Anna laughed. “Yes, I did. Although sometimes it all feels unreal. Was it like that when you got married?”
Her aunt’s expression was thoughtful. After a moment she said, “You know that your aunt Hannah’s people believe that the dead are never far away. She told me once—and this was before she met Ben—that her first husband and little boy sometimes came from the Shadowlands to talk to her. Some people dislike that idea because it frightens them. But when Simon died, I waited and waited. I wanted him to come back to talk to me, in my dreams at least. I wanted to scold him for being so reckless on the ice floes, the day he died. And he did come, finally, but by that time I wasn’t angry at him anymore. I just missed him.
“He still comes now and then, and when he does he looks as he did when we were young. Sometimes he has our littlest three girls with him, the ones we lost too soon.”
“And Nathaniel?”
Aunt Quinlan talked sometimes about her son, the last of six and the only boy. Nathaniel Ballentyne had died at Shiloh, on his twenty-fifth birthday, unmarried, childless.
“Nathaniel most of all,” her aunt said. “He knew how angry I was about him going off to fight. He’s been trying to make it up to me ever since. Sometimes he is as real to me as you are, sitting there.”
She shook herself a little. “Enough of that. There was something I wanted to tell you, and you let me wander off.”
Anna tried to prepare her mind, but Aunt Quinlan’s stories were never predictable.
“As a little girl you already knew what it meant to lose the people you love, and that made you shy. Then the war came along and we lost Paul and Harrison, and made it ten times worse. When you and Cap got to be friends I thought, Maybe he’ll pull her out of it, and he did. A good ways, he brought you back to being brave enough to face the world. Sophie brought you along even further. But it’s there in you still, the need to hide away.”
Anna had heard this before and she knew that it was at least in part true.
“So you’re saying Jack is going to change my view of things?”
Aunt Quinlan looked at her with an expression that was pure surprise. “That would be a silly thing to say, Anna. You know as well as I do that people rarely change once they reach a certain age. What I’m saying is, you’re a turned-inward soul; it’s the way you cope with the hard things in life. You hide away.”
“You think Jack doesn’t realize that about me.”
“Maybe he does,” her aunt said. “But if he does it’s only in his mind; he doesn’t know what it will feel like. I’m taking a long time to get to my point, so here it is. Hard things come along; they always have and they always will. When that time comes, you have to turn toward Jack and not away from him. And that’s not in your nature. You love the man—don’t bother blushing, I know you love him even if you can’t say the word in your own mind—but your first instinct will be still to shut him out. So be aware of that, and do what you can to stop yourself.”
Anna tried to smile. It made sense that Aunt Quinlan would worry about such things, simply because she had suffered so many losses herself. Nathaniel was gone, but she had also lost three girls before age ten, one to childbirth, and her second youngest to a cancer of the breast when she was just fifty. Only her oldest was left. There were grandchildren and great-grandchildren; she had her brother Gabriel, though she hadn’t seen him in a long time for the simple reason that she would not go home to the village where she was born, and he wouldn’t leave it. She was closest to her sister-in-law Martha, who wrote every week and did sometimes come to the city. And there were nieces and nephews and their families. But she felt the losses, and how could she not?
She said, “Auntie, I was right here, beside you, when the worst news came. I’d like to think that I learned something from you. That I have some of your strength.”
“That’s just it,” her aunt said. “That’s the hardest part, being strong enough to let the hurt in, and deal with it, and then let it settle in time, as it will.”
“Yes,” Anna said. “I see that. I can make one promise at least. I will think of you and this conversation when things are hard, and try not to turn away from it.”
“That’s all I’m asking,” said her aunt. “Now eat before you have to go off to the courthouse, or Mrs. Lee will scold me without mercy.”
“I have a few more minutes.” Anna bit into a sandwich, thinking. When she swallowed she said, “You’ve been following the news about Janine Campbell in the paper?”
“I have.”
“The rumors going around are that she killed her boys.”
Aunt Quinlan had a particular look, one that said she was at the end of her patience, and it was there now. “That’s pure foolishness.”
Anna swallowed another bite. “What do you think happened to them?”
“I can’t say, but I do know that nobody is asking the real question, the important one. Ubi est morbus?”
Anna laughed out loud to hear her aunt quoting the great physician Morgagni. Where is the disease?
“Where did that old chestnut come from?” she asked.
“This family is chock-full of doctors,” her aunt said. “You know when your ma and pa came to Paradise to take over Hannah’s practice, they lived with us at first. And did they love to talk medicine. They did it over every meal. Sometimes your aunt Hannah would be there too and they’d get into arguments and drag out books to prove each other wrong or themselves right. Nothing mean-spirited about it, mind. They were laughing half the time. And when they couldn’t get anywhere with a case, one of them would put that question on the table, Ubi est morbus?, and they’d start looking at the evidence again, from the very beginning. And most of the time, they figured out what was going on, and more than that, why they had been looking in the wrong place.”
“You’re not asking me what disease Mrs. Campbell had.”
“No, I’m saying that you have got to look and think symptom, not disease. If she’s a symptom, then ask, where is the disease?”
