The Outlander Series 7-Book Bundle

by Diana Gabaldon

  97

  CONDITIONS OF THE BLOOD

  I caught a flash of brown outside the door, and Adso shot off the counter as though someone had shouted “Fish!” The next best thing, evidently; it was Lizzie, on her way back from the dairy shed, a bowl of clotted cream in one hand, a butter dish in the other, and a large jug of milk pressed to her bosom, precariously held in place by her crossed wrists. Adso was twining round her ankles like a furry rope, in obvious hopes of tripping her up and making her drop the booty.

  “Think again, cat,” I told him, reaching to rescue the milk jug.

  “Oh, thank ye, ma’am.” Lizzie relaxed, easing her shoulders with a little sigh. “It’s only as I didna want to be making two trips.” She sniffed and tried to wipe her nose with a forearm, imperiling the butter.

  I snatched a handkerchief from my pocket and applied it, repressing the maternal impulse to say, “Now, blow.”

  “Thank ye, ma’am,” she repeated, bobbing.

  “Are you quite well, Lizzie?” Without waiting for an answer, I took her by the arm and towed her into my surgery, where the large windows gave me light enough to see by.

  “I’m well enough, ma’am. Truly, I’m fine!” she protested, clutching the cream and butter to her as though for protection.

  She was pale—but Lizzie was always pale, looking as though she had not a corpuscle to spare. There was an odd pallid look to her skin, though, that gave me an uneasy feeling. It had been nearly a year since her last attack of malarial fever, and she did seem generally well, but …

  “Come here,” I said, drawing her toward a pair of high stools. “Have a seat, just for a moment.”

  Clearly unwilling, but not daring to protest, she sat down, balancing the dishes on her knees. I took them from her and—after a glance at Adso’s unblinkingly predatory green gaze—put them in the cupboard for safekeeping.

  Pulse normal—normal for Lizzie, that is; she tended always to be a trifle fast and shallow. Breathing … all right, no catch or wheezing. The lymph glands under the jaw were palpable, but that was not unusual; the malaria had left them permanently enlarged, like the curve of a quail’s egg under the tender skin. Those in the neck were enlarged now, too, though—and those I generally could not feel.

  I thumbed an eyelid up, peering closely at the pale gray orb that looked anxiously back. Superficially fine, though slightly bloodshot. Again, though—there was something not quite … right … about her eyes, though I couldn’t put my finger on what that something might be. Could there possibly be a tinge of yellow to the white? I frowned, turning her head to the side with a hand under her unresisting chin.

  “Hullo, there. Everything all right?” Roger paused in the doorway, a very large, very dead bird held nonchalantly in one hand.

  “A turkey!” I exclaimed, summoning a warm note of admiration. I liked turkeys, all right, but Jamie and Bree had killed five of the enormous birds the week before, introducing a certain note of monotony into dinner of late. Three of the things were hanging in the smoking shed at the moment. On the other hand, wild turkeys were wily and difficult to kill, and so far as I knew, Roger had never managed to bag one before.

  “Did you shoot it yourself?” I asked, coming dutifully to admire the thing. He held it by the feet, and the big cupped wings flapped halfway open, the breast-feathers catching sunlight in iridescent patterns of blackish green.

  “No.” Roger’s face was flushed, from sun, excitement or both, a warm hue spreading under the tanned skin. “I ran it down,” he said proudly. “Hit it in the wing with a stone, then chased it and broke its neck.”

  “Wonderful,” I said, with somewhat more genuine enthusiasm. We wouldn’t have to pick buckshot out of the flesh while cleaning it, or risk breaking a tooth in the eating.

  “It’s a lovely bird, Mr. Mac.” Lizzie had slid off her stool and come to admire it, too. “Such a fat one as it is! Will I take it and clean it for ye, then?”

  “What? Oh, thanks, Lizzie, no—I’ll, um, take care of it.” The color rose a little higher under his skin, and I suppressed a smile. He meant he wanted to show off his catch to Brianna, in all its glory. He shifted the bird to his left hand, and held out the right to me, wrapped in a bloodstained cloth.

