Mother Hildegarde was a shrewd judge of human nature. Three of the ladies made it through the first ward, with its cases of scrofula, scabies, eczema, defluxions, and stinking pyemia, before deciding that their charitable inclinations could be entirely satisfied by a donation to L’Hôpital, and fleeing back to the dispensary to shed the rough hopsacking gowns with which we had been furnished.
In the center of the next ward, a tall, gangly man in a dark frock coat was carrying out what appeared to be the skillful amputation of a leg; particularly skillful in that the patient was not sedated in any visible way, and was being restrained at the moment by the efforts of two husky orderlies and a solidly built nun who was sitting upon the patient’s chest, her flowing draperies fortunately obscuring the man’s face.
One of the ladies behind me made a small gagging sound; when I looked round, all I saw was the rather wide rear aspect of two of the would-be Samaritans, jammed hip to hip in the narrow doorway leading toward the dispensary and freedom. With a last desperate tug and the rending of silk, they burst through and fled precipitately down the dark hallway, nearly knocking over an orderly coming on the trot with a tray piled high with linens and surgical instruments.
I glanced to the side, and was amused to find Mary Hawkins still there. Somewhat whiter than the surgical linens—which were quite a disgraceful shade of gray, truth be told—and a bit green about the gills, but still there.
“Vite! Dépêchez-vous!” the surgeon uttered a peremptory shout, aimed presumably at the shaken orderly, who hastily reassembled his tray and came on the gallop to the spot where the tall, dark man was poised, bone saw in hand, ready to sever an exposed thigh bone. The orderly bent to tie a second tourniquet above the site of operation, the saw descended with an indescribable grating sound, and I took pity on Mary Hawkins, turning her in the other direction. Her arm trembled under my hand, and the peony lips were blanched and pinched as a frostbitten flower.
“Would you like to leave?” I asked politely. “I’m sure Mother Hildegarde could summon a carriage for you.” I glanced over one shoulder to the vacant darkness of the hallway. “I’m afraid the Comtesse and Madame Lambert have left already.”
Mary gulped audibly, but tightened an already firm jaw in determination.
“N-no,” she said. “If you stay, I’ll stay.”
I definitely intended staying; curiosity and the urge to worm my way into the operations of L’Hôpital des Anges were much too strong to weigh against any pity I might feel for Mary’s sensibilities.
Sister Angelique had gone some distance before noticing that we had stopped. Returning, she stood patiently waiting, a small smile on her plump face, as though expecting that we, too, would turn and run. I bent over a pallet at the edge of the floor. A very thin woman lay listlessly under a single blanket, her eyes drifting dully over us without interest. It wasn’t the woman who had attracted my attention, so much as the oddly shaped glass vessel standing on the floor alongside her pallet.
The vessel was brimming with a yellow fluid—urine, undoubtedly. I was mildly surprised; without chemical tests, or even litmus paper, what conceivable use could a urine sample be? Thinking over the various things one tested urine for, though, I had an idea.
I picked up the vessel carefully, ignoring Sister Angelique’s exclamation of alarmed protest. I sniffed carefully. Sure enough; half-obscured by sour ammoniac fumes, the fluid smelled sickly sweet—rather like soured honey. I hesitated, but there was only one way to make sure. With a moue of distaste, I gingerly dipped the tip of one finger into the liquid and touched it delicately to my tongue.
Mary, watching bug-eyed at my side, choked slightly, but Sister Angelique was watching with sudden interest. I placed a hand on the woman’s forehead; it was cool—no fever to account for the wasting.
“Are you thirsty, Madame?” I asked the patient. I knew the answer before she spoke, seeing the empty carafe near her head.
“Always, Madame,” she replied. “And always hungry, as well. Yet no flesh gathers on my bones, no matter how much I eat.” She raised a stick-thin arm, displaying a bony wrist, then let it fall as though the effort had exhausted her.
I patted the skinny hand gently, and murmured something in farewell, my exhilaration at having made a correct diagnosis substantially quenched by the knowledge that there was no possible cure for diabetes mellitus in this day; the woman before me was doomed.
