He lay curled on the ground, wearing only a shirt, a water jug lying near his head. I knelt by him, peering as I touched him. His shirt and legs were stained, as was the grass where he lay. The excrement was very watery—most had soaked into the soil by now—but there was some solid matter. He’d been stricken later than Hortense and the children, then; his guts hadn’t been griping long, or there would be mostly water, tinged with blood.
“Padraic?”
“Mrs. Claire, thank the Lord ye’ve come.” His voice was so hoarse I could scarcely make out words. “My bairnies. Have ye got my bairnies safe?”
He raised himself on one elbow, shaking, sweat plastering strands of gray hair to his cheeks. His eyes cracked open, trying to see me, but they were swelled to mere slits by the bites of deerflies.
“I have them.” I put a hand on him at once, squeezing to force reassurance into him. “Lie down, Padraic. Wait a moment while I tend them, then I’ll see to you.” He was very ill, but not in immediate danger; the children were.
“Dinna mind me,” Padraic muttered. “Dinna . . . mind . . .” He swayed, brushed at the flies that crawled on his face and chest, then groaned as cramp seized his belly again, doubling as though some massive hand had crushed him in its grip.
I was already running back to the house. There were splashes of water in the dust of the path—good, Brianna had come this way, hurrying.
Amoebic dysentery? Food poisoning? Typhoid? Typhus? Cholera—please God, not that. All of those, and a lot more, were currently lumped together simply as “the bloody flux” in this time, and for obvious reasons. Not that it mattered in the short term.
The immediate danger of all the diarrhetic diseases was simple dehydration. In the effort to expel whatever microbial invader was irritating the gut, the gastrointestinal tract simply flushed itself repeatedly, depleting the body of the water necessary to circulate blood, to eliminate wastes, to cool the body by means of sweat, to maintain the brain and membranes—the water necessary to maintain life.
If one could keep a patient sufficiently hydrated by means of intravenous saline and glucose infusions, then the gut would, most likely, heal itself eventually and the patient would recover. Without intravenous intervention, the only possibility was to administer fluids by mouth, or rectum as quickly and as constantly as possible, for as long as it took. If one could.
If the patient couldn’t keep down even water—I didn’t think the MacNeills were vomiting; I didn’t recall that smell among the others in the cabin. Probably not cholera, then; that was something.
Brianna sat on the floor by the elder child, the little girl’s head in her lap, pressing a cup against her mouth. Lizzie knelt by the hearth, face red with exertion as she kindled the fire. The flies were settling on the motionless body of the woman on the bed, and Marsali crouched over the limp form of the baby on her lap, frantically trying to rouse it to drink.
Spilled water streaked her skirt. I could see the tiny head lolled back on her lap, water dribbling down a slack and horribly flattened cheek.
“She can’t,” Marsali was saying, over and over. “She can’t, she can’t!”
Disregarding my own advice about fingers, I ruthlessly thrust an index finger into the baby’s mouth, prodding the palate for a gag reflex. It was there; the baby choked on the water in its mouth and gasped, and I felt the tongue close hard against my finger for an instant.
Sucking. She was an infant, still breastfed—and suckling is the first of the instincts for survival. I whirled to look at the woman, but a glance at her flat br**sts and sunken n**ples was enough; even so, I grabbed one breast, squeezing my fingers toward the nipple. Again, again—no, no droplets of milk showed on the brownish n**ples, and the breast tissue was flabby in my hand. No water, no milk.
Marsali, grasping what I was about, seized the neck of her blouse and ripped it down, pressing the child to her own bared breast. The tiny legs were limp against her dress, toes bruised and curled like wilted petals.
I was tipping back Hortense’s face, dribbling water into her open mouth. From the corner of my eye, I saw Marsali rhythmically squeezing her breast with one hand, an urgent massage to make the milk let down, even as my own fingers moved in an echo of the motion, massaging the unconscious woman’s throat, urging her to swallow.
Her flesh was slick with sweat, but most of it was mine. Trickles of perspiration were running down my back, tickling between my buttocks. I could smell myself, a strange metallic scent, like hot copper.