  “I had a bit of an accident, wrestling the bird. Do you think perhaps …?”

  I unwrapped the cloth, pursing my lips at what lay underneath. The turkey, fighting for its life, had ripped three jagged gashes across the back of his hand with its claws. The blood had mostly clotted, but fresh drops welled up from the deepest puncture, rolling down his finger to drip on the floor.

  “Oh, just a bit,” I said, glancing up at him with eyebrows raised. “Yes, I do think perhaps. Come over here and sit down. I’ll clean it, and—Lizzie! Wait a moment!”

  Lizzie, seizing the distraction as an opportunity to escape, was sidling toward the door. She stopped as though shot in the back.

  “Really, ma’am, I’m quite all right,” she pleaded. “Nothing’s wrong, really there isn’t.”

  In fact, I had stopped her only to remind her to retrieve the butter and cream from the cupboard. Too late for the milk; Adso stood on his hind legs, head and shoulders stuck completely into the mouth of the jug, from which came small lapping noises. The sound of it echoed the small splat of Roger’s blood dripping on the floor, though, and gave me a sudden thought.

  “I’ve had an idea,” I said. “Sit down again, Lizzie—I want just a tiny bit of your blood.”

  Lizzie looked like a field mouse that has suddenly looked up from its crumb to discover itself in the midst of a meeting of barn owls, but she wasn’t the sort to defy an order from anyone. Very reluctantly, she climbed back onto the stool beside Roger, who had laid his turkey on the floor beside him.

  “Why do you want blood?” he asked, interested. “You can have all ye want of mine, for free.” Grinning, he lifted the injured hand.

  “A generous offer,” I said, laying out a linen cloth and a handful of clean glass rectangles. “But you haven’t had malaria, have you?” I plucked Adso out of the milk jug by the scruff of the neck and dropped him on the floor, before reaching into the cupboard above.

  “Not so far as I know.” Roger was watching my preparations, deeply interested.

  Lizzie gave a small, forlorn sound of mirth.

  “Ye’d ken it well enough if ye had, sir.”

  “I suppose I would.” He gave her a look of sympathy. “Very nasty, from all I hear.”

  “It is that. Your bones ache so ye think they’ve all broken inside ye, and your eyes flame like a demon’s. Then the sweat pours off your skin in rivers, and the chills come on, fit to crack your teeth with the chatterin’ …” She hunched into herself, shuddering at the memory. “I did think it was gone, though,” she said, glancing uneasily at the lancet I was sterilizing in the flame of my alcohol lamp.

  “I hope it is,” I said, frowning at the tiny blade. I picked up a small cloth and the blue glass bottle that held my distilled alcohol, and thoroughly cleaned the tip of her middle finger. “Some people never have another attack after the first, and I do hope you’re one of them, Lizzie. But for most people, it does come back now and then. I’m trying to find out whether yours might be coming back. Ready?”

  Without waiting for her nod, I jabbed the lancet swiftly through the skin, then set it down and snatched up a glass slide. I squeezed the fingertip, dotting generous blood drops on each of three slides, then wrapped the cloth round her finger and let go.

  Working swiftly, I took up a clean slide and laid it over a blood-drop, then drew it quickly away, smearing the blood thinly across the original slide. Again, and a third, and I laid them down to dry.

  “That’s all, then, Lizzie,” I told her with a smile. “It will take a bit of preparation before these are ready to look at. When they are, I’ll call you, shall I?”

  “Oh … no, that’s quite all right, ma’am,” she murmured, sliding off the high stool with a fearful look at the b
lood-smeared slides. “I dinna need to see.” She set down the discarded cloth, brushed at her apron, and scampered out of the room—forgetting the butter and cream, after all.

  “Sorry to keep you waiting,” I apologized to Roger. “I just thought …” I reached into the cupboard, withdrew three small earthenware pots, and uncorked them.

  “Not a problem,” he assured me. He watched with fascination as I checked each slide to be sure the blood-smear was dry, then slid a bit of glass into each of the pots.

  “All right, then.” Now I could turn my attention to cleaning and dressing his hand—a straightforward-enough process. “Not so bad as I thought,” I murmured, wiping caked blood off his knuckles. “It bled quite a bit, which is good.”

