by E. J. Levy
So I was not displeased to swing up into the saddle that autumn morning in March 1823 to commence my two-day journey to Hemel-en-Aarde, to inspect the leper colony that the governor had established at my recommendation six years before, when we’d first discussed the matter on our journey east, when my concerns had been his own, when the impress of my words was like a seal set in soft wax, which Lord Somerton took up readily, made his own; my cause, ours, as it seemed would also be so.
I knew better now.
Dantzen handed up a parcel tied with twine, overstuffed and straining with its own weight; I tried in vain to decline.
“What is this?” The paper was oily and heavy in my hands.
“Provisions for the journey.”
I planned to stop in Caledon, spend the night, then travel on from there. I would not need more than the water I’d brought, the bread, hard cheese. I didn’t want to be slowed down, I said. Truth was, I didn’t want to appear weak; I didn’t want to consider what I might need. I never liked to consider that.
“Doctor hungers same as any man,” Dantzen said, bored by my vanity. He stroked the neck of my pony. “I’m the one has to tend you if you come back sick, so don’t.”
If he was afraid that I might return contagious from my contact with the ill, the lepers, he disguised it well. We were men accustomed to disguise.
He handed up my parasol, red as his own. Psyche barked at a passing horse.
“Fine,” I said, irritated, as I opened the saddlebag to add the package.
I could hear Psyche’s high yipping behind me as I rode off.
It was approaching noon, the sun heavy overhead and baking the land and my horse’s glistening withers, when I stopped to water him and rest beneath a copse of silver trees. When I dismounted to sit in the sort of shade, I was glad to have the goat’s-milk cheese, the skin of cool well water, the packet of dried fruit (apples, peaches), the two sugar buns from Mrs. Saunders, and the fat sack of cellar-chilled carrots, sweet and fresh from the Company’s Garden. I was grateful for his foresight.
I should have grown accustomed to the beauty of the place, given my frequent visits to the valley in those years, but each time I crested the hill that offered a view of the land below—its vineyards and wheat fields fanned out like hammered brass and malachite—I was struck again by the perfection of the place. Hemel-en-Aarde, Heaven and Earth.
No one seemed to know who had named it, though I’d heard a German missionary praise its aptness, given that “the hills are so high, which embrace the valley all around, they seem to touch the sky and you cannot see anything but Heaven and Earth.” Dantzen said the name came from a Dutch surveyor, who claimed to have measured heaven and earth there while an angel dragged the measuring chain. (His assistant was named Engel.)
But what I had seen at the leper colony the previous October—after riots had broken out there—recalled not heaven but its opposite. The leper colony had been created by the governor at my recommendation, in a beautiful garden spot in view of the sea but sufficiently remote from town to satisfy the superstition of those who feared contagion. For a time it seemed an ideal solution, despite the lack of medical supervision. I was hopeful when the new hospital had opened there three years before, but then last October a number of patients had run away, complaining of abuse and starvation. I had traveled there immediately to investigate. My first visit I had been appalled to find patients confined to small rooms, supine on filthy stretchers, too feeble to rise. Forced to work for food, which was then cruelly withheld. I’d had the staff fired, the rations increased, exercise and medical attention ordered. That had been six months ago. Now I was returning to see how matters stood.
The entire establishment was much improved when I returned that March, under the guidance of Mr. and Mrs. Leitner, the Moravian missionaries who were now its superintendents. I was met by Mr. Leitner at the gate, and after taking some refreshment at their home we set out to tour the grounds together. We visited the communal gardens, the kitchen. I was impressed and said so.
“You’ve done well, Mr. Leitner,” I said. “I commend you. Only imagine how much better your patients will fare with a few improvements. In respect to diet, for example—”
“Their diet is ample,” Brother Leitner said. Perhaps a touch defensively. “Mrs. Leitner makes sure our charges are well provided for; they have dried peaches for digestion, when available.”
“A few peaches are not of the least use,” I said, waving a hand as if to clear a foul smell. “Forgive me for being frank. But proper diet is of the utmost importance in these cases.”
As we walked the grounds, inspecting the out buildings and hospital, I advised that vegetables should constitute the chief part of his patients’ diet. Until vegetables could be procured on a regular basis, beef might be supplied.
“All should have milk, rice, sugar, and coffee daily,” I said. “A soldier’s rations should suffice.” Given the many women, children, and invalids present, soup should be served. Two or three persons should be appointed to cook; Mr. and Mrs. Leitner should serve the food daily to ensure adequate proportions and quality. By no means should raw meat or flour be distributed as rations. A baker should be appointed (well paid, of course), and two persons hired as nurses to see to patients and ensure that medicines were taken as required.
I concluded my recommendations there, not wishing to interfere or overstep.
“You must write to me every week as to your progress, yes?”
Mr. Leitner’s face had grown flushed as we walked—from the heat, I supposed—but he declined my proposal to move inside where sun might be avoided. We continued on our walk.
“Forgive me, Doctor,” he said, “but you sound more like a hostess outfitting a pantry for a party than a physician.”
“More like a general mustering provisions for a war,” I said.