The throat moved in sudden peristalsis, and I took my hand away. Hortense choked and coughed, then her head rolled to the side and her stomach heaved, sending its meager contents rocketing back up. I wiped the trace of vomit from her lips, and pressed the cup to her mouth again. Her lips didn’t move; the water filled her mouth and dribbled down her face and neck.
Among the buzzing of the flies, I heard Lizzie’s voice behind me, calm but abstracted, as though she spoke from a long way off.
“Can ye stop cursing, ma’am? It’s only that the weans can hear ye.”
I jerked round at her, only then realizing that I had in fact been repeating “Bloody f**king hell!” out loud, over and over as I worked.
“Yes,” I said. “Sorry.” And turned back to Hortense.
I got some water down her now and then, but not enough. Not nearly enough, given that her bowels were still trying to rid themselves of whatever troubled them. Bloody flux.
Lizzie was praying.
“Hail Mary, full of grace, the Lord is with thee . . .”
Brianna was murmuring something under her breath, urgent sounds of maternal encouragement.
“Blessed is the fruit of thy womb, Jesus . . .”
My thumb was on the pulse of the carotid artery. I felt it bump, skip, and go on, jerking along like a cart with a missing wheel. Her heart was beginning to fail, arrhythmic.
“Holy Mary, Mother of God . . .”
I slammed my fist down on the center of her chest, and then again, and again, hard enough that the bed and the pale splayed body quivered under the blows. Flies rose in alarm from the soaked straw, buzzing.
“Oh, no,” said Marsali softly behind me. “Oh, no, no, please.” I had heard that tone of disbelief before, of protest and appeal denied—and knew what had happened.
“Pray for us sinners . . .”
As though she, too, had heard, Hortense’s head rolled suddenly to one side, and her eyes sprang open, staring toward the place where Marsali sat, though I thought she saw nothing. Then the eyes closed and she doubled suddenly, onto one side, legs drawn up nearly to her chin. Her head wrenched back, body tight in spasm, and then she suddenly relaxed. She would not let her child go alone. Bloody flux.
‘Now and at the hour of our death, amen. Hail Mary, full of grace . . .”
Lizzie’s soft voice went on mechanically, repeating her words of prayer as mindlessly as I had said mine earlier. I held Hortense’s wrist, checking for the pulse, but it was mere formality. Marsali curled over the tiny body in grief, rocking it against her breast. Milk dripped from the swollen nipple, coming slowly, then faster, falling like white rain on the small still face, futilely eager to nourish and sustain.
The air was still stifling, still thick with odor and flies and the sound of Lizzie’s prayers—but the cabin seemed empty, and curiously silent.
There was a shuffling noise outside; the sound of something being dragged, a grunt of pain and dreadful exertion. Then the soft sound of falling, a gasp of breath. Padraic had made it back to his own doorstep. Brianna looked to the door, but she still held the older girl in her arms, still alive.
I set down the limp hand that I held, carefully, and went to help.
61
A NOISOME PESTILENCE
THE DAYS WERE GROWING SHORTER, but light still came early. The windows at the front of the house faced east, and the rising sun glowed on the scrubbed white oak of my surgery floor. I could see the brilliant bar of light advancing across the hand-hewn boards; had I had an actual timepiece, I could have calibrated the floor like a sundial, marking the seams between the boards in minutes.
As it was, I marked them in heartbeats, waiting through the moments until the sun should have reached the counter where my microscope stood ready, slides and beaker beside it.
I heard soft footsteps in the corridor, and Jamie pushed the door open with his shoulder, a pewter mug of something hot held in each hand, wrapped with rags against the heat.
“Ciamar a tha thu, mo chridhe,” he said softly, and handed one to me, brushing a kiss across my forehead. “How is it, then?”
“It could be worse.” I gave him a smile of gratitude, though it was interrupted by a yawn. I didn’t need to tell him that Padraic and his elder daughter still lived; he would have known at once by my face if anything dire had happened. In fact, bar any complications, I thought both would recover; I had stayed with them all night, rousing them hourly to drink a concoction of honeyed water, mixed with a little salt, alternating with a strong infusion of peppermint leaf and dogwood bark to calm the bowels.