  “Aye, if you say so.” He didn’t flinch at all, but carefully kept his face turned away from what I was doing, his attention focused out the window.

  “Washes out the wounds,” I explained, dabbing with alcohol. “I needn’t swab so deeply to clean them.”

  He drew in his breath with a sharp hiss, then, to distract himself, nodded at the pots where the slides were soaking.

  “Speaking of blood, what are you doing with Mistress Mousie’s?”

  “Trying something. I don’t know whether it will work or not, but I’ve made up some experimental stains, using extracts from some of the dyeing-plants. If any of them work on blood, I’ll be able to see the red cells clearly under the microscope—and what’s in them.” I spoke with a mixture of hope and tentative excitement.

  Trying to duplicate cellular stains with the materials I had at hand was a long shot—but not totally unfeasible. I had the ordinary solvents—alcohol, water, turpentine and its distillates—and I had a great range of plant pigments to try, from indigo to rosehips, along with a good working knowledge of their dyeing properties.

  I hadn’t any crystal violet or carbofuchsin, but I had been able to produce a reddish stain that made epithelial cells highly visible, if only temporarily. It remained to be seen whether the same stain would work on red blood cells and their inclusions, or whether I should need to try differential staining.

  “What is in them?” Roger turned to look at me, interested.

  “Plasmodium vivax,” I said. “The protozoan that causes malaria.”

  “You can see it? I thought germs were much too small to see, even under a microscope!”

  “You’re as bad as Jamie,” I said tolerantly. “Though I do love to hear a Scotsman say ‘gerrrms.’ Such a sinister word, spoken in a deep voice with that rolling ‘r,’ you know.”

  Roger laughed. The hanging had destroyed much of the power of his voice, but the lower, harsher registers remained.

  “Nearly as good as murrrrderr,” he said, rumbling like a cement mixer.

  “Oh, nothing’s as good as ‘murrrderr’ to a Scot,” I assured him. “Bloody-minded blokes that you all are.”

  “What, all of us?” He grinned, plainly not minding this gross generalization in the least.

  “To a man,” I assured him. “Mild enough to look at, but insult a Scot or trouble his family, and it’s up wi’ the bonnets of bonnie Dundee. All the blue bonnets are over the border, and next thing you know, it’s lances and swords all over the Haughs of Cromdale.”

  “Remarkable,” he murmured, eyeing me. “And you’ve been married to one for …”

  “Quite long enough.” I finished my sponging and rinsing and blotted the back of his hand, small red patches soaking into the fresh gauze. “Speaking of bloody men,” I added casually, “do you happen to know your own blood type?”

  One dark brow went up at that. Well, I didn’t mean to slip it by him, after all; I’d only wanted a way to broach the question.

  “Yes,” he said slowly, “I do. It’s O-positive.”

  The dark green eyes were fixed on mine, steady with interest.

  “Very interesting,” I said. I replaced the gauze square with a fresh one, and started winding a bandage around it.

  “Just how interesting is it?” he asked. I glanced at him, and met his eyes.

  “Moderately.” I drew out the slides, dripping pink and blue dyes. One slide I propped against the milk jug to dry, the other two I exchanged, putting the pink slide into the blue stain, and vice-versa.

  “There are three main blood groups,” I said, blowing gently on the propped-up slide. “More really, but those three are the ones everyone knows about. It’s called the ABO grouping, and everyone is said to have type A, type B, or type O blood. The thing is, like all your other traits, it’s determined genetically, and—human beings being heterosexual, generally speaking—you have one half your genes for any trait from one parent, the other half from the other.”

  “I dimly recall that bit from school,” Roger said dryly. “All those bloody charts—excuse me—about hemophilia in the Royal Family, and the like. I assume it has a certain amount of personal significance now, though?”

  “I don’t know,” I said. “It might have.” The pink slide looked dry; I laid it gently on the stage of the microscope and bent to adjust the mirror.

