A Lady in the Smoke

by Karen Odden

  “Are these symptoms usual for railway injuries?”

  Paul nodded. “Yes. I’ve seen them many times before.”

  “What do you believe was the primary cause of these symptoms?”

  “Concussion of the spinal cord. It occurs when the spine is hit with force, which happens frequently in railway accidents because passengers are thrown about when the carriages run into each other.”

  James paused before asking his next question, and at first I wondered if he had forgotten it. But no, he had merely been breaking the rhythm of the questions and answers. The judge’s eyes flicked up at the continued silence, and then James spoke. “And how does that injury bring about symptoms such as you saw in Mr. Benedict?”

  “Concussion of the spine creates a hemorrhage inside the spinal canal, small lesions or cuts in the membranes of the cord, and inflammation of the cord. Any or all of these three injuries can create symptoms that then spread across the body.”

  “And what steps did you take to mend these injuries?”

  “There is very little we can do about laceration of the membranes, other than complete rest. But the hemorrhage and inflammation can often be resolved by dry cupping—”

  “Please explain that.”

  “You apply a small glass cup, like so”—his hands pantomimed the act—“upside-down near the spine; with gentle heat, a small vacuum is created, which causes the blood in and around the tissues to circulate, as it does in a natural, healthy state, thereby promoting healing.”

  “You have been accused of willful neglect, but it seems that you did perform a relatively standard procedure. How many times did you do this for the patient?”

  “Only twice, because he was removed from my care shortly thereafter.”

  “Removed from your care?” James stopped pacing and gave a troubled look. And though I knew every minute of this had been rehearsed, somehow James managed to suggest that his concern for Felix was spontaneous.

  “On Sunday morning,” Paul continued, “I returned to perform dry cupping once more. Mr. Benedict appeared somewhat improved; his pulse had dropped, and he seemed to be resting comfortably. But that night, when I returned to the Polk Hotel to tend to a different patient, I stopped in to see Mr. Benedict and found that Dr. Morris, the Benedicts’ family physician, had been called in. I had no issue with Dr. Morris assuming responsibility for Mr. Benedict’s care, of course, until I learned that he wished to take Mr. Benedict home by train. I begged him not to, after which I was told that my counsel was no longer needed and I was”— a slight hesitation—“asked to leave the room. Mr. Benedict was removed to London the following day.”

  James halted, and his expression was skeptical. “Is it advisable to move patients with injuries to the spine?”

  “No. It often does a great deal of damage. As many of us know”—he gave a quick glance at the jury—“train rides, by their very nature, are bumpy and irregular. They are also potentially frightening and damaging to the nerves, especially for someone who had just experienced an accident.”

  James pursed his lips. “If Mr. Benedict had remained in Travers, how often would you have performed dry cupping?”

  “Once a day for four days.”

  “And what do you say to the contention that you used a mish-mash of unscientific remedies?”

  Paul’s mouth twitched. “I administered a special tea, which is a mild stimulant to the digestive system. When a patient is in bed for a long time, his intestinal tract can become stagnant, which causes a whole host of other problems.”

  “Why tea and not some more scientific concoction?” James asked.

  “I prefer to treat symptoms with the mildest substance that still provides the desired effect.”

  “Did you administer any other medicines?”

  “I administered a sedative, cannabis with bromide, to bring down his pulse and to help him sleep. I also required that he be turned in his bed every two hours to reduce pressure on the spine and prevent bedsores.”

  “Did you bleed him?”

  “No. Generally I’ve found that railway accidents require an influx of fluids. Bleeding doesn’t often help, and can in fact make things worse.”

  “So against your advice,” James said, “Mr. Benedict was removed by train to London on Sunday. When did you see him next?”

  “On Tuesday afternoon. I was in London, and I received an urgent message to attend to him at his home in Bedford Square.”

  “And you went, even though you had been rudely dismissed before. That was quite good of you.” James said explicitly what Paul had left unsaid in his testimony and paused to let the jury take note. “In what condition did you find your patient?”