And Anna knew two things: her aunt was right, and she wouldn’t be able to get it out of her head until she could talk it through with Jack.
• • •
THE COURTROOM WAS crowded and hot, and Sophie wished herself away, someplace where she wouldn’t have to sit and listen to men talk about Janine Campbell. A woman they had never known and would never understand, not if her ghost came forward to answer their questions.
When the coroner announced that Archer Campbell was delayed, there was a great sigh from the reporters at the back of the room. Then he called Anna to the stand and Sophie thought that they would have enough to write about, once Anna started to testify.
She took her seat across from the jury of men who were, supposedly, her peers. With the exception of Comstock, all of them dressed in somber colors and expensively tailored suits. Most of them had been reading journals or newspapers, but as she approached, Abraham Jacobi and Manuel Thalberg met her gaze and nodded, as colleagues greeted each other across a room. Dr. Lambert even raised a hand, which was a bit of a surprise. She couldn’t remember ever speaking to the man, but apparently he knew Anna.
The coroner left most of the questions to the physicians, and there were many of them, but Anna was a good teacher and that carried over to her testimony. Even when Josiah Stanton asked the same question three times like a particularly dull student, she stayed calm. She described her education, talked about medical school and work at dispensaries and clinics when she was an intern, about postgraduate work and the professors she had studied with in New York and abroad.
Stanton wore an expression of unapologetic surprise that a woman physician should have such credentials. For a moment Sophie thought he was going to challenge Anna, but then he thought better of it. And good for him.
The coroner had only one real question for her.
“In your professi
onal opinion, Dr. Savard, how did Mrs. Campbell die?”
Sophie appreciated the man’s clarity and lack of melodrama, and so did Anna, because she answered in kind.
“Sometime late on Tuesday or early Wednesday Mrs. Campbell attempted to induce an abortion on herself by means of an instrument as much as ten inches long, with a keen edge. In the process she punctured her uterus and caused damage to other abdominal organs. Infection will have set in immediately and once that happened, her death was inevitable.”
“Why would you assume that?” Hawthorn asked.
Anna blinked at him, and really, it was a question that should need no answer.
She said, “Dr. Lister’s and Dr. Pasteur’s findings on antisepsis have been accepted by doctors and surgeons—” Anna paused to look at the jury, her expression almost inviting someone to disagree. Morgan Hancock of Women’s Hospital stared back at her, his mouth in a hard line. If he was going to challenge the very idea of bacteriology, they would be here a very long time. There was a pause, and he looked away.
“It is accepted,” Anna repeated, “that bacteria, which are too small to be observed by the human eye, are the cause of infection. Some types of bacteria are harmless or even beneficial, but there are also pathogenic bacteria that cause infection and illness. Bacteria are everywhere, but an infection starts, or can start, I should say, when pathogenic bacteria enter the body through a wound. Surely you’re aware of the way President Garfield died.”
She stopped herself, because James Garfield’s death was still a very controversial subject among doctors. If the coroner asked for clarification, there might be an extended debate. But he did not, and she went on.
“In Mrs. Campbell’s case, she used an instrument that was not sterilized—in a well-run operating room, every object that comes in contact with a patient is sterilized, made free of bacteria by means of heat. Mrs. Campbell inadvertently introduced pathogenic bacteria of many different kinds into puncture wounds in the uterus and intestines. If she had come into any good hospital at that point there’s a chance she might have been saved if all the septic matter had been evacuated, but only a very small chance. Would any of the jury care to disagree with me? Dr. Hancock?”
“No,” Hancock said, his voice gruff.
Anna allowed herself a small smile. “As it was, the infection ran riot, so to speak. There was so much damage and so many different kinds of bacteria, the natural defenses of the body were simply overwhelmed. The result was a systemic infection, and the huge amount of pus and purulent matter found in her abdomen. When she was brought to the New Amsterdam she was near death following from cryptogenic pyaemia, blood loss, and shock.”
“But you operated anyway.”
“I didn’t know the extent of the damage until I had her on the operating table. She died not five minutes after I made the first incision.”
“To be clear, you agree with the postmortem report on the cause of death?”
“I agree on the cause, but I do not agree about the agent. The postmortem reads ‘person or persons unknown’ performed the operation. I am fairly certain that it was Mrs. Campbell who operated on herself.”
“What makes you so sure of that?” Stanton asked. “For my part I am not convinced.”
Anna sat up straighter and looked at him directly. “I have treated many women who came to the New Amsterdam after a poorly done abortion. Some of them will say, in the vaguest way, that they went to someone for help. No one has ever volunteered the name of a practitioner—”
“An abortionist,” Anthony Comstock interrupted.
“As you like,” Anna said, without looking at him. “You may condemn those people who perform operations, but they are generally technically skilled. Some are less particular about hygiene, which is the cause of most complications in such cases. There was nothing skilled about the operation performed on Mrs. Campbell. It was clumsy, even violent.”
For a full ten minutes she answered very specific questions about the surgery and Mrs. Comstock’s condition. When the jurors began to argue among themselves about definitions, Hawthorn interrupted.
