Will and Drew continued to cram for their examinations. Two days before the first test, Drew jubilantly reported that he’d gotten a job as an assistant at the medical inspection station at Castle Garden in New York. Castle Garden was the entry point for the hundreds of thousands of European immigrants swarming to the United States. The press regularly predicted that by the time the decade was over, the total number of arrivals for the ten-year period might reach five million—much to the disgust of established families such as the Pennels.
Both young men passed their examinations, thus advancing to the third class. Drew left Boston and a few weeks later wrote from New York to invite Will to come for a visit.
The idea was appealing. Will was bored reading medical texts, and it would be some weeks before he began his studies in Dr. Charles Green’s special summer course in obstetrics. Until very recently, medical students hadn’t been permitted to witness childbirth; that was the province of the midwife. Also, questions of the patient’s modesty were involved. The only obstetrical training most doctors received came from lectures or study of anatomical models. Since 1883, however, Harvard had required that every third-year student attend at least two cases of labor before receiving a diploma. Dr. Green’s short course was intended as preparation. In late July, Will boarded a train for New York.
iii
Castle Garden, a huge building with a conical roof, was located at the upper west end of Battery Park.
The structure dated from 1807. It had been planned as a fort to defend lower Manhattan, but that use had been found impractical—as had its second function as a site for public entertainment. Although Jenny Lind had packed Castle Garden during her Barnum-sponsored concert tour in 1850, the building’s shedlike design was simply all wrong for a music hall. Finally it had been leased to the Commissioners of Emigration.
Will reached sprawling Battery Park on a hot, humid morning. The hazy air all but hid the Jersey shore, and blurred the hull and superstructure of a rusty oceangoing vessel moving slowly up the river. As Will watched, the ship came to a dead stop. Tugs and a pilot boat steamed away while the vessel’s anchor chain paid out noisily. At the ship’s rail stood a couple of hundred men and women. Some held up infants, presumably hoping the babies would appreciate the heat-sodden skyline, or the huge copper-clad figure of Liberty out in the harbor. Bartholdi’s gigantic statue with its flaring lamp upraised had finally been erected on its pedestal late in 1886. Small excursion boats took sightseers a mile and a half out to Bedloe’s Island for a closer inspection. Will thought he should make that one of his stops before he returned to Boston.
He was fascinated by a group of about twenty men, most of them unsavory looking, who lounged near the gates of Castle Garden. As the new arrivals emerged from the building, bundles of belongings slung over their shoulders and bewildered expressions on their faces, the waiting men took advantage of that bewilderment.
From the shadow of the park’s bandstand, Will watched one of the men step up to an elderly couple, smile and tip his derby. The man spoke to the couple in a foreign tongue. Russian, perhaps; he couldn’t be sure.
The old man and woman broke out in smiles at the sound of a familiar language. The man—a hard-faced sort with a large diamond ring on the little finger of his right hand— noticed Will watching and glared. Will moved on. The man stepped between the elderly couple and began talking in a confidential tone.
Another white-haired man came through the gates, a homemade crutch under his left arm. A laughing eight-year-old boy rode his right shoulder. Next came the boy’s parents—a big-shouldered man in ragged clothes, and a buxom, extremely ugly girl who was entranced by the sights around her. A man broke away from the loungers and sauntered toward the group.
“Good morning to you. Would you be interested in halfprice railroad tickets to your destination?”
The grandfather said something in a foreign language to indicate that he didn’t understand. He asked a question.
The American grinned. “Sure, I can talk bohunk. I was raised on it. My folks spoke nothing else.”
He proceeded to prove it, slipping his arms around the young couple as if he’d known them for years. The parents, the old man, and the child all looked at the stranger with expressions of trust and gratitude.
At the gates, Will sent in his name; he’d have to wait until Drew came for him. The guard, a florid Irishman, told him no one was allowed to leave without a permit—and no one was allowed to enter without being vouched for by an employee.
