They had reached the East Lecture Theatre where the meeting was being held. Moss opened the door and allowed Saracen to enter first.
“Good evening,” said Martin Saithe, looking over his glasses and then at his watch. “I think we are all here now.” He exaggerated the act of looking at everyone present to confirm it.
Saracen disliked the lecture theatres in the General for there never seemed to be enough light in them, especially at night when single bulbs hanging beneath metal shades seemed to provoke more shadow than illumination. Apart from the installation of projection equipment no concession at all appeared to have been made to the modern era. The dark, wooden bench seating rose steeply to the ceiling and curved in a hemisphere round a central podium as it had done when Victorian medical students had filled it. Saithe was standing behind a table that had, in its time, witnessed a continual stream of embarrassed and hapless people, there to display their afflictions for the education of the ‘young gentlemen’.
Saithe said, “I must apologise for our surroundings this evening but Dr MacQuillan has some slides for us; we need the projector.”
A small, balding man with a dense black moustache and wearing a tweed suit took this as his cue and got to his feet. He joined Saithe behind the table and picked up an automatic slide changer. Saracen thought he recognised a slightly aggressive air about the man, in the way he stood with his feet well apart and the way he held the slide changer at a distance from his body.
Saithe said, “Dr MacQuillan is an expert on Yersinia pestis, the organism that causes plague. He has kindly agreed to fill in the gaps in our knowledge.”
MacQuillan gave a little grunt of acknowledgement and took the floor from Saithe. He picked up a pointer from the table and clicked on the first slide. “First the culprit.”
MacQuillan’s Scottish accent and clipped words matched his stance, thought Saracen, who had now classified him as a pugnacious, no nonsense Scotsman. Good, he thought, the absence of bullshit should speed things up considerably.
MacQuillan slapped the pointer against the screen and said, “This is Yersinia pestis, a rod shaped bacterium less than two thousandths of a millimetre long. It looks like any other bacterium you might say and you would be right but, in the fourteenth century, this little fellow wiped out one quarter of the entire population of Europe.” MacQuillan paused but found his audience too sophisticated to gasp out loud. “Ironically,” he continued, “Man is infected as an unwitting interloper between infected rats and their fleas. An infected rat dies, its fleas look for a new host. A human being is nearby, Bingo, he gets plague.
MacQuillan clicked the slide changer and a monster from science fiction leapt on to the screen. “Xenopsylla cheopis,” said MacQuillan, “The rat flea. The cycle is as follows. Flea bites infected rat and picks up the organism. The bacteria multiply inside the insect’s gut. It regurgitates them and, mixed with its saliva, it passes on the disease to its next victim, usually another rat…but not always.”
“But surely plague can be transmitted in other ways,” said Phoebe Kendal, the General’s senior nursing officer.
“Indeed it can,” replied MacQuillan. “The process I have described is for the transmission of bubonic plague. There is another form of the disease termed, pneumonic plague which is what we are seeing here in Skelmore. In advanced stages of the illness the patient produces copious amounts of bloody, frothing sputum containing myriads of plague bacteria. This gives rise to highly infectious aerosols produced when the patient coughs or sneezes. People in the vicinity inhale the infected particles and contract pneumonic plague.”
“Thank you Doctor,” said Phoebe Kendal.
MacQuillan changed the slide. “The bubonic form,” he said. “The patient shown here is close to death. Note the swollen lymph glands and here,” he slapped the pointer once more against the screen, “in the inguinal region is the primary bubo, the most common site for it.” Another click of the changer and a different patient appeared. “This man has pneumonic plague; he is about three hours from death. Note the skin colour; he’s almost black, hence the nickname, Black Death.”
“What’s the mortality rate?” asked Moss.
“In untreated cases of pneumonic plague mortality is almost one hundred percent. In untreated bubonic cases, between fifty and seventy-five.”
“You said ‘untreated’,” said Saracen.
“Yes, the use of modern antibiotics can alter things dramatically. Tetracycline therapy will reduce bubonic plague fatality to around one percent. It is also extremely effective against the pneumonic form if the time factor is right.”
“Time factor?”
“After twelve hours nothing will save you.”
Saithe asked about incubation time for the disease.
“One to six days depending on the infecting dose,” said MacQuillan.
Saracen was beginning to wonder why Braithwaite, the county medical officer was saying nothing, and was about to say so to Moss, when MacQuillan answered his question for him.
“I have spoken to Dr Braithwaite and his people are currently taking appropriate action to contain the outbreak. I don’t think I am being too optimistic when I say that this should all be over in the very near future.”
“Can I ask what ‘appropriate action’ means?” said Moss.
“Over to Dr Braithwaite,” said MacQuillan and sat down.
Braithwaite got to his feet with the usual difficulty of a very fat person and turned to face his audience. He wrinkled up his nose and eyes as if he had suddenly been exposed to light and thrust his hands deep into the voluminous pockets of his trousers. “Well, basically,” he began, pausing to clear his throat unnecessarily; “It’s a question of tracing contacts quickly and treating them.”
“With what?”
“Tetracycline.”
“And if they are children?” asked Moss.
“I know what you are getting at Doctor but, in this case, I think we have to overlook the deposition of the drug in growing bones and teeth and give the children tetracycline too.”
No one chose to disagree.
“What about protection for hospital staff?”
“Anti-plague vaccine and serum is on its way,” replied Braithwaite.
“For my men too?” asked Carradyce.
“Of course.”
“But not the public?” asked Saracen.
Braithwaite screwed up his face still further. “No, not at this stage,” he said. “We don’t want to encourage any unnecessary panic and I feel that this unfortunate incident can be adequately contained without mass vaccination.”
“Then you have established the link between the man who died at the County Hospital and either Archer or Cohen?” said Saracen.
Braithwaite shifted uncomfortably on his feet and cleared his throat once more. “I think we have come as close as we can,” he said. “The man was employed on the development at Palmer’s Green. I think it reasonable to suppose that he must have come into contact with either Mrs Archer or Mr Cohen.”
“It would have to have been Cohen,” said Saracen.
Braithwaite looked bemused; MacQuillan stepped in to save him. “By the incubation time, yes you are quite right Doctor. Mrs Archer has been dead too long for it to have been her who infected the man. The deceased must have been infected within the last six days; that makes it Cohen.”
“Are you taking steps to prove it?” asked Saracen.
Braithwaite was dismissive. “Enquiries will be made but it is purely academic,” he said.
Moss said, “Am I right in thinking that what we are aiming for is six clear days without a case of plague?”
“Better say eight to be absolutely sure,” said MacQuillan. “Eight days without a case and Skelmore will be in the clear.”
“Assuming all the presumptions are right,” said Saracen.
“I don’t think I understand,” said Braithwaite coldly.
“I said assuming all the presumptions are correct and A gave it to B who gave it to C etc.”