I lifted the mug—goosefoot tea—closing my eyes as I inhaled the faint, bitter perfume, and feeling the tight muscles of my neck and shoulders relax in anticipation.
He had seen me twist my head to ease my neck; Jamie’s hand came down on my nape, large and wonderfully warm from holding the hot tea. I gave a small moan of ecstasy at the touch, and he laughed low in his throat, massaging my sore muscles.
“Should ye not be abed, Sassenach? Ye’ll not have slept at all the night.”
“Oh, I did . . . a bit.” I had dozed fitfully, sitting up by the open window, roused periodically by the startling touch on my face of the moths that flew in, drawn to the light of my candle. Mrs. Bug had come at dawn, though, fresh and starched, ready to take over the heavy nursing.
“I’ll go lie down in a bit,” I promised. “But I wanted to have a quick look first.” I waved vaguely toward my microscope, which stood assembled and ready on the table. Next to it were several small glass bottles, plugged with twists of cloth, each containing a brownish liquid. Jamie frowned at them.
“Look? At what?” he said. He lifted his long, straight nose, sniffing suspiciously. “Is that shit?”
“Yes, it is,” I said, not bothering to stifle a jaw-cracking yawn. I had—as discreetly as possible—collected samples from Hortense and the baby and, later, from my living patients, as well. Jamie eyed them.
“Exactly what,” he inquired cautiously, “are ye looking for?”
“Well, I don’t know,” I admitted. “And in fact, I may not find anything—or anything I can recognize. But it’s possible that it was either an amoeba or a bacillus that made the MacNeills sick—and I think I would recognize an amoeba; they’re quite big. Relatively speaking,” I added hastily.
“Oh, aye?” His ruddy brows drew together, then lifted. “Why?”
That was a better question than he knew.
“Well, partly for the sake of curiosity,” I admitted. “But also, if I do find a causative organism that I can recognize, I’ll know a bit more about the disease—how long it lasts, for instance, and whether there are any complications to look out for specially. And how contagious it is.”
He glanced at me, cup half-raised to his mouth.
“Is it one you can catch?”
“I don’t know,” I admitted. “Though I’m fairly sure it is. I’ve been vaccinated against typhus and typhoid—but this doesn’t look like either one of those. And there are no vaccines for dysentery or Giardia poisoning.”
The brows drew together and stayed that way, knotted as he sipped his tea. His fingers gave my neck a final squeeze and dropped away.
I sipped cautiously at my own tea, sighing in pleasure as it gently scalded my throat and ran hot and comforting down into my stomach. Jamie lounged on his stool, long legs thrust out. He glanced down into the steaming cup between his hands.
“D’ye think this tea is hot, Sassenach?” he asked.
I raised my own brows at that. Both cups were still wrapped in rags, and I could feel the heat seeping through to my palms.
“I do,” I said. “Why?”
He lifted the mug and took a mouthful of tea, which he held for a moment before swallowing; I could see the long muscles move in his throat.
“Brianna came into the kitchen whilst I was brewing the pot,” he said. “She took down the basin, and the pannikin of soap—and then she took a dipper of water steaming from the kettle, and poured it over her hands, one and then the other.” He paused a moment. “The water was boiling when I took it off the fire a moment before.”
The mouthful of tea I had taken went down crooked, and I coughed.
“Did she burn herself?” I said, when I had got my breath back.
“She did,” he said, rather grimly. “She scrubbed herself from fingertips to elbows, and I saw the blister on the side of her hand where the water fell.” He paused for a moment, and his eyes met mine over the mugs, dark blue with worry.
I took another sip of my un-honeyed tea. The room was cool enough, just past dawn, that my hot breath made tiny wisps of steam as I sighed.
“Padraic’s baby died in Marsali’s arms,” I said quietly. “She held the other child. She knows it’s contagious.” And knowing, could not touch or pick up her own child without doing her best to wash away her fear.
Jamie moved uneasily.
“Aye,” he began. “But still . . .”
