The Way of All Flesh

by Ambrose Parry

  ‘Do you know where we are bound?’ he asked, reckoning a carriage journey would give him time to fully wake up and gather his wits.

  ‘Nearby, I gather. Albyn Place.’

  ‘Not two hundred yards away,’ Raven observed. ‘At least for once the patient should be able to properly compensate Dr Simpson for coming forth at such an hour.’

  Jarvis audibly scoffed. It was hard to see his expression in the half-light but Raven could vividly imagine it.

  ‘What?’

  ‘You have been studying under the professor but you have observed so little about him.’

  ‘I have observed him refusing payment from the poor, but surely he would not need to extend such exceptions to the rich.’

  ‘Mr Raven, there is not the time to discuss this at length, but may it suffice for me to tell you that I have on occasion found Dr Simpson to be using rolled-up five-pound banknotes in order to stop the rattling of a window.’

  Raven and Jarvis made it to the foot of the stairs as Simpson emerged from his office on the floor above, grasping his bag. Jarvis held out his hat and coat in readiness, sweeping the latter about the professor and placing the former upon him in a practised motion before opening the door.

  The cold hit Raven like the cup of water Jarvis had threatened and he eyed the professor’s sealskin overcoat enviously as they swept westward along Queen Street.

  ‘An early start to a Monday morning, but an exciting one, no doubt,’ Simpson said, a croak in his voice betraying how he had been recently hauled from sleep.

  ‘You were late to bed, were you not?’ Raven asked, knowing Simpson had still been out when he turned in for the night.

  ‘I had dinner at Professor Gregory’s house. We talked a very long time.’

  ‘Have you bumped into McLevy again on your travels? I was wondering what emerged from the post-mortem on Rose Campbell.’

  ‘I have not heard anything, no. What specifically is your interest?’

  ‘I remain curious as to what might have caused the body to be so contorted. Is it possible that this was evidence of poison?’

  ‘I wouldn’t know,’ Simpson replied. ‘If it’s poisons you’re interested in, then Christison is your man.’

  Raven felt his pulse race. This could make being dragged out of bed into the darkness worthwhile.

  ‘Professor Christison? You would make an introduction?’

  ‘Introduce you to his work, for sure. I have his treatise in my office. You would have much to learn from studying it.’

  ‘Thank you,’ Raven said, though gratitude was not what he felt.

  Simpson had no curiosity over the fate of Rose Campbell, beyond perhaps a physiological explanation for what had happened to her corpse. The greater drama around her did not seem visible to the man. Perhaps he only saw such things in abstract, and that was why he was able to distance himself from the horrors and tragedies that he dealt with in his job.

  He thought about Jarvis’s story of Simpson fixing a rattling window with a banknote. Money meant nothing to him. He inhabited a realm of books and theory.

  If Mrs Gallagher had come to Simpson instead of Raven, he would have treated her injuries, but it would not have occurred to the professor how he might address the cause. When he went to dangerous parts of town, the crowds parted for him. They all knew his name, looked up to him, wished him well. He was like a god who did not inhabit the same plane as mere mortals, and though he would help them, he was not affected by their plights.

  ‘Now, let us test how your faculties serve you at this ungodly hour,’ Simpson said as they approached Albyn Place. ‘The patient we are about to treat is a young woman in her eighth month of pregnancy, who suddenly started bleeding, painlessly but heavily. Diagnosis?’

  Raven searched his tired brain for the answer. A number of possibilities presented themselves, but he dismissed those that would not justify their hurrying to her aid at this hour.

  ‘Placenta praevia,’ he said.

  Simpson nodded sagely as a door opened ahead of them.

  A maid stepped forth to greet them, anguished and on the verge of hysteria. She babbled indecipherably, tripping over her own incoherent words as she pointed to the stairs inside. All Raven caught was the name: Mrs Considine. The maid’s hand, he noticed, was smeared with red, and a livid crimson streak extended from the waist of her skirt to its hem.