“Otherwise we’d have the damned rascals inside the building too.” He indicated the lounging men who were laughing and talking with one another. “As it is, they pollute this place day and night. They pay off the police so they won’t be run in for their duty tricks. We try to warn the greenhorns. And there’s a currency exchange inside where they can get an honest shake. But they’ve been packed in steerage for weeks, and most of ’em are tired and so nervous, they don’t get around to doing business till they meet their newfound friends out here. Disgusting, that’s what it is!”
Will pointed at the family he’d observed. “I heard that man mention cut-rate railroad tickets to those four.”
“Oh, sure, he’ll sell them a half-price ticket to Minnesota or Kansas or anyplace else they want to go. Only they won’t be able to read it and see it’s worthless. The sharps either speak a foreign language or learn enough of a few to get by. These are the very first Americans the greenhorns meet outside of Castle Garden. What a fine impression of our country it must give them!” The guard glowered at the men..
“Will!”
He turned at the sound of the familiar voice. There came Drew, a spotted linen smock flying around his legs. The heat plastered his red-gold curls to his pale forehead. In a moment, he was shepherding his friend through the gate.
“So you’ve seen our version of John, chapter two.”
“What?”
“The temple of the moneychangers that Jesus purged. I wish someone would purge Battery Park.”
“I was watching some of those men operate. They’re very skillful.”
“Skillful crooks! They all have their specialties. Some only watch for prosperous immigrants. They buy them a meal, drug their drinks—and the newcomers wake up in some alley, prosperous no longer. Some of the men concentrate on befriending young girls traveling alone—you can imagine where they wind up. By the way—Jo sends you her regards.”
The thought of Drew’s sister brought a look of embarrassment to Will’s face. “I haven’t had time to answer her letters for months.” A wry smile. “Do you suppose that’s why she stopped writing?”
“That and the fact that she’s seeing a boy.”
“Oh? Who?”
“The minister’s son. He bores her to tears, but at least she has a suitor of whom Pa approves. She’s filled out a lot. I’ve never seen anyone so grateful to be grown up.”
“You said you hoped she’d be less grumpy when that happened.”
“My hope has been fulfilled. Now she’s only grumpy when she looks in the mailbox and finds you haven’t sent a letter. You’re still her favorite.”
Will wished Jo Hastings would grow out of her adolescent devotion to him; he hoped Drew hadn’t told her about Laura.
“Is Jo working at the store?” he asked.
“Six days a week.” Drew led his friend into the building and down a dark corridor ten degrees hotter than the outdoors.
“Is she happy?”
“I think she’s miserable. She’ll never get over the fact that she can’t realize her ambition because we’re poor and she’s a girl. She sympathizes with Pa’s predicament, but that doesn’t make her like being the victim of it.”
He and Will entered a small office. Drew took Will’s valise, then reached toward a wall peg. He handed his friend a heavy linen smock of the kind he was wearing.
“Put this on, if you don’t mind. We have a patient.”
“We?”
??
?Yes, I need your help.”
“What about the regular doctors?”
“Too busy. I don’t know whether I wrote you about the procedure here.”
“No.”
“Arriving ships anchor in the river—”
Will nodded. “I watched a big one putting her anchor down.”
“They stay in the river while a Customs House launch takes the immigrants off in groups. We’ll be receiving that ship’s first load within the hour. A vessel that came in earlier this morning brought us two hundred and fifty, including our patient.”
“Who is he?”
“She,” Drew corrected. “A Polish girl. She seems to be sans a husband, but she’s very much pregnant. At full term, in fact. Some of the others on her boat spoke a little English. They say this is her first child. She’s been in labor about twenty-six hours. Too long. Her pains have stayed steady and strong, but the baby’s progress has stopped.”
“The fetus in the wrong position?”
“Yes. Almost a direct posterior position, as far as I can tell.”
“Wasn’t there a doctor aboard her ship?”
“No.”