In subdued spirits, I rose to follow Sister Angelique, who slowed her bustling steps to walk next to me.
“Could you tell from what she suffers, Madame?” the nun asked curiously. “Only from the urine?”
“Not only from that,” I answered. “But yes, I know. She has—” Drat. What would they have called it now? “She has … um, sugar sickness. She gets no nourishment from the food she eats, and has a tremendous thirst. Consequently, she produces large quantities of urine.”
Sister Angelique was nodding, a look of intense curiosity stamped on her pudgy features.
“And can you tell whether she will recover, Madame?”
“No, she won’t,” I said bluntly. “She’s far gone already; she may not last out the month.”
“Ah.” The fair brows lifted, and the look of curiosity was replaced by one of respect. “That’s what Monsieur Parnelle said.”
“And who’s he, when he’s at home?” I asked flippantly.
The plump nun frowned in bewilderment. “Well, at his own establishment, I believe he is a maker of trusses, and a jeweler. When he comes here, though, he acts usually as a urinoscopist.”
I felt my own brows rising. “A urinoscopist?” I said unbelievingly. “There actually are such things?”
“Oui, Madame. And he said just what you said, about the poor thin lady. I have never seen a woman who knew about the science of urinoscopy,” Sister Angelique said, staring at me in frank fascination.
“Well, there are more things in heaven and on earth than are dreamt of in your philosophy, Sister,” I said graciously. She nodded seriously, making me feel rather ashamed of my facetiousness.
“That is true, Madame. Will you have a look at the gentleman in the end bed? He has a complaint of the liver, we believe.”
We continued, from one bed to another, making the complete circuit of the enormous hall. We saw examples of diseases I had seen only in textbooks, and every kind of traumatic injury, from head wounds inflicted in drunken brawls to a carter whose chest had been crushed by a rolling wine barrel.
I paused by some beds, asking questions of those patients who seemed able to answer. I could hear Mary breathing through her mouth behind my shoulder, but didn’t check to see whether she was in fact holding her nose.
At the conclusion of the tour, Sister Angelique turned to me with an ironic smile.
“Well, Madame? Do you still desire to serve the Lord by helping his unfortunates?”
I was already rolling up the sleeves of my gown.
“Bring me a basin of hot water, Sister,” I said, “and some soap.”
* * *
“How was it, Sassenach?” Jamie asked.
“Horrible!” I answered, beaming broadly.
He raised one eyebrow, smiling down at me as I lay sprawled on the chaise.
“Oh, enjoyed yourself, did ye?”
“Oh, Jamie, it was so nice to be useful again! I mopped floors and I fed people gruel, and when Sister Angelique wasn’t looking, I managed to change a couple of filthy dressings and lance an abscess.”
“Oh, good,” he said. “Did ye remember to eat, in the midst of all this frivolity?”
“Er, no, as a matter of fact, I didn’t,” I said guiltily. “On the other hand, I forgot to be sick, too.” As though reminded of delinquency, the walls of my stomach took a sudden lurch inward. I pressed a fist under my breastbone. “Perhaps I should have a bite.”
“Perhaps ye should,” he agreed, a little grimly, reaching for the bell.
He watched as I obediently downed meat pie and cheese, de
scribing L’Hôpital des Anges and its inmates in enthusiastic detail between bites as I ate.
“It’s very crowded in some of the wards—two or three to a bed, which is awful, but—don’t you want some of this?” I broke off to ask. “It’s very good.”
He eyed the piece of pastry I was holding out to him.
“If ye think ye can keep from telling me about gangrenous toenails long enough for a bite to make it from my gullet to my stomach, then yes.”
Belatedly, I noticed the slight pallor on his cheeks, and the faint pinching of his nostrils. I poured a cup of wine and handed it to him before picking up my own plate again.
“And how was your day, my dear?” I asked demurely.
* * *
L’Hôpital des Anges became a refuge for me. The blunt and unsophisticated directness of nuns and patients was a wonderful refreshment from the continual chattering intrigues of the Court ladies and gentlemen. I was also positive that without the relief of allowing my facial muscles to relax into their normal expressions at the Hôpital, my face would quickly have frozen into an expression of permanent simpering vapidity.
