Lucius? And with sub-grade temperature. She became ill Wednesday evening?”

  “It would seem so. She complained of an odd malaise for several hours, but professed to no serious distress until the early morning hours yesterday. And in that short time…” He nodded at the girl’s pathetic figure, and reached down to gently spread the light blanket across her upper body. “Come downstairs for a moment. But first…Mrs. Crowell?” Hardy asked, and she nodded. “I want that stripped linen out of this room. If it cannot be properly washed, then it must be burned in the incinerator.” He turned to Thomas. “You have such?”

  “Behind the clinic. Of course. But burned? You’re speaking of something that is highly contagious. Surely, with something like food poisoning…”

  “We are beyond that,” Hardy said cryptically. “We have contagion, of the worst sort.”

  Thomas stared at Hardy, and then at Lucy Levine. “Mrs. Crowell,” he said softly, “I know that Eleanor Stephens was not planning to work tonight, but now it is imperative that she do so.”

  Hardy interrupted before Thomas could continue. “If the laundry room is not adequate in some way, you must tell us immediately. If the linen has not been soiled, it may be laundered with lye soap, otherwise burned. At all times, this woman must be on clean linen. I don’t care if it is changed ten times a night. Your use of towels is commendable. Continue to do so.”

  “Yes, Doctor.”

  “And be mindful of your own hygiene, always. Repeated cleansing of the hands is an absolute necessity. Finish with alcohol.”

  “You are thinking…” Thomas asked, since it seemed to him that Hardy clearly had a diagnosis in mind.

  “Let me show you, with the culture,” Hardy said. He turned away from the bed, beckoning Thomas. “It’s best we be in accord with this.”

  “I’ll have Howard fetch Miss Stephens,” Thomas said to Mrs. Crowell. “He’s in the barn still?”

/>   “I believe so,” the nurse replied.

  “Good.” He turned to Hardy. “When I arrived, I saw you at the incubator?”

  “Indeed. I want to be sure. A culture gives us something to examine in patient detail. In the meantime, I have made a crude suspension for you, taken from the evacuations. I want you to view the slide immediately.”

  “This very moment,” Thomas said, and he felt not foreboding but incredible excitement driving his pulse skyward. “Wait…Miss Crowell, stay with the patient. Make sure she remains dry, clean, and warm. If she will take no fluids, then we must try something else…perhaps by injection. Warm wraps over her abdomen may provide some relief. If the pain is great, a single injection of morphine now may be of some help. Begin with a quarter grain.”

  He knelt by the head of the bed, looking Miss Levine directly in the face, eye to eye, a hand on her forehead. “We’re with you now, Lucy. Keep your courage. Do you understand me?” Perhaps she did, perhaps not, but Thomas was galvanized by the chill of her breath. “If the cramps in her legs become severe, an inhalation of chloroform may be of help,” he added. “We’ll be right back. I shall alert Mr. Deaton myself.”

  Hardy turned away, and then stopped. His tone was sharply commanding. “And nurse—every time, and I mean every time you handle her linens when they become soiled, every time you handle the patient in any way, you must cleanse your hands and arms as thoroughly as if you were about to assist Dr. Parks or myself in surgery. Do you understand that? Every time. With no hesitation, no delay. That is an absolute instruction that will not be debated. You will make whatever arrangements are necessary for fresh, clean clothing as well.” He nodded at her soiled apron. “Get rid of that immediately.”

  He spun around before she could reply, and made for the stairway, with Thomas on his heels. Behind the clinic, Howard Deaton was cleaning the inside of the ambulance, and Thomas stared at the soiled blankets. “My God,” he whispered. “All to be burned, Howard. Not laundered.”

  “You can’t burn all of them,” Deaton said automatically.

  “Oh, yes, we can. And liberal coal oil to make the fire instant and hot. In fact, before the night is finished, we’ll be burning a good deal. If one incinerator is inadequate, fashion another. Lindeman must have something you can use. Wake him, if necessary.” He held up his hand, lifting a finger. “First, tend to the blankets you have there. Second, wash your hands all the way to your elbows with strong soap and hot water, disinfect after that with corrosive sublimate. You’ll find the bottle of that in the dispensary, marked as a solution. Ask Mrs. Crowell to assist you. Keep it away from your eyes. A witch hazel or brandy splash afterward may make it more agreeable. And then… and then… go fetch Nurse Stephens. Understood?”

  Deaton looked at Thomas askance. “What hit her?”

  “We’re about to find out, Howard.” Thomas returned to the clinic, and in the laboratory, Hardy straightened up. Gas light flinted off the polished brass barrel of the Heinnenberg.

  “See for yourself, Thomas.” Hardy offered his place at the microscope. “While you’re looking, I’ll see if Mrs. Crowell knows what she is about. The evacuations are so frequent that if she is capable with the tube and bulb, so much the better. I’ll be back in a moment to speak with you about a strategy.” He dropped his hand on Thomas’ shoulder and then was gone before Thomas could frame a single question.

  After some finagling, Thomas forced the image into startling clarity under the Heinnenberg’s big lens. At his elbow, a volume of Fellow’s The Theory and Practice of Medicine had been opened and marked. Although the poor rendition in the textbook paled in comparison with the brilliant image in the Heinnenberg microscope, Thomas could see the deadly similarities.