  “Unfortunately, he was worse. His mother, Mrs. Benedict, told me he had become increasingly restless, until his limbs would jerk involuntarily; his pupils remained dilated before light; he had developed a high fever; and he had been waking from nightmares.”

  “To what do you attribute the change?”

  “First and foremost, traveling to London,” Paul said soberly.

  “Was there anything else—any treatment performed by Dr. Morris that might have exacerbated his symptoms?”

  Dr. Morris leaned over to say something to Sir Solmes, who was already rising to his feet, his chair legs scraping against the floor. “My lord—”

  The judge raised a hand to stop him. “I want to hear it.” He turned back to Paul. “Go on.”

  Paul nodded his thanks. “I saw that Mr. Benedict had been bled, at the arm.” He touched the inside of his right elbow. “And when I asked about it, I was told by his valet that he had been bled Monday morning, and his symptoms became worse immediately afterward.”

  James inclined his head thoughtfully. “Yet they waited another full day before sending for you. Is it your assumption that Dr. Morris used his influence to keep you from being recalled?”

  “I couldn’t say.”

  I saw what James was doing. He was planting ideas about Dr. Morris in the mind of the judge and jury while allowing Paul to take the high moral ground and refrain from criticizing his fellow medical man. Once again, I marveled at how carefully they’d crafted their exchanges.

  “What else did you observe about Mr. Benedict’s condition?” James asked.

  “His digestive system seemed worse, and when I asked, the maid told me that he was no longer receiving the tea. Furthermore, he had a bedsore on his hip that had become septic. I believe this was the cause of the infection and fever.”

  “What did you do to treat him?” James asked.

  “I dressed his bedsore and administered a sedative.” Paul bit his lower lip briefly. “I stayed with him that night, and at about three in the morning, I finally administered laudanum, for the poor man was in agony and unable to sleep. He died just before dawn.”

  “An autopsy was performed, correct?”

  “Yes, by the coroner.”

  James stopped his pacing. “And what did it reveal?”

  A spasm of regret passed over Paul’s face. “It showed that the hemorrhaging in the spinal cord had diminished as a result of the dry cupping—as was visible by the color of the tissue. However, it’s doubtful that he could have made a complete recovery, no matter what was done. There was some sclerosis of the column of Goll—that is, the posterior column of the spinal cord—and two of his lumbar vertebrae were chipped and scraping against each other. People have been known to live with this condition, so long as the spinal cord remains intact, but often there is at least some associated pain.”

  “With the benefit of hindsight, what would you have done differently?”

  “I’d have kept him in Travers and pursued the treatment I’d begun there.”

  “Thank you.” James paused. “Mrs. Benedict is suing the Great Southeastern for damages. In your opinion, does she have a legitimate claim?”

  “Yes,” Paul said. “Her son’s case was in keeping with dozens of others I have seen as a railway surgeon.”


  Out of the corner of my eye, I saw Mrs. Benedict shift, as if she were surprised. Had she thought that Paul wouldn’t uphold her claim against the railway? Is that how she had been influenced to bring this case against him?

  “That is all, my lord,” James said and took his seat.

  Sir Solmes stood up, glanced briefly at a paper before him, and put his hands behind his back. Then he began to walk toward Paul, who shifted slightly in his chair. I knew that expression of his, that tilt of his head. He was listening very carefully.

  “Mr. Wilcox, are you always correct in your assessments of railway injuries?”

  “No, I am not,” Paul replied.

  “How old are you?”

  “I will be twenty-five next month.”

  Sir Solmes’s lip curled in what looked like genuine amusement. “You’ve been practicing for what—two years?”

  He knows perfectly well how long Paul had been practicing.

  Paul smiled and gave no sign of annoyance. “I was apprenticed at age eighteen; I trained for two years, and I’ve been practicing for four.”

  “Oh!” he said, as if surprised. “Apprenticed! I beg your pardon. Just to be clear on this point—you have no university degree?”