“It’s different,” I said, and put a hand on his wrist, as much for my own comfort as his.
The transient coolness of the morning air touched face and mind alike, dispelling the warm tangle of dreams. The grass and trees were still lit with a chilly dawn glow, blue-shadowed and mysterious, and Jamie seemed a solid point of reference, fixed in the shifting light.
“Different,” I repeated. “For her, I mean.” I took a breath of the sweet morning air, smelling of wet grass and morning glories.
“I was born at the end of a war—the Great War, they called it, because the world had never seen anything like it. I told you about it.” My voice held a slight question, and he nodded, eyes fixed on mine, listening.
“The year after I was born,” I said, “there was a great epidemic of influenza. All over the world. People died in hundreds and thousands; whole villages disappeared in the space of a week. And then came the other, my war.”
The words were quite unconscious, but hearing them, I felt the corner of my mouth twitch with irony. Jamie saw it and a faint smile touched his own lips. He knew what I meant—that odd sense of pride that comes of living through a terrible conflict, leaving one with a peculiar feeling of possession. His wrist turned, his fingers wrapping tight around my own.
“And she has never seen plague or war,” he said, beginning to understand. “Never?” His voice held something odd. Nearly incomprehensible, to a man born a warrior, brought up to fight as soon as he could lift a sword; born to the idea that he must—he would—defend himself and his family by violence. An incomprehensible notion—but a rather wonderful one.
“Only as pictures. Films, I mean. Television.” That one he would never understand, and I could not explain. The way in which such pictures focused on war itself; bombs and planes and submarines, and the thrilling urgency of blood shed on purpose; a sense of nobility in deliberate death.
He knew what battlefields were really like—battlefields, and what came after them.
“The men who fought in those wars—and the women—they didn’t die of the killing, most of them. They died like this—” A lift of my mug toward the open window, toward the peaceful mountains, the distant hollow where Padraic MacNeill’s cabin lay hidden. “They died of illness and neglect, because there wasn’t any way to stop it.”
“I have seen that,” he said softly, with a glance at the stoppered bottles. “Plague and ague run rampant in a city, half a regiment dead of flux.”
“Of course you have.”
Butterflies were rising among the flowers in the dooryard, cabbage whites and sulfur yellows, here and there the great, lazy sail of a late tiger swallowtail out of the shadow of the wood. My thumb still rested on his wrist, feeling his heartbeat, slow and powerful.
“Brianna was born seven years after penicillin came into common use. She was born in America—not this one”—I nodded toward the window again—“but that one, that will be. There, it isn’t usual for lots of people to die of contagious illness.” I glanced at him. The light had reached his waist, and glowed on the metal cup in his hand.
“Do you remember the first person you knew of who had died?”
His face went blank with surprise, then sharpened, thinking. After a moment, he shook his head.
“My brother was the first who was important, but I kent others before him, surely.”
“I can’t remember, either.” My parents, of course; their deaths had been personal—but born in England, I had lived in the shadow of cenotaphs and memorials, and people just beyond the bounds of my own family died regularly; I had a sudden vivid memory, of my father putting on a homburg and dark coat to go to the baker’s wife’s funeral. Mrs. Briggs, her name had been. But she hadn’t been the first; I knew already about death and funerals. How old had I been then—four, perhaps?
I was very tired. My eyes felt grainy from lack of sleep, and the delicate early light was brightening to full sun.
“I think Frank’s was the first death Brianna ever experienced personally. Maybe there were others; I can’t be sure. But the point is—”
“I see the point.” He reached to take the empty cup from my hand, and set it on the counter, then drained his own and set it down, too.
“But it’s no herself she fears for, aye?” he asked, his eyes penetrating. “It’s the wean.”
I nodded. She would have known, of course, in an academic sort of way, that such things were possible. But to have a child die suddenly before you, from something like a simple case of diarrhea . . .
“She’s a good mother,” I said, and yawned suddenly. She was. But it would never have struck her in any visceral way that something so negligible as a germ could suddenly snatch away her child. Not until yesterday.
Jamie stood up suddenly, and pulled me to my feet.