  “The thing is,” I said, squinting through the eyepiece as I twiddled the focusing knob, “those blood groups are to do with antibodies—little odd-shaped things on the surfaces of blood cells. That is, people who are type A have one sort of antibody on their cells, people with type B have a different sort, and people with type O don’t have any at all.”

  The red blood cells showed up suddenly, faintly stained, like round pink ghosts. Here and there a blotch of darker pink indicated what might be a bit of cellular debris, or perhaps one of the larger white blood cells. Not much else, though.

  “So,” I went on, lifting the other two slides from their baths, “if one of his parents gave a child the gene for type O blood, and the other gave him one for type A, the child’s blood will show up as type A, because it’s the antibodies that are tested for. The child does still have the gene for type O, though.”

  I waved one of the slides gently in the air, drying it.

  “My blood type is A. Now, I happen to know that my father’s blood was type O. In order to show up with type O blood, that means that both his genes must have been for O. So whichever of those genes he gave me, it has to have been for O. The A gene therefore came from my mother.”

  Seeing a familiar glaze come over his features, I sighed and set the slide down. Bree had been drawing pictures of penicillin spores for me, and had left her pad and graphite pencil by the microscope. I took it and flipped to a fresh page.

  “Look,” I said, and drew a quick chart.

  “Do you see?” I pointed with the stick of graphite. “I don’t know my mother’s type for sure, but it doesn’t matter; for me to have type A blood, she must have given me her gene for it, because my father hadn’t one.”

  The next slide was nearly dry; I laid down the pencil, put the slide in place, and bent to look through the eyepiece.

  “Can you see blood types—these antibodies—through a microscope?” Roger was quite close behind me.

  “No,” I said, not looking up. “The resolution’s nowhere near good enough. But you can see other things—I hope.” I moved the knob a fraction of an inch, and the cells sprang into focus. I let out the breath I had been holding, and a small thrill went through me. There they were; the disc-shaped pinkish blobs of the red blood cells—and here and there, inside a few of the cells, a darkish blob, some rounded, some looking like miniature nine-pins. My heart thumped with excitement, and I made a small exclamation of delight.

  “Come look,” I said, and stood aside. Roger bent, looking quizzical.

  “What am I looking at?” he asked, squinting.

  “Plasmodium vivax,” I said proudly. “Malaria. The small dark blobs inside the cells.” The rounded blobs were the protozoans, the single-celled creatures transferred to the blood in a mosquito’s bite. The few that looked like bowling pins—those were protozoa in the act of budding, getting ready to reproduce themselves.

/>   “When they bud,” I explained, bending for another look myself, “they multiply until they burst the blood cell, and then they move into new blood cells, multiply, and burst those, too—that’s when the patient suffers a malarial attack, with the fever and chills. When the Plasmodium are dormant—not multiplying—the patient is all right.”

  “And what makes them multiply?” Roger was fascinated.

  “No one knows, exactly.” I drew a deep breath, and corked up my bottles of stain again. “But you can check, to see what’s happening, if they are multiplying. No one can live on quinine, or even take it for a long period—Jesuit bark is too expensive, and I don’t know what the long-term effects on the body might be. And you can’t touch most protozoans with penicillin, unfortunately.

  “But I’ll check Lizzie’s blood every few days; if I see the Plasmodium increasing sharply, then I’ll start giving her the quinine at once. With luck, that might prevent an outbreak. Worth a try, certainly.”

  He nodded, looking at the microscope and the pink-and-blue-splotched slide.

  “Well worth it,” he said quietly.

  He watched me move about, tidying up the small debris of my operations. As I bent to retrieve the bloody cloth in which he’d wrapped his hand, he asked, “And you know Bree’s blood type, of course?”

  “Type B,” I said, eyes on the box of bandages. “Quite rare, particularly for a white person. You see it mostly in small, rather isolated populations—some Indian tribes in the American Southwest, certain black populations; probably they came from a specific area of Africa, but of course by the time blood groups were discovered, that connection had been long lost.”

  “Small, isolated populations. Scottish Highlanders, perhaps?”

  I lifted my eyes.

  “Perhaps.”

  He nodded silently, clearly thinking to himself. Then he picked up the pencil, and slowly drew a small chart of his own on the pad.