  “From one half to two-thirds the size of the tubercule bacillus,” he read quickly. “Thicker and somewhat curved, resembling a crescent or comma in shape, sometimes occurring in a double S. Length of the bacillus rarely exceeds a micron, with most half that. Frequently aggregated in small groups, perhaps even a spiral.” He went back to the microscope, shifting the slide this way and that to observe the entire specimen. “My God,” he whispered, and sat back.

  When Thomas had been at University, it had been fashionable among the medical students to discuss various careers paths. One popular notion had been to serve the wealthy and healthy, earning a sumptuous living. A second, favored by the most altruistic, was to journey to the far reaches of the globe, waging war against the dangerous diseases that decimated entire populations, diseases that preyed most commonly on the poverty-stricken and down-trodden. In between the two extremes were the majority, doctors-to-be who wanted a quiet life in modest private practice, whether in the congested cities or in the country.

  In his class, Thomas had been alone in his fascination with the trauma that both war and peace could inflict on the human body.

  But in deference to the second group, those who wished to confront the major scourges of the world, professors were fond of pontificating on what young physicians should do when serving in India, Burma, or China, fighting an epidemic.

  “Exactly,” Thomas said aloud. This very bacillus had been the subject of discussion on more than one occasion, and Thomas could now freely admit—when he most needed for circumstances to be otherwise—that he hadn’t listened to the professors as well as he might now wish. He took a deep breath, and readjusted the instrument and the objectives, seeking more power. When his eye started to water with the concentration, he sat back again, referring again to the text.

  “The bacillus thrives in foul water, especially briny water, and Koch considers the Delta of the Ganges to be its natural home,” the book’s passage reported. The good Dr. Koch, Thomas thought, a man who knew more about the ‘wee beasties’ than anyone else on the planet—and still didn’t know very much. “Such tiny things,” Thomas murmured. He looked up at heavy bootsteps. Hardy reappeared, this time rubbing his hands, the smell of strong chemicals permeating the tiny room. “You’ve started a culture?” Thomas asked.

  “Two, actually,” Hardy replied. “Peptone and beef broth. And by the way, Mrs. Crowell is most adept around the patient, although she had never performed this particular procedure. She appeared to feel somewhat more relieved when I admitted that I had never done it myself…but that you had instructed me carefully.” He grinned. “A small untruth, but a useful one. We’re a pair, aren’t we. Of course, by the time this night is finished, we’ll be seasoned veterans.”

  “And the patient took how much?”

  “The better part of a liter the first time.” Hardy grimaced. “And then promptly evacuated again. We repeat and repeat, whatever is necessary.” He reached over Thomas’ shoulder and turned several pages in the text. “I have followed this compound,” he said. “I don’t know what else to do.” Thomas read the mercifully brief list of preparations—boiled water with an infusion of chamomile, a few grains of tannin, a generous allowance of laudanum, and fifty grains of powdered gum arabic. On the counter across the room, he saw the pitifully inadequate supply of gum arabic.

  “Do we have enough of anything for this? I mean to accomplish a continuing treatment?”

  “I don’t know.” Hardy nodded at the clutter of chemical bottles on the counter. “I hope you’ll excuse my rummaging about.”

  Thomas shook his head impatiently. “The clinic is yours, Lucius. Do as you see fit, always.”

  “Well,” Hardy continued, “We have a great sufficiency of laudanum and morphine, somewhat less so of cocaine, should pain become unbearable.” He reached out and tapped the book. “This?” Thomas scanned the indicated paragraph. “We have chloride of sodium and sodium carbonate. If she continues to evacuate in such volumes, then we should not hesitate. You’ve done hypodermoclysis?”

  “Never. Not even the bulb…”

  “Before this night, anyway,” Hardy said. “We must hydrate, or we lose her. I believe it’s that simple.” When Thomas didn’t reply, he reached out again to tap the book
. “So. Am I correct about this?”

  “I fear so. I would never have believed it, but the symptoms leave no question. I don’t see how you could be wrong.” He sat back. “And if it’s some lesser thing, we can only be successful by treating for the worst possibility.” He took a deep breath. “And this is certainly the worst, Lucius. We must act on the supposition.” He patted the barrel of the expensive microscope. “Were the proof not in front of my own eyes, I would think a silly mistake has been made. This is hardly cholera country.” He patted the open pages of the text. “We are far, far from the Ganges River.”

  “Any country may be cholera country, if the conditions are right,” Hardy replied. “You might recall the scourge in England and Wales half a century ago that killed fifty thousand. And as recently as ’73, when cholera rampaged through portions of New York City.” He heaved a sigh. “But the immediate question is simple, so simple. How are we to save Miss Levine’s life?” He lowered his voice. “And how to prevent the progression of what is now an isolated case? How many live in this village?”

  “I’ve been told nearly eleven hundred if one includes the various small establishments on the periphery, along with the logging camps.”

  Hardy’s expression was grim. “Fifty thousand in Egypt eight years ago, Thomas. This disease can be traced into every dark corner of the globe.” The muscles of his cheek clenched, and for the first time, Thomas saw some of Lucius Hardy’s confidence drain away.

  “Not much frightens me, Thomas.” He nodded at the microscope. “This does.”

  “Indeed,” Thomas said quietly. “This text instructs us. The cholera is no shrinking violet, Lucius. It will not be content in taking but one life. Someone brought the condition to Port McKinney, and Miss Levine is the first case brought to our attention. We can guarantee that she will not be the last. But how did this specter come under the Clarissa’sroof? According to this,” and Thomas nodded at the text, “there has been no generalized epidemic of cholera since that reported in 1873 in New York. Only isolated cases since. We can hope that’s true.”