Early on, I learned that there had been nothing unusual about the appearance of my mother’s body, given the conditions of her burial-the coldness of the ground, the brief length of time she had been buried. The heart is a pump, my anatomy instructor said, and at death, blood and other fluids often settle there and in the chest cavity after the heart ceases beating.
My professors called consumption by another name-tuberculosis, or TB. Tuberculosis was not an enigma to these men of science. Over forty years before my brother’s death, sanitariums were being established in Europe, and TB patients were living longer lives. But of all the discoveries that had been made about the disease, perhaps the most exciting had come in 1882, when Robert Koch identified its true cause-Mycobacterium tuberculosis. Koch’s discovery proved that TB was transmitted from a consumptive to a healthy person through bacteria contained in the consumptive’s cough-not by vampires.
Although saddened that my knowledge had come too late to save my family, I had no difficulty accepting these new discoveries. But educating the public, whether the poor of Boston or the farmers of Carrick Hollow, was a challenge. I determined to practice medicine in Carrick Hollow upon graduation, to do my best to counter the superstitious remedies that offered no real hope to its inhabitants.
I visited one of my chief correspondents and supporters soon after my return-old Dr. Ashford received me gladly, and we talked at length about the medical histories of families in the area and exchanged information on the latest medical supplies and pharmaceuticals. We also discussed my schooling and how much medical education had changed since he had taken the title “doctor.”
“The War of the Rebellion was where I learned medicine,” he said. “We learned on our feet, not from the books. I haven’t had much of a head for the science of it-just tried to do what worked.” He paused, then added, “Remember, John, that folks here are quite independent, even when it comes to medicine. They take care of their own problems, using the same remedies their grandparents used. It’s hard to fight their traditions.”
“I suspect that will be the hardest part of my job,” I replied. “I have confidence that I can do some good here, if my neighbors will only accept me.”
“You’ve always had both the mind and the manner for medicine,” he said. “You’ll do well in Carrick Hollow. It’s time they had a doctor as fine as yourself.”
As it happened, the residents of the village took me in with open arms, proud of my accomplishments, and glad to have a physician so nearby. Several of them helped me to convert a building formerly used by a lawyer into a small clinic, which had the advantage of living quarters on the upper story.
I had the good fortune to be of some help to my first patients, and soon others were ready to follow my medical advice and help me to establish my practice. I fell easily into life in Carrick Hollow, surrounded by the sense of community I so missed in Boston.
Only one problem continued to trouble me-my father’s state of mind.
Father had never fully recovered from the deaths in our family, especially not from the loss of my mother. Noah had been greatly relieved when I told him that I meant to set up my practice in the village. “Perhaps you will be able to cheer him,” he said. “He has not been the same since-since the day Nathan died.”
But although he was always kind to me in those months, my father never smiled, and seldom spoke. His sleep was often disturbed by nightmares, and if not for our constant coaxing, he would not have eaten enough to keep his strength up. He worked hard, but the joy he had once taken in his labors was gone. There was a lost look in his eyes, and the smallest happiness seemed beyond his reach. It was as if, on that long ago day at the cemetery, his own heart had fallen on those flames, and turned to ashes with my mother’s.
His lifelessness was a condition found in others in Carrick Hollow-in Isaac Gardner, in Mr. Robinson, and in others who had performed Winston’s brutal ritual. Bitterly I reflected that nothing in my medical training would cure these men. I vowed that no one in Carrick Hollow would ever be forced to endure that ritual again.
Soon after I had opened my office, I was given an opportunity to make good on that vow. I was visited by Jacob Wilcox, a middle-aged man just returned to Carrick Hollow from factory work in Fall River. His rumbling cough was a tell-tale sign of tuberculosis, but my examination revealed that the disease was in its early stages.
I recommended the best hope for his recovery-the strict regimens of a sanitarium. I suggested one in the Adirondack Mountains, which had the advantages of being close to Rhode Island and less costly than those in the western United States. He thanked me, took the information, and went on his way.
A few days later, at my father’s request, I visited the farm. Coming down the drive, hearing the welcoming bark of our old dogs, I felt what had become a customary mixture of sadness and deep comfort in returning to my childhood home. Noah and my father came out to help me stable the horse, and my brother and I spoke of inconsequential things. I could not help but notice that Father seemed agitated, and Noah wary.
My father did not broach the subject that concerned him until we had finished eating our simple meal-a meal he had barely touched. He put a log on the fire, then turned to me and said, “I’m told that you saw a patient with consumption today.”
“Yes,” I answered hesitantly. I had not previously told him of my devotion to the study of consumption, and I was concerned that he would be touched on the raw by any mention of it.
He frowned. “I talked to young Wilcox after you saw him. What is this treatment you prescribed? Why do you send him to the mountains?”
“In hope of curing his consumption,” I said.
“Curing! Is it possible?”
“Sometimes, yes.” I began to tell him of the benefits the TB patient might find in life in a sanitarium-exposure to a healthful climate, enforced rest, fresh air, proper care and good nutrition. “And of course, the sanitarium separates those who have this contagion from any who might be vulnerable to it, so the disease is less likely to be spread to others.”
“You have especially concerned yourself with the study of-you call it ‘TB?’”
“Yes.”
His questions became more persistent, and soon I was talking to him of Brehmer, Villemin, Koch and all the others whose discoveries had brought us to our present understanding of the disease. My father listened with rapt attention, but I saw that he became more and more uneasy as I spoke. Soon, however, I recognized that he was dismayed not by what I had learned about TB, but by his own previous ignorance.
“Dr. Ashford did not know of this!” he said. “Your mother, the children-their consumption was a death sentence! I should have sought another physician, a younger man, such as yourself. If we had known of these sanitariums-”
“It still might not have helped-sanitariums only give consumptives a chance to recover. Some people survive, others arrive only to die a few weeks later.”
“But Nathan-your mother, Robert and Daniel-all of them, even Rebecca-they might have lived had we sent Rebecca away?”
“I don’t know. There were so many others in Carrick Hollow who were ill that winter. Perhaps they would have caught TB from Mrs. Gardner, or Jane, or another. We cannot always cure this disease, Papa. I can’t say for certain who would live and who would die. For all that men in my profession have learned, life and death are still in God’s hands.”
He was silent.
“We cannot change the past, Papa. I only hope to save others from the horror our family experienced. In truth, my most difficult battle is not against the disease, but rather the ignorance-the sort of ignorance which allows men like Winston to convince others that the afflicted are beset by vampires. As long as he spouts his nonsense, others will die, because he will have his neighbors believing that spiritual mumbo-jumbo-and not infection-are at the root of the disease.”