  Paul assented.

  I stared at him. Why hadn’t he said that he had attended until he could no longer afford it? It wasn’t because he lacked the intelligence—and he was a gentleman’s son—

  Paul continued smoothly, “It’s conventional for surgeons to be apprenticed, so that we have practical experience as well as theoretical knowledge.”

  And then I realized that Paul—or perhaps James—had anticipated that sort of attack by Sir Solmes, for he’d been ready. He had shown no shame at having been trained by apprenticeship; on the contrary, he had suggested the benefit of it. Several of the jurors had worn expressions of disdain after Sir Solmes pointed out that Paul had no degree; I watched as it faded from their faces.

  “Nicely done,” my uncle murmured under his breath.

  Sir Solmes turned back to Paul, his thin lips smiling. “Let us turn to Mr. Benedict’s condition. You say that he had developed a bedsore. But isn’t it true that he had a contusion on his hip at that very place—and that you refused to bandage it, or treat it in any way?”

  Paul remained unperturbed. “It was a bad bruise, but not an open wound. It didn’t require a bandage.”

  “And you felt it was best to flip him over—like some sort of pancake—every few hours?”

  “I prescribed careful turning, to prevent the pooling of fluids around his spine, yes.”

  “That is not the treatment Dr. John Frye prescribes in a recent issue of the Lancet. In fact, he says quite the opposite.” Sir Solmes walked back to his table and drew out a copy of the journal from a stack of papers. “I assume you are familiar with this publication.”

  “Of course,” Paul replied.

  “Here, Dr. Frye says specifically that ‘railway patients who have suffered damage to the spine must be kept completely immobile on their backs,’ ” he emphasized, “ ‘for the first two weeks. If they are not, a high fever can result.’ ” Sir Solmes set the paper on the table. “How would you respond to that?”

  “I can only say that in my experience, patients who remain immobilized that way find that the pain in the spine increases. I’ve seen no indication that shifting them in bed causes a fever. And certainly a train ride would be more—”

  “In your many years of experience,” Sir Solmes cut across him, his voice satirical, “you have found it advisable to move the patient by flipping him about, but it is not advisable to move him on what is essentially a cushioned stretcher?”

  Paul’s jaw stiffened, but only for a moment. He opened his mouth to answer, but Sir Solmes was already on to the next question: “Mr. Wilcox, Dr. Frye—a man of thirty years’ experience, both practical and theoretical—also insists that patients with railway injuries must be bled. What do you say to that?”

  “I have not found it to be a good treatment.”

  “Indeed. Mr. Wilcox, do you ever bleed your patients?”

  A brief hesitation. “Rarely.”

  “Rarely!” Sir Solmes looked amazed. “Indeed! Medical men have been bleeding people for hundreds of years. What sort of arrogance leads you to believe you know better than they?”

  I could feel my cheeks grow warm with annoyance. My uncle reached over and patted my gloved hands; involuntarily, I had twisted them together again.

  “I believe what I have seen in my cases,” Paul said evenly.

  “Ah.” Sir Solmes tipped his head, as if he were truly curious. “In what sorts of cases would you bleed a patient?”

  “I have done so in cases when patients had high fevers that did not respond to other treatments. Mr. Benedict had no fever when I first saw him.”

  “But by your own admission you did not check on Mr. Benedict for several days between seeing him in Travers and visiting him in London. Is that correct?”

  “Yes.”

  “So if he developed a high fever, would Dr. Morris have been right to bleed him?”

  “I couldn’t say.”

  “You mean, you don’t know.”

  Paul kept his composure. “Not without knowing the particulars.”

  “And what would you say if I told you that immediately after drinking some of your tea, Mr. Benedict started vomiting violently and coughing up blood? Would you not say that the tea was detrimental to him?”

  “That seems reasonable, but I don’t believe that is what happened.”