“Couldn’t someone in the crew have helped her?”
“Medical care isn’t included when you buy a steerage ticket, Will.”
“All right, but how’d she become your responsibility?”
“The captain ordered her off, and never mind her condition. An orderly’s watching her in case there’s an emergency, but I’ve delayed about as long as I can. I’m going to have to deliver her myself.”
Will frowned. “Why? You told me only routine examinations were done at Castle Garden.”
“That’s right. Serious cases are transferred to the hospital on Ward’s Island. I don’t believe I have time to ship this girl there.” He shoved the smock at Will.
“Drew, I’ve never seen a delivery! I haven’t even had a course in—”
“Neither have I, for God’s sake. But we’ve both read textbooks—and last summer in Hartford, I paid an old midwife to let me watch half a dozen accouchements. I had to pretend to be her son. Some women are insane on the subject of modesty. They’d rather perish than have a physician see their private parts. Anyway, for three of the deliveries, the old woman had to use the forceps. Years ago she hired a blacksmith to make some to her specifications. She was masterful with them. I learned a lot watching her. Now come on—enough conversation. If we don’t give this girl proper care, no one will.”
The old sense of inadequacy gripped Will then. “I’m not sure I’m capable of being any real hel—”
“You can administer ether, can’t you? I’ll even tell you how many spoonfuls to sprinkle into the inhaler.”
The contempt reddened Will’s cheeks. But he still didn’t move.
Drew cast an anxious eye on a small desk clock. “Now what’s wrong? Do you object because the girl’s poor and foreign? Do you only associate with rich patients now that you’ve taken up with the Pennels?”
“That’s goddamn unfair, Drew!”
“Of course it is. But it got a reaction.”
“For your information, I don’t need to be told how many spoonfuls of ether to sprinkle into the inhaler. I memorized a few things besides the tenth edition of Gray’s!”
“That was my impression,” Drew said with a mocking lift of his eyebrows. “Will you or won’t you help?”
Will snatched the smock from Drew’s hand, flung it on a chair and started to strip off his coat. Drew’s quick smile couldn’t quite hide his tension.
CHAPTER XII
BIRTH
i
IN A SMALL, BADLY lighted room bearing no resemblance to a modern surgical theater, Drew examined a rectangular table with a large brown stain in the center. Two blocks of rough wood had been nailed to the corners of the table nearest him. He touched each block, then spun to the loutish young orderly in the filthy white jacket.
“Couldn’t you find wood without splinters, Clarence?”
The orderly acted as if the question insulted him. “No, I couldn’t.”
Drew pointed to the blocks. “Then cover these with cloths soaked in the carbolic solution. Put a sheet soaked in carbolic over the whole table, and two dry ones on top. Where’s the girl?”
“On my gurney, down the hall.”
“We’ll bring her in after we fix the table. Get the linens.”
The orderly shuffled away. “Fast, for Christ’s sake!” Drew shouted. “I’d like to deliver the child sometime before the leaves fall!”
The orderly moved a little faster. The door slammed. Drew sighed. “Shouldn’t have yelled at him. I’ll need his help, too. Damn heat’s getting me.”
The heat, and the problem confronting them, Will thought as he studied the room. For a moment the only sound was the faint bubbling of a kettle of water boiling on a ring above a gas burner.
Drew noticed his friend’s frown and said, “We’re splendidly set up, aren’t we? No windows. No separate ventilated room for administering the anesthetic. You’ll have to do it right in here.” He cocked an eye at the gas fixture hanging above the table, its jets trimmed low. “Be careful with the ether. Blowing the fetus into the world isn’t the procedure I had in mind.”
“Where’s your equipment?”
“Behind you—what little we have.”
Will moved to an old walnut cabinet. “You sound nervous.”
“Why, no,” his friend replied as he pulled a book, then a forceps, from storage cubbies. “I always keep a text handy when I work. It reassures the patient. If the doctor doesn’t know what the hell to do next, perhaps the author does.”
