Luckily, I had a small supply of Jesuit bark among the selection of herbs and medicines I’d brought with me. It wouldn’t cure him, but I could, with luck, limit the more-severe attacks and relieve some of the symptoms. Thinking of this reminded me suddenly of Lizzie Wemyss. Coming to America as Brianna’s bond servant, she also had contracted malaria from the coastal mosquitoes. I’d managed to control the disease in her fairly well, but how had she fared in my absence?

“I’m sorry, what did you say?” My attention was jerked back to the conversation, but I added LOTS of Jesuit bark to my mental list before replying.



PLUMBING

LIKE PLUMBING, MEDICINE is a profession where you learn early on not to put your fingers in your mouth. I smelled my next patient coming and was reaching for the jar of soft soap and the bottle of raw alcohol before she came through the door. And the instant I saw her, I knew what the problem was.

There were two women, in fact: one was a tall, rather commanding-looking woman, well dressed and wearing a hat rather than the usual bonnet. The other was a small, slight girl who might have been any age between twelve and twenty. She was what they called a mulatto, half black and half white, with café au lait skin and snub features. I set her lower age limit at twelve only because she had apparent breasts bubbling over the top of her stays. She was dressed neatly but plainly in blue gingham, and she stank like an open sewer.

The tall woman paused, looking me over consideringly.

“You are a female physician?” she asked, in a tone just short of accusation.

“I am Dr. Fraser, yes,” I replied equably. “And you are … ?”

She flushed at that and looked disconcerted. Also very dubious. But after an awkward pause, she made up her mind and gave a sharp nod. “I am Sarah Bradshaw. Mrs. Phillip Bradshaw.”

“I’m pleased to meet you. And your … companion?” I nodded at the young woman, who stood with her shoulders hunched and her head bent, staring at the ground. I could hear a soft dripping noise, and she shifted as though trying to press her legs together, wincing as she did so.

“This is Sophronia. One of my husband’s slaves.” Mrs. Bradshaw’s lips compressed and drew in tight; from the lines surrounding her mouth, she did it routinely. “She—that is—I thought perhaps—” Her rather plain face flamed crimson; she couldn’t bring herself to describe the trouble.

“I know what it is,” I said, saving her the difficulty. I came round the table and took Sophronia by the hand; hers was small and very callused, but her fingernails were clean. A house slave, then. “What happened to the baby?” I asked her gently.

A small, frightened intake of breath, and she glanced sideways at Mrs. Bradshaw, who gave her another sharp nod, lips still pursed.

“It died in me,” the girl said, so softly I could scarcely hear her, even though she was no more than an arm’s length from me. “Dey cut it out in pieces.” That had likely saved the girl’s life, but it surely hadn’t helped her condition.

Despite the smell, I took a deep breath, trying to keep my emotions under control.

“I’ll need to examine Sophronia, Mrs. Bradshaw. If you have any errands, perhaps you’d like to go and take care of them … ?”

She unzipped her lips sufficiently as to make a small, frustrated noise. Quite obviously, she would like nothing better than to leave the girl and never come back. But just as obviously, she was afraid of what the slave might tell me if left alone with me.

“Was the child your husband’s?” I asked baldly. I didn’t have time to beat around the bush; the poor girl was dripping urine and fecal matter on the floor and appeared ready to die of shame.

I doubted that Mrs. Bradshaw meant to die of that condition, but she plainly felt it almost as acutely as did Sophronia. She went white with shock, then her face flamed anew. She turned on her heel and stamped out, slamming the door behind her.

“I’ll take that as a ‘yes,’ then,” I said to the door, and turned to the girl, smiling in reassurance. “Here, sweetheart. Let’s have a look at the trouble, shall we?”

Vesicovaginal fistula and rectovaginal fistula. I’d known that from the first moment; I just didn’t know how bad they might be or how far up the vaginal canal they’d occurred. A fistula is a passage between two things that ought never to be joined and is, generally speaking, a bad thing.

It wasn’t a common condition in civilized countries in the twentieth century but more common than one might think. I’d seen it several times in Boston, at a clinic where I gave time once a week to provide medical care to the city’s poor. Young girls, much too young to be considering the opposite sex in any serious way, becoming pregnant before their bodies had ripened enough. Prostitutes, some of them. Others just girls who had been in the wrong place at the wrong time. Like this one.

A full-term baby that couldn’t be forced out through the birth canal, and days of nonproductive labor, the child’s head a battering ram against the tissues of the pelvis, the bladder, the vagina, and the bowel. Until at last the tissues thinned and split, leaving a ragged hole between bladder and vagina, or between vagina and rectum, allowing the body’s waste to drip out unhindered through the vagina.

Not a matter of life or death, but revolting, uncontrollable, and bloody uncomfortable, too. Sophronia’s inner thighs were swollen, a bright, patchy red, the skin macerated by the constant wetness, the irritating fecal slime. Like a permanent diaper rash, I thought, suppressing a deeply visceral urge to find Mr. Bradshaw and make a few fistulas in him with a blunt probe.

I talked to her while I made my examinations, soothingly, and after a little she began to answer me, though still in whispers. She was thirteen. Yes, Mr. Bradshaw had took her to his bed. She hadn’t minded. He said his wife was mean to him, and she was—all the slaves knew it. Mr. Bradshaw had been nice to her, gentle-like, and when she fell pregnant, he’d taken her from the laundry and put her to kitchen work, where she’d have good food and wouldn’t have to break her back with the heavy linens.

“He was sad,” she said softly, looking up at the ceiling while I wiped away the filthy trickle between her legs. “When the baby died. He cried.”

“Did he,” I said, in what I hoped was a neutral voice. I folded a clean towel and pressed it between her legs, throwing the wet one she’d been wearing into my bucket of vinegar and water. “When did the baby die—how long ago, I mean?”

She frowned, the expression barely rippling the pure young skin of her forehead. Could she count? I wondered.

“Be some time before the sausage-makin’,” she said uncertainly.

“In the fall, then?”

“Yessum.”

And it was mid-December now. I poured water over my dirty hand and dribbled a bit of soap into my palm. I really must try to get a nailbrush, I thought.

Mrs. Bradshaw had come back but hadn’t come in; I’d pulled the curtains over the front window, but her shadowed outline was plain on the cloth, the jaunty feathers in her hat stuck up like a silhouette cowlick.

I tapped my foot thoughtfully, then shook myself into order and went to open the door.

“I might be able to help,” I said without preamble, startling the woman.

“How?” She blinked at me, and, taken unawares, her face was open, troubled but without the pinched look she’d worn earlier.

“Come inside,” I said. “It’s cold out here in the wind,” and guided her in, a hand on her back. She was very thin; I could feel the knobs of her spine, even through her coat and stays.

Sophronia was sitting on the table, hands folded in her lap; when her mistress came in, she bent her head, looking at the floor again.

I explained the nature of the difficulty, so well as I could—neither of them had any grasp of internal anatomy at all; it was simply a matter of holes to them. Still, I managed to get the general point across.