  “But it is, Mr. Wilcox. You seem to think that his stomach ailment came because he was no longer swallowing your brewed tea. The truth is, he could no longer keep it down. You refused to bandage his wound, refused to bleed him—for some unknown prejudice of your own—in defiance of all known medical wisdom and practice. And you kept him in a constant state of unrest by turning him about, a practice that may well have induced his fever. Indeed, Mr. Wilcox, your arrogant belief in your own unorthodox methods is positively outrageous, not to mention dangerous, even to an otherwise healthy man in the prime of his life.”

  Otherwise healthy?

  I had to bite my lip keep from crying out.

  Paul’s eyes flashed, but his voice was gentle when he replied: “I am not arrogant. But I’ve seen more than one hundred railway injuries, and I know what I’ve observed firsthand to be effective treatment. Given that I was kept away from my patient for two days, I cannot and will not make any observations regarding Mr. Benedict’s state of health or illness during that time.”

  “Well, fortunately we shall hear from Dr. Morris shortly, and he will fill in the gaps in your knowledge. But—” Sir Solmes raised a hand. “Just for a moment, I would like you to recall another case that did not go well.”

  My stomach tightened. Now we’d find out if the notes Paul had prepared on those seventeen cases were enough.

  James rose out of his chair to protest. “My lord, this unrelated case does not have any bearing—”

  The judge motioned for him to sit. “Introduction of past cases is quite usual in these sorts of trials, Mr. Isslin, as you well know. If this medical man has a history of improper handling of railway cases, I want to hear it.” He grimaced faintly. “Not that he can have much of a history of any kind, at his age.”

  “Yes, my lord.” James sat back down without fuss. So he had known this was what the judge would say; the protest had been merely for show.

  Sir Solmes bowed toward the judge. “My lord, I am finished questioning Mr. Wilcox for now. I would like to call Mrs. Albertine Rowell to the stand.”

  Rowell. One of the names on Paul’s list.

  I felt almost faint from the surge of relief that coursed through me. At least Paul would be prepared.

  There was a rustling movement behind Mrs. Benedict, and a tall woman in a fine dark blue dress and a thick veil stood up. She wore a cameo brooch at her throat, and her right hand flashed with a diamond that
she wore over her glove. She moved to the center aisle and stepped up into the witness box.

  The judge asked her to remove her veil, and she complied. She was a handsome woman in her mid-fifties, with a long, narrow nose and pursed lips.

  After she was sworn in, Sir Solmes stepped forward. “Mrs. Rowell,” he began, his voice deferential and kind. “I understand that the events you are about to describe are quite recent, and I have no wish to add to your distress. But will you explain how you came to know the defendant, Mr. Paul Wilcox?”

  “I will.” She shifted in her seat and inclined her head toward Paul. “That man killed my son, Percy Rowell.”

  I wasn’t the only one who was startled at the baldness of her statement. Low gasps and murmurs filled the courtroom.

  She sat back with a satisfied expression that made me want to slap her. The judge did the next best thing. His gavel banged the wooden table, and he leaned forward. “Has that been proven in a court of law?”

  She drew herself up, her expression cold. “Do you doubt my word? Do you know who I am?”

  “Yes, I know who you are, Mrs. Rowell,” he said. “You are the daughter of a wealthy and respected industrialist from Manchester. But in this courtroom, you may not make accusations or declare verdicts.” He laid the gavel down. “Now, with all respect, I ask you to explain, in as unembroidered a fashion as possible, the nature of your acquaintance with Mr. Wilcox.”

  She looked balefully at the judge and then turned back to Sir Solmes, unchastened by the rebuke. “My son was in a terrible railway accident, just like poor Mr. Benedict.”

  “When was that?”

  “May thirtieth of last year.”

  “And can you describe his condition after the accident?”

  “At first, he seemed to be all right, but when he grew worse, we sent for Mr. Erichsen, of course, the famous railway surgeon. He wrote that he couldn’t come, but that he’d send his colleague, Mr. Wilcox. My poor boy suffered for two more days before Mr. Wilcox had the grace to appear.”