The Invisible Victory

'Do they know the infecting germ yet?' Her reassurance had made me anxious.

'They'll have the culture tomorrow. With luck, she'll be on the mend by then.'

The following evening, a nurse asked me to wait outside the ward door. The midwife appeared with the news, 'I'm afraid your wife's rather poorly, Mr Elgar.' I felt a pang of alarm. 'Her temp's gone up, and she's rather miserable because she's having a rigor or two. The doctor's just been with her, and he thinks the infection is still localized to the birth canal.'

I was even more suspicious of her optimism. 'What was the organism? I've had some training in bacteriology.'

'It's a haemolytic streptococcus,' she said calmly.

'Oh,' I said. Rosie was seriously ill. Potentially, gravely so. I went into the ward to find her pale, shivering and frightened. I stayed only a few minutes, distrusting too plainly my own reassurances.

'The doctor wants to move your wife to the hospital isolation block out at Chiswick,' the midwife imparted as I left. 'She'll be better looked after there.'

'Can Dr Colebrook see her? You know that I'm acquainted with him.'

'Dr Colebrook sees all the patients in the isolation block.'

'It's puerperal fever, isn't it?'

'I don't think we need quite say that. It's a severe infection, but still not a generalized one. Let's hope for the best, shall we? Can we get hold of you if we want to?'

'I'm at Arundel College all day. At night you'll have to send a policeman, or something.'

The isolation block in Goldhawk Road at Chiswick had been opened five years. Its forty beds gathered puerperal fever cases from the whole of west London. The patients were nursed in separate cubicles off battleship-grey corridors and the place reeked of antiseptic. Colebrook had instituted nursing with rubber gloves, sterile gowns and face masks, like a surgical operation, but two or three out of every thousand women delivered at Queen Charlotte's still died from childbed fever, and twelve of the forty ill women in the cubicles would not leave them alive.

With characteristic kindness, Colebrook came from his laboratory to Rosie's cubicle as I was leaving on the Friday afternoon.

'She doesn't look too well, Coli.'

'The infection seems to have spread to the peritoneal membrane lining the abdomen,' he said in his solemn way. 'That's not a good sign, I'm afraid. And of course your poor wife is suffering, with the distention and tenderness.'

We started walking along the corridors towards the door. 'She was very distressed at leaving the baby.'

'The little girl will be looked after on the ward until she's better. Obviously, we can't allow the babies here, there's too much risk of infection.'

I frowned. 'Where could this terrible streptococcus have come from?'

'Perhaps from the midwife's hands. The labour was rather long, and she had a number of vaginal examinations. Perhaps from Mrs Elgar's own nose and throat. Perhaps from the air. We can never say. Though if our precautions of gloves and so on were more widely used, the mortality rate might start to come down at last.'

We walked a few more steps in silence. I had of course felt concern for Rosie while she was having the child, but only as if she were suffering from some straightforward illness, like influenza. Now I saw she might die, I think for the first time in my life I began to develop fondness for her.

'For centuries, of course, the disease was a complete mystery,' Colebrook continued. 'It was seen as a visitation of some particular town or parish, which lifted after a month or two and let the women bear children perfectly healthily once more. For which the local ecclesiastic doubtless took all the credit. But in reality, the streptococcus was simply being passed from case to case by the midwife or doctor. That revolutionary idea was mooted at the end of the last century by an Aberdonian obstetrician called Alexander Gordon, who was ostracized for it and had to join the Navy-a hard fate for a midwifery expert. I suppose none of us likes being accused of possessing dirty habits.

'Didn't a man called Semmelweiss come into it somewhere?'

We pushed through a pair of frosted glass doors. 'You don't want to go into all this, Elgar. You've enough to upset you, without my lecturing about your troubles.'

'I'm interested. The doctor I lodged with in Wuppertal kept a photograph of him in his surgery. I remember he had a beautiful moustache, and resembled a Viennese opera singer, or the man on the packet of Gillette razor blades.'

'Semmelweiss was at the Allgemeines Krankenhaus in Vienna ninety years ago. There were two obstetric wards there, one used for training medical students the other for training midwives. Five of the students' mothers died of puerperal fever for one of the midwives'. It was ascribed to the poor women's shame at being examined internally by young men. But the students went to the labour ward straight from an obstetrical class in the post mortem room, while the midwives were taught everything from models. Ignaz Semmelweiss put the fever down to "cadaveric particles", made everyone wash their hands in lime water, and knocked down the mortality by two thirds. Mind, it took another fifty years before Louis Pasteur discovered bacteria and showed _how _it worked. Meanwhile, Semmelweiss was sacked, went mad and died from septicaemia contracted at a post mortem.'

'Semmelweiss was another man who saw the range of mountains which everyone overlooked?'

'Most definitely,' agreed Colebrook.

We had reached the front door. 'What's my wife's outlook?'

He considered this for a moment. 'Her infection may well localize itself as a pelvic abscess, which can be drained surgically. But it will be a long and debilitating illness, there's no getting away from that. And one which may well leave her sterile for the rest of her life.'

'I wouldn't mind. I don't want any more children.'

Colebrook raised his heavy eyebrows but said only, 'I expect you've informed her relatives?'

'My wife has none. She comes from a home for destitute children. She's completely anonymous. She's a particle unconnected to anyone in the world except me. The circumstances of my marriage were singular, don't you think?'

'A little unusual, perhaps,' said Colebrook guardedly.

'She was a housemaid. Why do you imagine I married her? Because I got her with child. And on to her death bed.'

'You must not simply accept that she is going to die,' he told me severely.

'Of course she will.' I was anguished not through love but through guilt, which are intertwined often enough.

'I'm going to give her a blood transfusion in the morning. I've already got a donor. It will reinforce her own white scavenger cells, in the best Almroth Wright tradition.'

Transfusion was then a complicated operation, done directly with a syringe and yards of bright red rubber tubing, the donor lying on the bed next to the chalk-white desperately ill woman. I suggested. 'Couldn't you try Ehrlich's arsenicals? Sir Edward once said something about your using them.'

'I was chasing a hare. We thought they increased the ability of the blood to kill streptococci, when injected for the entirely different purpose of killing the germs of syphilis. But they don't. We're giving streptococcal antiserum, naturally. Otherwise, we must rely on the skills of the nurses, as in any other severe infection. But your wife has a sound constitution.'

'Then what about "Prontosil"?'

'The answer's simple. I haven't got any.'

'But I have.'

His eyebrows rose again. 'How?'

'I stole them. From Domagk. Twenty tablets.'

Colebrook shook his head. 'I'm afraid that's out of the question, Elgar. I couldn't give any maternity patient an untested new drug.'

'But it has been tested. One of those papers alongside Domagk's was specifically on its use in puerperal fever. From Professor Max Heinkel's clinic in Jena. Isn't that good enough?'

'No, it is not good enough,' objected Colebrook forthrightly. 'I have been through those papers most carefully, and a lot of the experimental and clinical work in Germany was most slipshod. As far as Domagk's lab work goes, mice are not men. Surely you remember well enough The Lion's axiom-"experimental infections in animals have no relevance to natural infections in humans".'