Seeing that I appeared to know what I was doing, and required nothing of them beyond a few bandages and linens, the nuns quickly accepted my presence. And after an initial shock at my accent and title, so did the patients. Social prejudice is a strong force, but no match for simple competence when skill is in urgent demand and short supply.
Mother Hildegarde, busy as she was, took somewhat more time to make her own assessment of me. She never spoke to me at first, beyond a simple “Bonjour, Madame,” in passing, but I often felt the weight of those small, shrewd eyes boring into my back as I stooped over the bed of an elderly man with shingles, or smeared aloe ointment on the blisters of a child burned in one of the frequent house fires that beset the poorer quarters of the city.
She never gave the appearance of hurrying, but covered an immense amount of ground during the day, pacing the flat gray stones of the Hôpital wards with a stride that covered a yard at a time, her small white dog Bouton hurrying at her heels to keep up.
A far cry from the fluffy lapdogs so popular with the ladies of the Court, he looked vaguely like a cross between a poodle and a dachshund, with a rough, kinky coat whose fringes fluttered along the edges of a wide belly and stumpy, bowed legs. His feet, splay-toed and black-nailed, clicked frantically over the stones of the floor as he trotted after Mother Hildegarde, pointed muzzle almost touching the sweeping black folds of her habit.
“Is that a dog?” I had asked one of the orderlies in amazement, when I first beheld Bouton, passing through the Hôpital at the heels of his mistress.
He paused in his floor-sweeping to look after the curly, plumed tail, disappearing into the next ward.
“Well,” he said doubtfully, “Mother Hildegarde says he’s a dog. I wouldn’t like to be the one to say he isn’t.”
As I became more friendly with the nuns, orderlies, and visiting physicians of the Hôpital, I heard various other opinions of Bouton, ranging from the tolerant to the superstitious. No one knew quite where Mother Hildegarde had got him, nor why. He had been a member of the Hôpital staff for several years, with a rank—in Mother Hildegarde’s opinion, which was the only one that counted—well above that of the nursing sisters, and equal to that of most of the visiting physicians and apothecaries.
Some of the latter regarded him with suspicious aversion, others with jocular affability. One chirurgeon referred to him routinely—out of Mother’s hearing—as “that revolting rat,” another as “the smelly rabbit,” and one small, tubby truss-maker greeted him quite openly as “Monsieur le Dishcloth.” The nuns considered him something between a mascot and a totem, while the junior priest from the cathedral next door, who had been bitten in the leg when he came to administer the sacraments to the patients, confided to me his own opinion that Bouton was one of the lesser demons, disguised as a dog for his own fell purposes.
In spite of the unflattering tone of the priest’s remarks, I thought that he had perhaps come the closest to the truth. For after several weeks of observing the pair, I had come to the conclusion that Bouton was in fact Mother Hildegarde’s familiar.
She spoke to him often, not in the tone one generally uses for dogs, but as one discussing important matters with an equal. As she paused beside this bed or that, often Bouton would spring onto the mattress, nuzzling and sniffing at the startled patient. He would sit down, often on the patient’s legs, bark once, and glance up inquiringly at Mother, wagging his silky plumed tail as though asking her opinion of his diagnosis—which she always gave.
Though I was rather curious about this behavior, I had had no opportunity of closely observing the odd pair at work until one dark, rainy morning in March. I was standing by the bed of a middle-aged carter, making casual conversation with him while I tried to figure out what in bloody hell was wrong with the man.
It was a case that had come in the week before. He had had his lower leg caught in the wheel of a cart when he carelessly dismounted before the vehicle had stopped moving. It was a compound fracture, but a fairly uncomplicated one. I had reset the bone, and the wound seemed to be healing nicely. The tissue was a healthy pink, with good granulation, no bad smell, no telltale red streaks, no extreme tenderness, nothing at all to explain why the man still smoldered with fever and produced the dark, odorous urine of a lingering infection.
“Bonjour, Madame.” The deep, rich voice spoke above me, and I glanced up at the towering form of Mother Hildegarde. There was a whish past my elbow, and Bouton landed on the mattress with a thump that made the patient groan slightly.