As we passed among the houses where the patients lived, I was pleased to observe a marked improvement since my visit six months ago: the patients all looked far better and cleaner, none having the least disposition to mutiny, nor to escape. But I noted nonetheless a disturbing consistency of condition—an unsettling uniformity of illness, unusual in sickness as in health.
Men and women sat in the shade of the houses or lay quietly on cots, eyes dull, too still. Children—even those unaffected by illness—were as lethargic as the elderly, without lessons or games. I paused to squat before a young woman, a mother; I extended my hand in greeting, was surprised to find her own limp in mine and chilled. I stood.
“Are all here in such dire condition?” I asked.
“We turn no one away because of the extremity of the case,” Mr. Leitner replied.
“Of course. But I mean has no one come to you more fit than these present?”
“All are welcome here.”
“Welcome to die,” I said.
“They have a proper Christian burial, Doctor; proper Christian rites.”
“I’m sure that’s a great comfort,” I said.
“Their souls are comforted.”
“I would benefit more than their souls,” I said, impatient. “Even Christ cured the lepers, didn’t he? He did not settle for merely harvesting their souls.”
I could see that I had shocked him.
“Please,” I said. “Tell me about your patients.”
His report unsettled me: Of the 156 patients resident there that year, many were very weak and declining. The previous year, he said, “twelve baptized and fourteen unbaptized departed this life,” a shocking mortality for any hospital, even a Cape hospital. I couldn’t see why 15 percent should die each year from a treatable disease.
“But matters have improved,” Brother Leitner said.
“They could hardly have gotten worse.”
“Beg your pardon?”
“Continue, please,” I said.
“This year,” he said, “twenty-five adults and five children have been baptized and eight admitted to the Lord’s Supper; ten have passed
on.”
“Died, you mean,” I said.
“Yes, but to all glad tidings of great joy were proclaimed,” he said. “All are instructed in the blessed truths of the Gospel. Our people are remarkably attentive and devout at all their meetings.” He fairly beamed.
“Given the high mortality, one can see why they are inclined to pray.”
Leitner praised the Christian goodness of the landowners who’d brought the lepers here, releasing them from their labors.
And that was when I realized what unsettled me. What was wrong. Like a picture hung at a tilt.
Not a single person present was in an early stage of the disease; all were extreme late cases, well developed, save for the few children there with their parents but themselves unafflicted. It should have been obvious what was happening. Of course.
“Might I interview the patients?” I asked.
Leitner looked alarmed. “I beg your pardon?”
“Speak with them,” I said. “I should like to hear from them directly about their circumstances, how they came to be here; I should like to interview the children in particular.”
Leitner said nothing; I feared he might refuse.
“I wish only to ascertain something of their history,” I said, “to better understand their condition, their needs. So we can assist you in meeting them.” At last he agreed.
So I spent the morning talking with patients, squatted down beside a woman on a cot, a man leaning against a building, a child, and learned what suspicion had suggested: there was not a single slave among them; all were freedmen, indentured servants, or Khoikhoi. The audacity of it shocked me, even when I thought I was beyond shock now.
When I told Brother Leitner what I’d discovered, he seemed unconcerned; perhaps he did not understand the import of the evidence before us. So I explained.
“These are all free men and women, Mr. Leitner; laborers. Does that not seem peculiar to you? That only free men and women should arrive here requiring your help? Slaves fall ill, the same as any man.”
“Are you suggesting that the health of slaves is superior…?”
“I am suggesting nothing of the kind,” I said. “I observe that free men are simply freer to die than are the enslaved.”
“I don’t follow you, Doctor.”
“They might have been saved, these people, your patients, a cure might have been effected had any care at all been taken with their health early on at the first signs of infection. But no such care was taken. Because they are not valuable property, their health was of no concern to those who sent them here only after they became too ill to work. They were sent here not to recover their health, but to die.”
To his credit, Leitner seemed as shocked as I. He looked out over his charges with the horror of one viewing bodies on a battlefield. He was noticeably pale when I left soon after.
Leitner seemed a good man, well meaning, but his vocation had taken its toll. He was of that breed of dull do-gooders, ostentatious in their self-effacement, who seem to prefer not to trouble themselves over justice in this life, expecting it in the next. In his black frock and white-knotted tie, he appeared a model of Christian modesty; soft-spoken in a manner that was loud, meant to force his listeners to lean close and attend to him—an arrogant modesty. I’ve found it best not to trust a man who denies his appetites, knowing that such self-control can be a kind of fury, gentleness disguising its opposite.
So I endeavored to be gentle when I sent my recommendations and provisions two months after my visit, when I had delivered to the leper colony at Hemel-en-Aarde a requisition of medicines with a set of handwritten directions for the Leitners’ use.
The measures seemed perfectly obvious, but I have learned that the obvious is often overlooked. Like my own sex—it is hidden in plain sight.
