A Murderous Malady

by Christine Trent

  “We have to make room for them inside,” I declared.

  Lambert and Hughes nodded their heads, and we began discussing how to rearrange wards to accommodate everyone on the lawn.

  In the midst of this, a large wagon arrived, with the grocer’s name emblazoned on a sign in red and gold against a cream-colored background. Foodstuffs were brimming over the top of the wagon, and I oversaw their delivery into the freshly scrubbed kitchens, asking Mary to keep inventory of every single box, tin, bottle, and paper-wrapped package coming through the door.

  The four of us, along with the grumbling and suspicious existing staff of Middlesex, must have seemed like whirling dervishes with skirts, aprons, and coattails flying. As we proceeded through this work, I found it exhilarating; so much so that my heart pounded and my pulse raced from the sheer joy of seeing the hospital slowly take on the form of a clean and decent environment for patient recovery. It would take days, if not weeks, for my nurses to finish it all, but for now at least it wasn’t appalling.

  Understandably, Mary did not share in my exultation. She was eventually limping from pain in her knees and found herself a chair in a corridor outside the lying-in ward. As I walked by her repeatedly in the execution of some errand, her nose was buried in her notes and she was writing away furiously.

  In all the tumult of cleaning and reorganizing, I found my own mind leaping from topic to topic related to both the cholera outbreak and the Herbert attack. I was a nurse, and so my attentions desired to be fully on the epidemic. How was I going to manage Sidney’s request at the same time?

  Make a chart in your mind, I thought.

  As I ordered tins of meat on shelves, I made a mental image of the list of people I needed to see—whether for Sidney or for cholera—down the left side of the page, and where they were located across the top. Now, if I could just imagine what people intersected each other geographically, I might be able to—

  Nurse Hughes entered the pantry, out of breath and flustered. “Miss Nightingale, we have counted and assessed the women lying outside.”

  I frowned. “Do some of them belong in the lying-in ward? If so, we must take care of those inmates first.”

  Hughes bit her lip in consternation. “Well, one or two belong there, but the, er, problem is that they all seem to belong to a … lower … sort of class.”

  “Lower than Seven Dials?” I asked.

  “No, miss. They are largely prostitutes,” Hughes said nervously. “Should we still bring them in?”

  “Ah,” I said. This was a delicate matter. I couldn’t have it known among the male inmates that prostitutes had moved in en masse and were anywhere nearby, lest they think the hospital was providing some sort of illicit service for them. Yet the poor souls had to be brought in from the elements.

  I at least understood now why Goodfellow and the other physicians had sequestered the women from everyone else. However, they could not remain outdoors.

  I decided upon a course of action. “The lying-in ward is not full. Move those women to the left wall, then have the orderlies figure out a way to fix some sheets together to fashion a drape along the ends of their beds. This will separate them from the other side of the ward. Bring the outside women into the beds along the right wall as quickly as possible. I’ll be up to help as soon as I’m done here.”

  Hughes scurried off to do my bidding while I took a deep breath, determined to finish my current task and my mental charting before heading up to the lying-in ward.

  I began humming as I worked, and I found that the rhythm of it made me think more clearly. In fact, by the time I dusted off my hands from organizing the foods according to what ailments they were suitable for, I had decided upon my next steps.

  I would drop in on the Maddox family, as I had promised to do, and then on my way out of Soho I would visit Oswyn Davies to see about employment for Berenice.

  With good news for her hopefully in hand, I would find this Dr. Snow that Reverend Whitehead had mentioned, then return to St. Luke’s to see Berenice and to drop off my revised charts and maps for the priest.

  If I had not dropped from exhaustion at that point, I would go to Herbert House. The General and I were going to have an extensive conversation about Fenton’s dice.

  I also needed to check in on Liz. I realized it had been a couple of days since I’d seen her. She must think me a dreadful friend by now.

  Thus resolved, I retreated back upstairs to assist with moving the prostitutes into the lying-in ward.

  The expectant mothers, whose view was now restricted by white sheets strung together that permitted them to see shadows beyond them but no actual activity, were anxious.

  I stepped behind the sheets to speak with them, raising my voice so they could hear me over the moans of the sick and the creaking of iron bedsteads occurring on the other side as the prostitutes were settled into the ward.

  “I am sorry for the disturbance in these final hours of your confinement,” I began.

  The woman in the bed next to where I stood reached out and clutched a fistful of my skirt. “Who are they? Have you moved men in here?”

  The others nodded and vocalized their anxieties.

  I patted her hand in comfort. “No, no, they are women also. But they have cholera and must be kept separate from you. That’s why we have erected this curtain.” I estimated that the choleric women were at least fifteen feet away from these women about to give birth. As long as we kept the cholera side thoroughly aired out, all would be well.

  I hoped.

  The women before me, some swollen to an extent that they were probably unrecognizable from their normal states, nodded, willing to trust me in their distress.

  “How long has it been since a doctor has been through here?” I asked brightly.

  The woman who had grabbed my skirt released it. “Yesterday afternoon,” she answered.

  “Yesterday!” I exclaimed. “All of you need close attention. I will seek out a doctor immediately.”