“What do you think?” said Mother Hildegarde. I wasn’t at all sure whether she was addressing me or Bouton, but took the benefit of the doubt and explained my observations.
“So, there must be a secondary source of infection,” I concluded, “but I can’t find it. I’m wondering now whether perhaps he has an internal infection that’s not related to the leg wound. A mild appendicitis, or a bladder infection, perhaps, though I don’t find any abdominal tenderness, either.”
Mother Hildegarde nodded. “A possibility, certainly. Bouton!” The dog cocked his head toward his mistress, who jerked an oblong chin in the direction of the patient. “A la bouche, Bouton,” she ordered. With a mincing step, the dog pushed the round black nose that presumably gave him his name into the carter’s face. The man’s eyes, heavy-lidded with fever, sprang open at this intrusion, but a glance at the imposing presence of Mother Hildegarde stopped whatever complaint he might have been forming.
“Open your mouth,” Mother Hildegarde instructed, and such was her force of character that he did so, even though his lips twitched at the nearness of Bouton’s. Dog-kissing plainly wasn’t on his agenda of desirable activities.
“No,” said Mother Hildegarde thoughtfully, watching Bouton. “That isn’t it. Have a look elsewhere, Bouton, but carefully. The man has a broken leg, remember.”
As though he had in fact understood every word, the dog began to sniff curiously at the patient, nosing into his armpits, putting stubby feet on his chest in order to investigate, nudging gently along the crease of the groin. When it came to the injured leg, he stepped carefully over the limb before putting his nose to the surface of the bandages round it.
He returned to the groin area—well, what else, I thought impatiently, he’s a dog, after all—nudged at the top of the thigh, then sat down and barked once, wagging triumphantly.
“There it is,” said Mother Hildegarde, pointing to a small brown scab just below the inguinal crease.
“But that’s almost healed,” I protested. “It isn’t infected.”
“No?” The tall nun placed a hand on the man’s thigh and pressed hard. Her muscular fingers dented the pale, clammy flesh, and the carter screamed like a banshee.
“Ah,” she said in satisfaction, observing the deep prints left by her touch. “A pocket of putrefaction.”
It was;
the scab had loosened at one edge, and a thick ooze of yellow pus showed under it. A little probing, with Mother Hildegarde holding the man by leg and shoulder, revealed the problem. A long sliver of wood, flying free of the splintered cartwheel, had driven upward, deep into the thigh. Disregarded because of the apparently insignificant entrance wound, it had gone unnoticed by the patient himself, to whom the whole leg was one giant pain. While the tiny entrance wound had healed cleanly, the deeper wound had festered and formed a pocket of pus around the intrusion, buried in the muscle tissue where no surface symptoms were visible—to human senses, at least.
A little scalpel work to enlarge the entrance wound, a quick grip with a pair of long-nosed forceps, a smooth, forceful pull—and I held up a three-inch sliver of wood, coated with blood and slime.
“Not bad, Bouton,” I said, with a nod of acknowledgment. A long pink tongue lolled happily, and the black nostrils sniffed in my direction.
“Yes, she’s a good one,” said Mother Hildegarde, and this time there was no doubt which of us she was speaking to, Bouton being male. Bouton leaned forward and sniffed politely at my hand, then licked my knuckles once in reciprocal acknowledgment of a fellow professional. I repressed the urge to wipe my hand on my gown.
“Amazing,” I said, meaning it.
“Yes,” said Mother Hildegarde, casually, but with an unmistakable note of pride. “He’s very good at locating tumors beneath the skin, as well. And while I cannot always tell what he finds in the odors of breath and urine, he has a certain tone of bark that indicates unmistakably the presence of a derangement of the stomach.”
Under the circumstances, I saw no reason to doubt it. I bowed to Bouton, and picked up a vial of powdered St.-John’s-wort to dress the infection.
“Pleased to have your assistance, Bouton. You can work with me anytime.”
“Very sensible of you,” said Mother Hildegarde, with a flash of strong teeth. “Many of the physicians and chirurgiens who work here are less inclined to take advantage of his skills.”
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