Rules for the General Treatment of the Lepers, Which It Is Requested Mr. and Mrs. Leitner Attend To:
1st. The strictest attention must be paid to the personal cleanliness of the Lepers; their bedding and clothing must be frequently changed, and they must bathe twice a week at the least. The children should be bathed daily…
2nd. The diet is of great consequence, nothing salted, such as fish…should be permitted. Milk, rice, vegetables, and fruit should be used as much as possible; fresh mutton and soup daily, unless otherwise ordered.
3rd. The sores must be washed twice daily with Tar water and dressed with Tar plaster; the old plasters must be thrown away.
4th. The state of the bowels must be attended to…The venereal cases must be kept apart from the other, and treated as ordered.
5th. The very bad cases of Leprosy must be separated from the others, and a sufficient quantity of Wine given to the sick (from 2 glasses to a pint, daily).
6th. The food must be clean and well cooked…the meals should be almost daily inspected by Mr. and Mrs. Leitner. Good order must be preserved, but no cruelty or deprivation of food must ever be resorted to. The parties must be considered not as Convicts, but as Unfortunate. The School and Church should be encouraged, as so should industry as much as possible.
As my visits to this Institution will be frequent I shall from time to time point out any necessary changes…
I concluded with the request that Mr. Leitner write me every week as to the changes, success, difficulties, &c.
I hoped they would find them helpful.
I was not altogether surprised when Lord Somerton summoned me to Government House to tell me there had been a complaint; given my efforts to reform the sale of patent medicines, resistance to regulation was to be expected. In truth, I welcomed the occasion to meet with the governor, my former friend, even as we were no longer friendly.
“Let me guess,” I said, when I saw the letter on his desk. “The pharmacists have lodged a complaint,” I said. “The quacks.” I dropped into a chair before his desk.
“It’s Hemel-en-Aarde,” Lord Somerton said. “Brother Leitner believes that you have exceeded your authority. He wrote to Reverend Halbeck to confirm that you have none over him.”
“My God,” I said. “What sort of man worries about rank when lives are at stake?”
“That’s precisely when men worry about rank, is it not?”
“A soldier doesn’t care about the rank of the man who saves him.”
“Perhaps not. But Mr. Leitner cares a great deal about this. He is your enemy now.”
“No,” I said, “leprosy is.”
He read aloud to me from the complaint, as if to clarify the matter: Brother Leitner had rejected my recommendations to allow patients to bathe regularly in the sea. He said that he preferred “to hold services rather than bathing parades.”
“Funeral services,” I replied. I was glib, but I understood how serious the charges were. Reverend Halbeck had forwarded the letter to Colonel Bird, who had sent it on to Lord Somerton as a courtesy, as it was a courtesy to tell me of it. It was a warning.
Lord Somerton did not smile, but nor did he reprimand me. I thought he sympathized, as he had sided with sound reason in the past, but all he said was, “You must be careful, Doctor. You’re making enemies.”
“Disease is my only enemy,” I said. “Honi soit qui mal y pense,” quoting the Anglo-Norman motto like an incantation. Shamed be he who thinks evil.
“I’m afraid it doesn’t work that way.” His voice was uncommonly subdued. He seemed sad, or perhaps worried. But he said no more about the matter.
“I don’t mind making enemies in a good cause,” I said, as I stood. “A man is judged by his enemies. All principled men make enemies.”
I pretended not to care, to be indifferent to personal criticism. How could I explain that I could not descend to the personal? I had observed how vitally important it was in the affairs of men and in the practice of medicine to be guided by reason, to rise above one’s feelings—as I had two years before when Lord Somerton returned with his new wife, as I had done in regard to the child I’d carried. It was necessary in medicine, as in war, to r
emain objective. I was impersonal in my practice of medicine, as one must be. To see clearly and judge rightly of symptoms, one must observe dispassionately, disinterestedly. My uncle had squandered great gifts on the altar of the personal, picking fights even with his good friend Joshua Reynolds, the famed painter. I would not make the same mistake.
“Thank you,” I said. “For letting me know.”
Lord Charles was not quick to act on the matter of patent medicines and licensure, but when he did, he was decisive.
Perhaps he grasped the necessity of reform, perhaps he had grown tired of my harangues. Whatever the case, on September 26, 1823 the governor’s office issued a proclamation that revised the Cape medical code to ensure that no one could practice medicine without the skill to do so, that all who wished to serve as physician, surgeon, or apothecary must first be licensed and provide documents to attest to their training, whether “a regular Diploma from a University or College, in Europe, or in the case of Surgeons, Apothecaries, etc., of such Certificate as is usually required.”
The proclamation controlled the traffic in drugs as well, ensuring that no merchant, trader, or dealer could peddle so-called medicines without first having those drugs reviewed by the Colonial Medical Inspector. Which was to say, me.
The mob that swarmed Government House the next day was impressive, as a cloud of locusts is; almost as soon as the proclamation was made, a deputation of medical-men manqué arrived at Lord Somerton’s office, demanding an explanation, outraged that their profits might be curtailed for the public good. Fools though they were, they would not be easily parted from their money.
They did not take kindly to regulation, that enemy of self-serving charlatans everywhere. Their principal complaint contained nothing of principle, mere avarice disguised as right: they had invested heavily to make a profit, and profit they would.