  As I stepped out from behind the makeshift drape, I nearly collided with a well-dressed man I didn’t know.

  “Forgive my eavesdropping,” he said. “Perhaps I can be of assistance. I am a physician. My name is John Snow.”

  Standing before me was a man at least in his forties. He had thinning hair swept to one side and a bulbous nose planted squarely on top of a flat face. His lips were thin and his eyebrows thick. Those eyebrows were quite expressive over his dark, intense gaze. He wore the clothing of a professional man.

  “Dr. Snow? The same one who is the physician treating cholera victims in Soho?”

  He laughed gently. “Most people these days ask if I am the same physician who administered chloroform to the queen while she gave birth to Leopold back in April, but yes, I am also working to help these unfortunate souls.”

  I knew that Queen Victoria had started a rage among women to have chloroform render them insensible while birthing their children. I was interested in having a future discussion with him about it, but there were so many other more pressing topics for now.

  “I know of you, not only from the signs posted, but I have met with Reverend Henry Whitehead.” I held out my hand, which he clasped, bowing over it in a courtly manner. In that moment I saw that he was every bit a gentleman accustomed to working with members of society.

  “I live on the outskirts of Soho myself,” he said. “So it is convenient to treat those who have come down with it. You said you needed a doctor?”

  I couldn’t believe that the man himself had come to me. “I—actually, I need to speak to you specifically, sir.”

  I stopped one of Middlesex’s nurses, who was inexplicably walking past me with a vase of snowy white delphinium stalks in it. Were they for one of the doctor’s offices?

  “Nurse, can you find Dr. Goodfellow or one of the other physicians and ask him to come round to visit the lying-in women?”

  The woman, whose complexion was as pale as the flowers in her arms, gazed at me
in disbelief. “Tell a doctor what to do?” she asked dumbly.

  “No, of course not,” I said. I did not believe nurses should assert themselves over doctors, although I supposed I did not always follow my own rule. “Ask if one would mind attending on the women. Say I have requested it.”

  Snow interjected, “Would you like me to—”

  I quickly shook my head. “No, it is imperative that I speak with you privately.”

  I led Snow outside the lying-in ward, where Mary still sat, scribbling away, and asked her to join us with her notebook stuffed with papers.

  I then sought out the room where I had met with the physicians the previous day. Fortunately, it was not in use, and the three of us sat down at one end of the table.

  “I am Florence Nightingale, sir. I am the superintendent of the Establishment for Gentlewomen During Temporary Illness. I have been asked to assist here at Middlesex with the care of cholera inmates.” I also introduced Mary to him.

  “You seem to have brought violent winds of change with you,” he observed. “I’ve never seen the staff here move so quickly before. It’s almost as if they are in terror of something.” He smiled at me.

  “Yes, well, I am simply employing some techniques for hospital organization that I devised when I entered service at the Establishment. Presumably the physicians here will not toss me out before I am done.”

  Snow nodded. “I, too, am assisting here in my own way. I am working on theories about how the disease is spreading through Soho, and since many of the sufferers end up here, I have offered my services while gathering data on each victim.”

  We were quite possibly duplicating work. “I happened to meet Reverend Whitehead at St. Luke’s, and he presented me with his research on how the epidemic was spreading. You see, I have a great penchant for charts and statistics, too, and the priest thought I could be of some use in analyzing his work thus far.”

  Snow gazed at me curiously. “How unusual for a woman of your station to be interested in such matters.”

  Despite my dusty, bedraggled appearance after so much hard work, I was glad that I had chosen a nice day dress to wear to the hospital, for it enabled me to speak with Snow as an equal. “My mother wouldn’t have described my interest as unusual, but unseemly. However, I appreciate your courteous description, sir.”

  He nodded. “Did you wish for me to review your analysis, or did you have some other reason for speaking to me?” he inquired.

  Without my asking, Mary handed me all the new charts and diagrams she and I had developed together, and I spread them out for Snow to see. He pulled a pair of brass spectacles from the inside of his vest pocket and put them on, then glanced through my papers quickly. “You have also seen that the concentration is in Broad Street,” he said.

  “Yes,” I agreed. “I wonder if something is emanating from the street there that is causing it.”

  He removed the spectacles and placed them on top of my map. Looking at me with great seriousness, he said, “I have another theory, but Reverend Whitehead disagrees with me.”

  Given that Whitehead and I were in general agreement, I wondered what Snow’s theory was.

  “The cholera victims all suffer the same symptoms, do they not? Severe, milky diarrhea; vomiting; and the related dehydration, irritability, and lethargy. If all the symptoms are occurring within the digestive system, does it not make sense that the disease is a digestive affliction rather than a miasmatic one?”

  This made no sense to me. “But can’t we see that the disease spreads from house to house and street to street? If it is digestive, that implies that it is something one is eating. Unless everyone is sharing the same meal—quite an impossibility—then it cannot be digestive.”

  “Ah.” Snow put his spectacles on again and put his finger on my map, pushing it across the table to me. “But what sorts of things do you know are located in Broad Street?”

  I thought on this. “Many dilapidated houses. The water pump. Street performers. A public toilet.”