Less sarcastically, he continued, “I really am glad you’re here. I wouldn’t trust Clarence to give the anesthetic. I didn’t tell you all the complications. The fetus is extremely large. And the mother’s pelvis is all wrong for childbearing. It’s the truncated kind—more like a man’s than a woman’s. Add my inexperience and you might logically conclude that the whole business is very chancy. Your conclusion would be right.”
ii
Drew poured some of the boiling water into a smaller basin next to a second one containing carbolic solution. Will, meantime, began to lay out the anesthesia equipment on a small table. He noted the title of the book Drew planned to keep handy. A System of Midwifery. It was a widely used text by Dr. Leishman of the University of Glasgow.
Clarence returned with sheets and rags. Will and Drew took over preparation of the table. After it was draped, Drew tore strips of clean rag with which to tie the patient’s ankles to the blocks once her heels were braced against them.
Next Drew washed his hands in the smaller basin of boiled water, relatively cool now. Once he’d rinsed off the soap he dipped his hands and lower arms into the adjacent pan of carbolic solution.
The room was intensely hot. Will asked about dispensing with the smocks. “I prefer them, but I suppose we can.” Will got rid of his, rolled up his sleeves and drained the dirty water from the small basin. He rinsed and refilled it, then washed his hands and immersed them in the basin of antiseptic.
Drew, meantime, instructed Clarence to pick up the separate halves of the forceps. Each half of forged metal consisted of a long shank with a handgrip at one end and, at the other, a blade somewhat resembling a large serving spoon from which most of the bottom had been cut out. Holding each shank at the midpoint, Clarence dipped the handles into the kettle of boiling water, then into the carbolic. Drew waited a few seconds to permit the handles to cool and took them in his own hands.
He studied the two halves of the forceps. They were meant to be united by an attachment mechanism near the midpoint of the shanks. When fitted together, the halves formed a single instrument with the concave surfaces of the blades facing inward for holding and judiciously pulling the head of the fetus. The design of the attachment mechanism allowed the two halves to slide forward or back, necessary for adjusting to irregularities in the shape of the fetus’ head. In a po
sterior-position fetus, such irregularities were to be expected.
As Drew stared at the instrument, his expression suggested that he might be remembering horror stories he’d heard at Harvard—stories of infants marked or mangled before birth by doctors whose handling of the forceps was unskillful. Will started to feel an ache in the pit of his stomach, and a sense of concern and responsibility for the unknown mother that he didn’t altogether welcome.
Drew immersed the unsterilized sections of the forceps in the boiling water, then the carbolic. At the same time, Will was sorting and arranging the apparatus for administering anesthesia: a battered metal Allis inhaler; a Goodwillie mouth gag for holding the jaws apart; a tenaculum to draw out the tongue, and a large curved needle with attached silk thread for transfixing it, if that became necessary; a silver trachea tube; a basin for catching vomit.
Drew raised the forceps for a final inspection. The carbolic solution dripped from the blades. A professor on the Harvard faculty had once referred to the forceps as the great prime mover of obstetrics. No one knew who had invented the instrument. Its origins were lost in the past. But Avicenna, the great Persian physician who had lived in the tenth and eleventh centuries, had been familiar with the forceps. Watching the wet blades shine in the gaslight, Will had a strong sense of the worthy traditions of his profession.
In the hall, a woman moaned. “Find the anesthetic?” Drew asked as he laid the forceps on a square of linen that had come out of the carbolic basin a few minutes earlier.
Will nodded, holding up two corked cans of ether. It was Dr. Squibb’s, generally considered the best available.
The orderly opened the door. The moaning grew louder. As Clarence tried to maneuver his cart into the stifling room, Drew’s eyes shifted past Will to the mother. Instantly, his anxious look disappeared, replaced by a confident smile. Will understood the abrupt change when he saw the young woman. She was awake, and terrified.