  Simpson took the stairs two at a time. Raven was a little slower, his climb burdened by memories of what had happened by his hand at another New Town address not two weeks ago. It was ever-present in his mind that someone had died as a result of his actions, yet he was equally consumed by the question of how this had happened. Had he been incompetent? Was ether itself dangerous?

  He had attempted to discuss the issue in a general way with Dr Simpson, in the hope of salving his conscience.

  ‘Do you have any concerns about the safety of ether, given that a small number of deaths have been attributed to its administration?’ he had asked one morning after breakfast.

  ‘The deaths that you refer to occurred two or three days after severe operations, and should not be attributed to the inhalation of ether itself. Many of the alleged failures and misadventures ascribed to it are to my mind the result of errors in its administration,’ Simpson said, a reply that did not allow Raven much comfort. ‘Successful etherisation requires a full and narcotising dose be administered by impregnating the respired air as fully with the vapour as the patient can bear, and the surgeon’s knife should never be applied until the patient is thoroughly and indubitably soporised.’

  Raven thought of Mrs Graseby’s initial reluctance to inhale the ether and her sudden movement in response to Beattie’s manipulation.

  ‘Have you ever experienced any difficulties?’ he asked.

  ‘For the past nine months I have employed it in almost every case of labour that I have attended, without any adverse consequences. I have no doubt that in some years hence the practice will be general whatever the small theologians of the kirk might say.’

  Simpson had laughed then, incognisant of Raven’s growing unease.

  But what was a soporising dose? How could such a thing be measured? What was the difference between Simpson using ether for the first time and Raven using it unsupervised on Mrs Graseby? It occurred to Raven that it was as much an art as it was a science, and that his own efforts had surely not deviated so far from what was required as to have caused a death. Yet he had no other explanation for what had occurred. Without that he was still inclined to blame himself.

  They found the patient in a bedroom on the second floor, the door thrown wide to the wall. Lamps and candles had been placed upon every available surface, the flickering play of light picking out a dark glistening seemingly everywhere, a gory spectacle that made Raven grateful he had not breakfasted. Mrs Considine was supine upon the canopied bed, her nightclothes a red-soaked mass of material hauled up around her knees. There was blood over the bed, upon the carpet and on every item of furniture that had been touched by the patient or her maid.

  Mrs Considine appeared to have lapsed into unconsciousness, which was a source of some mercy to Raven, in that there would be no need for him to administer ether.

  Simpson had his coat off and his sleeves rolled up by the time Raven had closed the bedroom door. He performed a rapid examination in order to ascertain the cause of the haemorrhage.

  ‘Prepare a dose of ergot, Will,’ he stated without looking up. ‘Hurry, man. I must deliver the child without delay. It is the only way to arrest the bleeding.’

  The doctor all but shouted his instructions. Raven had never heard him raise his voice before, which was almost as disturbing as the blood. His anticipated diagnosis had been correct: a low-lying placenta, the afterbirth, situated at the opening of the womb so that it had presented before the child. Raven remembered the description word for word from the textbook, principally because of the lines that followed: In such circumstances, catastrophic haemorrhage i
s inevitable, with one in three mothers dying as a result.

  With fumbling hands, Raven did as he was instructed. He was still measuring out the required dose as Simpson brought down the breech and delivered the infant, who remarkably was found to be alive. The troublesome placenta was then removed, the ergot given and pressure applied to the flaccid but now empty uterus.

  The bleeding slowed to a trickle and the patient roused a little, but Raven was reluctant to feel any relief while Caroline Graseby remained fresh in his memory. She had shown signs of recovery too, only to succumb hours later while he waited anxiously for news.

  A small army of housemaids appeared, armed with hot water and towels. The infant was wrapped up and placed in a corner while the worst of the mess was cleaned.

  Mrs Considine attempted to sit, but found this more than she could manage and sank back onto her pillows, exhausted. She cast a tired but fond eye towards the newborn, and only then did Raven feel he could breathe free.