  “And animal carcasses,” Mary offered.

  But also nearby was the Lion Brewery, where almost no one had been infected. Why was that?

  A strange thought came to me. Was it possible that there was something within the brewery itself that was causing the spread of the disease? Were the plentiful smokestacks carrying the disease away from the building itself to deposit cholera elsewhere?

  Snow had his own opinion, though. “I think it might be a disease contained within the water pump. People gather water from the pump and take it home to drink. Then the household is infected.”

  I tried to give credence to what he was saying, even though my mind was preoccupied with thoughts of the Lion Brewery. “But doesn’t the water to the pump come from the Thames? If what you are saying is true, then the entire Thames is contaminated, which would mean cholera should be everywhere in London.”

  He seemed impressed with my argument. “You make a point. However, I am convinced that this is what is true. I not only studied the ’49 outbreak in Lambeth, but also had the unfortunate experience of growing up in York along the River Ouse, in a neighborhood which flooded every so often. Each time, there would be disease.”

  I was doubtful. “It seems to me that disease would spread much more effectively through the air than through brackish water,” I insisted, even though I was formulating another theory.

  To his credit, Snow took no offense, but simply said, “In my medical research, I have learned that it is frequently that which we cannot possibly suspect is true which is very often the deadly culprit.”

  I felt my stomach flutter as my mind turned to the Herberts. The doctor had just said something very profound; I was sure of it.

  * * *

  I gathered up the papers and thanked Dr. Snow for his time. Mary and I then sought out Dr. Goodfellow to tell him I would ensure my nurses returned each day for at least a week, and that I myself would be making visits as often as I could.

  Goodfellow acted uncomfortable. Had I insulted him? I always seemed to cause the most offense when I was the most passionate and sure about a topic. “If this meets with your approval, of course,” I added.

  He cleared his throat. “Ahem, yes, yes, that would be fine. Er … Miss Nightingale, I must express appreciation on behalf of us all, but, it will be … difficult, to say the least … to dredge up the funds necessary to pay you and your nurses. Particularly since we, well, since we already need to find money to pay for all of the new supplies you’ve brought in. It’s as though a new hospital has been erected in a single day.”

  I didn’t have the heart to tell him that there was much more to be done—scrubbing walls, repainting, and creating outdoor gardens where inmates could get fresh air, among other things—but I wanted to reassure him.

  “Sir, as I said once before, I do not require payment. I am a volunteer. Mary here is paid out of my own purse. I believe we can work out an arrangement for you to pay for only part of my nurses’ time.” I could probably ask my father for additional allowance to cover their time at Middlesex Hospital, but I wouldn’t commit to that until writing Papa a letter. “For now, I think we must concentrate on curing the inmates.”

  He offered a word of thanks but still seemed nervous. I waited patiently until he said, “I believe there is a way to recompense you. I have a great interest in treating nervous and hysterical disorders. I would like to offer my services at the Establishment in return for your time spent here. Truthfully, it would help my own research efforts, and perhaps I can be of assistance to you.”

  I wanted to take umbrage at the idea that he thought most of my inmates had problems of the mind, but it was certainly true that some of them did have illnesses with no apparent physical basis to them. Moreover, Dr. Killigrew came only on Tuesdays, and we could use a physician on the premises with more regularity. I struck the bargain with Dr. Goodfellow.

  The Establishment’s oversight committee might disapprove greatly of my independent decision in
this, but it would not be the first time I’d had to do battle with them.

  I went searching for my two nurses, gathering them together to give them final instructions before they, too, left for the day. Next, I sought out Middlesex’s existing nursing staff, demonstrating for them how to properly use feeding cups with their patients.

  I then hurried away from Middlesex with Mary on my heels, puffing and wheezing. “Miss Florence, why are we in such a rush?”

  I stopped and looked back at her, lagging ten feet behind me. She limped, favoring one leg over the other, and I realized that she was in pain from the day’s work. “I want to make some visits down near Broad Street before dark. But I am very inconsiderate; we should ride down there. Unless you prefer to go home now?”

  Mary shook her head resolutely, so we walked to the nearest cab stand. I was fortunate enough to find a driver who would take us all the way into Soho.

  As we rode, Mary shared with me what she had been so furiously working on whilst writing in the hospital corridor. It was her list of proofs that the attack on Liz had been the result of a jealous lover. Mary had settled her reasoning essentially as thus:

  The killer had to have purpose. It was unlikely to have been a random attack.

  The attacker called Elizabeth Herbert a prostitute.

  Mrs. Herbert is no such thing.

  The attacker must have been sending her a jealous message before ostensibly attempting to kill her.

  “Goose, you have very romantic notions,” I said, handing her back her notebook.

  However, Mary had remembered what I had forgotten: that the carriage attacker—who might or might not have been the same man who later shot at Liz—had indeed called her such a disturbing name. “But perhaps you are right that I should at least consider Caroline Norton as a possibility.”

  A flush of pleasure crept up Mary’s neck as she smiled happily.

  The driver deposited us at the corner nearest the Maddox home. He was either polite enough or uncaring enough not to issue us any admonishment about staying there too late.