“Dr. Savard, it is your opinion that Mrs. Campbell operated on herself in such a violent way that she caused fatal injury. You believe that she could have done such a thing on her own though she was not a very large woman.”
“Mr. Hawthorn,” she said. “Mrs. Campbell ran a household, did the scrubbing and cleaning and laundry. Have you ever lifted a tub of wet linen? She didn’t lead a pampered life. She gave birth four times and miscarried twice. She was not frail. Whatever thoughts or emotions motivated her to such an extreme act, she was determined and capable, and she persevered through the pain. As women do, every day. In your place I would want to know what drove her to such a point that she saw no other option than this drastic procedure she performed on herself.”
“Well, I can think of another question.” Comstock’s voice rose over the steady murmuring in the gallery. He looked out, Sophie thought, to make sure he had everyone’s attention.
“How would a simple, uneducated woman know what to do? Where did she get the knowledge and the surgical instruments she used? Did she have some text or instructions to follow? Maybe something like the pamphlet that was found in her dresser drawer, ‘Female Health and Hygiene.’ Are you familiar with it?”
“I’m willing to answer your questions, Mr. Comstock, but one by one. Could you start again?”
“I am Inspector Comstock,” he said stiffly. “And I’ll start again, but at the end. Are you familiar with the pamphlet that was found in her dresser drawer?”
“I was never in her home, and I know nothing about the contents of her dresser drawers.”
“Come now, Dr. Savard. Are you familiar with the pamphlet we found, or not?”
“I don’t recognize the title,” Anna said.
“No? Well, if the coroner will permit me to show it to you—”
Anna didn’t wait for the coroner’s opinion. She just held out a hand, looking Comstock directly in the eye. His mouth worked, puckering and jerking with pleasure he didn’t try to conceal. He stood up to approach her, but the coroner’s clerk stopped him.
“I’ll take it, sir.”
Anna could not let herself smirk at Comstock, and so she smiled at the clerk and thanked him.
She turned the pages of the pamphlet deliberately, slowly, and then handed it back to the clerk.
“I have seen pamphlets on hygiene, of course. Not this exact pamphlet, but others like it.”
“Isn’t it true that the hygienic measures described in that pamphlet are also used to induce abortion?”
“If there is a discussion of abortion in that pamphlet, I didn’t see it.”
“That doesn’t answer my question.”
Anna decided to give him the information he so clearly wanted. She said, “I have treated women who flooded themselves with lye soap, carbolic acid, rubbing alcohol, gin, quinine, bleach—the list is very long and the results are often ugly. Women with a little more money sometimes take medicines. Most of them are nothing more than weak tea; others are as bad as arsenic. Many women try three or four times with such medicines and then seek help elsewhere. The very poor care for themselves. They use straws or wires or bougies, almost any kind of spoon or slender, long instrument. Rubber tubing, metal probes, whalebone stays from old corsets. Your pamphlet addresses none of these things. And as far as I could see, it provided no instructions on terminating a pregnancy. Does that answer your question?”
Comstock met her gaze with sputtering animosity. He said, “I have no further questions at this time.”
“Then let’s move on,” the coroner said.
Anna turned toward him. “If I may suggest a solution to the question on the table?” Without waiting, she went on. “Dr. Lambert could speak to the question of how capable women are of injuring themselves. Dr. Lambe
rt?”
Lambert’s whole face contorted with surprise, but he spoke to Anna directly. “I think this point won’t be settled without a second postmortem. The remains?”
“The Bellevue dead house,” said the clerk.
Anna sat back, clearly satisfied to have achieved exactly this outcome. The coroner seemed less pleased, but he didn’t try to object. The jury would go to the morgue and the inquest would reconvene at four.
Conrad leaned forward and touched Sophie’s shoulder. “Go with them,” he said. “Your testimony will be compromised if you don’t.”
Sophie inhaled a sharp breath. The idea of a second autopsy in the damp recesses of the Bellevue dead house was unwelcome. It wasn’t so much the smells of putrification and mold, or the water that leached into the walls from the East River; those things were never pleasant but could be coped with. It was the idea of the men in the jury gathered around Janine Campbell, poking and prodding when she had been through so much already. But she would have to be there. With a female physician present the others would be utterly professional and focused on procedure. She only wished she could ask Anna to come along, but it was too much of an imposition.
Then help came from another quarter. Mary Putnam waved her closer, took Sophie’s hand, and shook it firmly. Small and wiry, a plain woman who could be transformed and animated into something more when she had a medical issue to debate. Mary Putnam had also been one of their professors at medical school. Her expertise as a physician and a scientist was unquestioned, even by the most unapproachable male doctors. She was without a doubt the most exacting instructor Sophie had ever encountered. Together with her husband they made a formidable team. And they were both here.
Sophie reminded herself that she could reveal every facet of the Campbell case to Abraham and Mary Putnam Jacobi without hesitation or fear, because she had given the best treatment there was to offer.
“I’m coming too,” Mary Putnam said. “The more female practitioners present, the better.”
“Will it be possible to keep Comstock out of the room?” Sophie asked.