  Then Mrs Considine began clutching at the front of her nightgown, a look of fear upon her face. Raven tried to assist by loosening the fastenings at her throat. She was breathing rapidly, gasping, her eyes wide with panic. It was as though she was struggling to find enough air in the room to sustain her.

  Raven looked to the professor, who stood at the other side of the bed, wearing an unusually stricken expression.

  ‘Dr Simpson, what should we do?’ he asked.

  Simpson swallowed, and when he replied, it was in a quiet, hollow voice.

  ‘Speak to her.’

  Three words that told him it was hopeless.

  Raven held her hands and tried to say reassuring things, his own voice distant as though he was witnessing himself from without. Mrs Considine continued to stare at him, her gaping eyes and terrified expression reminding him of the look on Evie’s face when he had found her. He willed her to keep breathing, hoping that she had retained just enough blood to remain alive.

  Her breathing slowed and then ceased.

  Raven looked to Simpson, hoping for some words of wisdom, some consoling thought to help make sense of what had just happened. Instead Simpson turned and made his way to a chair in the corner of the room, heedlessly spreading gore over an ever-increasing area. The professor sat down heavily and placed his head in his hands.

  An eerie silence settled upon the room, broken only by the disconcerting sound of dripping. Then the baby began to cry.

  Twenty-Eight

  No. 52 Queen Street was in a strange state of suspension. Raven sat by a window in the drawing room, Professor Christison’s Treatise on Poisons weighing heavily upon his lap, while George Keith and James Duncan were perched either side of the fireplace, also poring over papers and books. The house was unsettlingly quiet and still for this time of the morning, nothing functioning according to normal manner. For the second day, the morning clinic had been cancelled, and everyone was quite at a loss as to how they ought to occupy themselves.

  Breakfast had been served without Dr Simpson arriving to say grace, which indicated that the staff knew not to expect him. Upon returning from Albyn Place the previous morning, he had taken to his bed and had not emerged since. Mrs Simpson had joined them but briefly today in the dining room, eating a few mouthfuls of toast before withdrawing again without speaking a word.

  All was silent but for the crackling of the fire and the occasional shriek from the parrot. Nonetheless, despite the absence of distraction, Raven was not making any headway in finding a possible cause of Evie and Rose’s apparent agonies.

  Raven became aware that Duncan had closed the volume before him and was gazing thoughtfully in his direction. This was seldom the overture to anything good.

  ‘Tackling Christison, eh?’ he said. ‘An excellent resource, incontestably, but as physicians we must all take care not to be throwing the baby out with the bathwater.’

  Ordinarily Raven would not have encouraged him to expand, but right then he was content to be drawn away from the labour of his fruitless search.

  ‘What do you mean?’

  ‘One could argue that all poison is essentially an overdose. For surely there are properties in everything mentioned in Christison that may be beneficial in the right measure, or that may induce an effect we can harness in the patient’s interest.’

  ‘Yes, but establishing the relationship between dose and effect is fraught with difficulty. Speaking as one who has been exposed to all manner of foul vapours after dinner most evenings.’

  ‘Yes, but through such endeavours, posterity might at least find a footnote for you in medical history,’ Duncan replied.

  Keith smirked at this, which provoked a smile from Duncan. Raven strongly suspected the latter did not appreciate which of the pair the former had been amused by.

  Raven was less inclined towards levity; he regarded the on-going testing model as a catastrophe in the making. Simpson had every professor and chemist of his acquaintance on the lookout for prospective compounds that might exhibit anaesthetic properties. Any time one of them identified a new one, they would bring a sample to the house and it would be tested after dinner by all of the medical men present. Professor Miller, the surgeon who lived next door at No. 51, had taken to dropping in most mornings on his way to the Infirmary just to make sure everyone had survived the night. So far, nothing they tested had provoked anything more dramatic than dizziness, nausea and blinding headaches, but Raven couldn’t help thinking this was down to good fortune rather than sound judgment. It was not difficult to imagine Professor Miller arriving too late and discovering the entire gathering fatally poisoned.