“Go to bed, Sassenach,” he said. “That will wait.” He nodded at the microscope. “I’ve never known shit spoil with keeping.”
I laughed, and collapsed slowly against him, my cheek pressed against his chest.
“Maybe you’re right.” Still, I didn’t push away. He held me, and we watched the sunlight grow, creeping slowly up the wall.
62
AMOEBA
I TURNED THE MIRROR OF the microscope a fraction of an inch further, to get as much light as I could.
“There.” I stepped back, motioning Malva to come and look. “Do you see it? The big, clear thing in the middle, lobed, with the little flecks in it?”
She frowned, squinting one-eyed into the ocular, then drew in her breath in a gasp of triumph.
“I see it plain! Like a currant pudding someone’s dropped on the floor, no?”
“That’s it,” I said, smiling at her description in spite of the general seriousness of our investigation. “It’s an amoeba—one of the bigger sorts of microorganisms. And I very much think it’s our villain.”
We were looking at slides made from the stool samples I had retrieved from all the sick so far—for Padraic’s family was not the only one affected. There were three families with at least one person ill with a vicious bloody flux—and in all of the samples I had looked at so far, I had found this amoebic stranger.
“Is it really?” Malva had looked up when I spoke, but now returned to the eyepiece, absorbed. “However can something so small cause such a stramash in something so big as a person?”
“Well, there is an explanation,” I said, swishing another slide gently through the dye bath and setting it to dry. “But it would take me a bit of time to tell you, all about cells—you remember, I showed you the cells from the lining of your mouth?”
She nodded, frowning slightly, and ran her tongue along inside her cheek.
“Well, the body makes all kinds of different cells, and there are special kinds of cells whose business it is to fight bacteria—the small, roundish sorts of things, you remember those?” I gestured at the slide, which being fecal matter, had the usual vast quantities of Escherichia coli and the like.
“But there are millions of different sorts, and sometimes a microorganism comes along that the special cells aren’t able to deal with. You know—I showed you the Plasmodium in Lizzie’s blood?” I nodded toward the stoppered vial on the counter; I had taken blood from Lizzie only a day or two before, and shown the malarial parasites in the cells to Malva. “And I do think that this amoeba of ours may well be one like that.”
“Oh, well. Will we give the sick folk the penicillin, then?” I smiled a little at the eager “we,” though there was little enough to smile at in the situation overall.
“No, I’m afraid penicillin isn’t effective against amoebic dysentery—that’s what you call a very bad flux, a dysentery. No, I’m afraid we’ve nothing much to be going on with save herbs.” I opened the cupboard and ran an eye over the ranks of bottles and gauze-wrapped bundles, puzzling.
“Wormwood, for a start.” I took the jar down and handed it to Malva, who had come to stand beside me, looking with interest into the mysteries of the cupboard. “Garlic, that’s generally useful for infections of the digestive tract—but it makes quite a good poultice for skin things, as well.”
“What about onions? My grannie would steam an onion, and put it to my ear, when I was a wee bairn and had the earache. It smelt something dreadful, but it did work!”
“It can’t hurt. Run out to the pantry, then, and fetch . . . oh, three big ones, and several heads of garlic.”
“Oh, at once, ma’am!” She set down the wormwood and dashed out, sandals flapping. I turned back to the shelves, trying to calm my own sense of urgency.
I was torn between the urge to be with the sick, nursing them, and the need to make medicines that might be of help. But there were other people who could do the nursing, and no one but me who knew enough to try to compound an antiparasitic remedy.
Wormwood, garlic . . . agrimony. And gentian. Anything with a very high content of copper or sulfur—oh, rhubarb. We were past the growing season, but I’d had a fine crop and had put up several dozen bottles of the boiled pulp and syrup, as Mrs. Bug liked it for pies, and it provided some vitamin C for the winter months. That would make a splendid base for the medicine. Add perhaps slippery elm, for its soothing effects on the intestinal tract—though such effects were likely to be so slight as to be unnoticeable against the ravages of such a virulent onslaught.