  ‘I would rather my honour not be posthumous before I even qualify to practise,’ Raven said.

  ‘Oh, don’t be melodramatic. Though you are right in that testing remains the great challenge, not helped by the vocal opposition abroad these days to using animals as subjects. How else are we to establish lethal doses, and how else to determine effects if we cannot dissect the creatures afterwards?’

  ‘I am of the mind that anyone opposed to a dog testing poison should volunteer himself in its stead,’ Raven suggested. He was not serious but it amused him that Duncan would not realise this.

  ‘Indeed. The problem is that canine physiology is insufficiently similar to our own for us to draw accurate conclusions. I only wish we had such a supply of disposable human subjects.’

  ‘How about prisoners?’ Keith suggested.

  Raven glanced across and caught the gleam in his eye. For pity’s sake, don’t give him ideas, he thought.

  Too late.

  ‘Indeed,’ Duncan mused. ‘It would be a means by which murderers and thieves could contribute something to the overall good of humanity.’

  ‘Why not whores?’ Raven asked, his tone more aggressive and forceful than he intended.

  Duncan responded with a strange look, as though weighing up what might be behind this interjection. The ensuing tension was accentuated by the house’s unaccustomed silence, until it was dispelled by Keith diverting the subject.

  ‘At any dose, there are some poisons that have no effect but harm, and yet they continue to be prescribed. Mercury, for goodness’ sake. Apart from causing ulceration of the mouth, the loss of both teeth and hair, its only effect is to precipitate salivation, which flimsy wisdom interprets as the body purging itself in order to balance the humours. Such thinking is positively medieval.’

  ‘This is why homeopaths continue to prosper,’ Raven offered. ‘So much allopathic medicine is toxic, so the benefit of homeopathy is that you don’t get sicker other than from the natural progression of your disease.’

  ‘And as you will learn, Will, patients demand pills, and doctors are only too willing to supply them while there is money in it. Polypharmacy is as much the resort of greedy charlatans as homeopathy: doctors selling complex combinations of remedies, then still more to offset the side effects of those. I feel I am shouting into the wind telling patients that the surest route to health is good d
iet and regular exercise. They feel they have not had their money’s worth if they do not leave with a prescription, and in their minds, the more complex the physic, the more impressive the physician.’

  ‘Nonetheless,’ Duncan argued, ‘we have established the efficacy of some truly remarkable medicines, so there are surely more to be discovered. And I don’t mean some nebulous tonic such as Gregory’s powder. Who knows what conditions might be improved or actually cured by some natural derivative or by simply the right compound? I have made it my purpose to find out.’

  ‘Though until you can solve the aforementioned problems of testing them,’ Raven said, ‘it will be your destiny to fail.’

  Duncan got to his feet and regarded Raven for a moment, much as an owl might regard a field mouse.

  ‘We shall see,’ he said quietly, then walked from the room.

  Raven returned to the Christison, though his commitment was hardly redoubled by having had a break. He pored over another few pages and issued the deepest of sighs. It would have been simple enough if he knew the name of a poison and wished to learn more about its catalogued effects, but he was attempting the very opposite.

  Keith put down the journal he was reading and glanced across.

  ‘Is everything all right with you, Will? You seem profoundly restive.’

  ‘I think the mood of the house is infecting me.’

  Keith nodded, sitting back and contemplating for a moment.

  ‘The majority of cases that you will see with the professor will be difficult ones. You must prepare yourself for that.’

  Raven offered a weak smile in response, thinking that the true reason for his having witnessed so few normal deliveries since he began his apprenticeship was that he was not permitted to accompany the professor to see his more aristocratic clients. The obstructed labours of the poor – that’s what he was left with.

  ‘You would benefit from a diversion,’ Keith continued. ‘A non-medical pursuit that would provide you some fresh air and a new perspective.’