I began pounding wormwood and agrimony in my mortar, meanwhile wondering where the bloody hell the thing had come from. Amoebic dysentery was normally a disease of the tropics, though God knew, I’d seen any number of peculiar tropical diseases on the coast, brought in with the slave and sugar trade from the Indies—and not a few further inland, too, since any such disease that wasn’t instantly fatal tended to become chronic and move along with its victim.
It wasn’t impossible that one of the fisher-folk had contracted it during the journey from the coast, and while being one of the fortunate persons who suffered only a mild infection, was now carrying the encysted form of the amoeba around in his or her digestive tract, all ready to shed infective cysts right and left.
Why this sudden outbreak? Dysentery was almost always spread via contaminated food or water. What—
“Here, ma’am.” Malva was back, breathless from her hurry, several large brown onions in hand, crackling and glossy, and a dozen garlic heads bundled in her apron. I set her to slicing them up, and had the happy inspiration of telling her to stew them in honey. I didn’t know whether the antibacterial effect of honey would be likewise effective against an amoeba, but it couldn’t hurt—and might conceivably make the mixture a little more palatable; it was shaping up to be more than a trifle eye-watering, between the onions, the garlic, and the rhubarb.
“Phew! What are you guys doing in here?” I looked up from my macerating to see Brianna in the door, looking deeply suspicious, nose wrinkled against the smell.
“Oh. Well . . .” I’d become habituated to it myself, but in fact, the air in the surgery was fairly thick with the smell of fecal samples, now augmented by waves of onion fumes. Malva looked up, eyes streaming, and sniffed, wiping her nose on her apron.
“We’re magking bedicine,” she informed Bree, with considerable dignity.
“Is anyone else fallen sick?” I asked anxiously, but she shook her head and edged into the room, fastidiously avoiding the counter where I had been making slides of fecal material.
“No, not that I’ve heard. I took some food over to the McLachlans’ this morning, and they said only the two little ones had it. Mrs. Coinneach said she’d had diarrhea a couple of days ago, but not bad, and she’s all right now.”
“They’re giving the little ones honey water?”
She nodded, a small frown between her eyebrows.
“I saw them. They look pretty sick, but nothing like the MacNeills.” She looked rather sick herself, at the memory, but shook it off, turning to the high cupboard.
“Can I borrow a little sulfuric acid, Mama?” She’d brought an earthenware cup with her, and the sight of it made me laugh.
“Ordinary people borrow a cup of sugar,” I told her, nodding at it. “Of course. Be careful with it, though—you’d best put it in one of those vials with a waxed cork. You do not want to chance tripping and spilling it.”
“I definitely don’t,” she assured me. “I only need a few drops, though; I’m going to dilute it down pretty far. I’m making paper.”
“Paper?” Malva blinked, red-eyed, and sniffed. “How?”
“Well, you squish up anything fibrous you can get your hands on,” Bree told her, making squishing motions with both hands in illustrations. “Old bits of used paper, old rags of cloth, bits of yarn or thread, some of the softer sorts of leaves or flowers. Then you soak the mash for days and days in water and—if you happen to have some—dilute sulfuric acid.” One long finger tapped the square bottle affectionately.
“Then once the mash is all digested down to a sort of pulp, you can spread a thin layer of it on screens, press out the water, let it dry, and hey-presto, paper!”
I could see Malva mouthing “hey-presto” to herself, and turned away a little, so she couldn’t see me smile. Brianna uncorked the big square bottle of acid and, very carefully, poured a few drops into her cup. Immediately, the hot smell of sulfur rose like a demon amidst the miasma of feces and onions.
Malva stiffened, eyes still streaming but wide.
“What is that?” she said.
“Sulfuric acid,” Bree said, looking at her curiously.
“Vitriol,” I amended. “Have you seen—er, smelled it before?”
She nodded, put the sliced onions into a pot, and put the lid neatly on.
“Aye, I have.” She came to look at the green glass bottle, dabbing at her eyes. “My mother—she died when I was young—she had some of that. I remember the smell of it, and how she’d say as I mustn’t touch it, ever. Brimstone, folk called the smell—a whiff o’ brimstone.”