“What was that?” Edgar asked.
“I think the child has consumption. That little bottle is Steven’s Consumption Cure,” said Carroll. “Direct from England. I somewhat doubt its efficacy, but we don’t have much better. Do you know of Koch’s discoveries?”
“Only what I have read in the broadsheets. But I couldn’t tell you anything. I know Steven’s Cure only because we bought it for our housemaid—her mother has consumption.”
“Well, the German thinks that he found the cause of consumption in a bacteria, he calls it a ‘tubercle bacillus.’ But that was five years ago. As closely as I try to follow the advances, I am too isolated, and it is difficult to know how science has changed.”
“And the plant?”
“The medicine men call it mahaw tsi It is a famous Kachin cure, and their medicine men guard it from foreigners. It took a long time to convince them to show it to me. I am pretty certain it is a species of Euonymus, although I can’t be sure. They use it for many ailments, some believe that even saying the words mahaw tsi can cure disease. They say it is especially potent for diseases of air, and this baby has a cough. Anyway, I mix it with Holloway’s ointment. For a long time I was doubtful about the herbs, but I think that I see some improvement in my patients who use them. That and prayer.”
Edgar stared at the Doctor. “To whom?” he asked, finally. But another patient had arrived, and the Doctor didn’t answer.
It was a young boy, holding his left hand close to his body. Carroll motioned for Edgar to sit in a chair behind him. He reached for the boy’s hand, but the boy guarded it. The boy’s mother, who stood behind him, spoke to him sharply. Finally Carroll gently pried his arms open.
Three fingers on the boy’s left hand were almost completely severed, held by ragged tendons and covered with clotted blood. Carroll handled the wound carefully, and the boy winced in pain. “This is bad,” the Doctor muttered, and spoke to the woman in Shan. The boy began to cry. Carroll turned and said something to Nok Lek, who removed a package from the cabinet and rolled it out on the desk. There was a cloth, and bandages, and several cutting tools. The boy started to yell.
Edgar looked uncomfortably over the waiting room. The other patients were still, unexpressive, watching.
Carroll removed another bottle from the cabinet. He took the boy’s hand and stretched it over the cloth on the table. He poured the contents of the bottle out over the wound. The boy jumped and screamed. Carroll poured more, wiping the hand vigorously with the cloth. He took a smaller vial from the cabinet and poured a thick liquid onto a bandage, which he rubbed over the wound. Almost immediately the boy began to calm down.
The Doctor turned to Edgar. “Mr. Drake, I am going to need your help. The salve should numb some of the pain, but he is going to start to scream when he sees the saw. I usually have a nurse but she is with other patients now. That is if you don’t mind helping, of course. I did think it might be interesting for you to observe our surgery at work, seeing how important such projects are for local relations.”
“Local relations?” Edgar said faintly. “You are going to amputate?”
“I have no other choice. I have seen wounds like this turn a whole arm gangrenous. I am just going to take off the injured fingers. The wound on his hand doesn’t look deep. I wish I had ether here, but my supply ran out only last week and they haven’t sent me more. We could have him smoke opium, but it will still hurt. I would rather be finished with this as quickly as possible.”
“What can I do?”
“Just hold his arm. He is small, but you will be surprised how fiercely he will try to throw you off.”
Carroll rose, as did Edgar behind him. The Doctor gently took the boy’s hand and laid it on the table. He tied a tourniquet above the boy’s elbow and motioned for Edgar to hold his arm. He did so, but his actions felt rough and cruel. Then Carroll turned to Nok Lek and nodded and Nok Lek reached over and twisted the boy’s ear. The boy shrieked and shot his free hand up to his ear, and before Edgar could turn back to the table, the doctor had cut off one, two, and then a third finger. The boy looked at them, perplexed, and then screamed again, but Carroll had already wrapped the bloody hand in the cloth.
The morning wore on, patient after patient filed into the examining chair before the window: a middle-aged man with a limp, a pregnant woman and a woman who could not conceive, a child Carroll diagnosed as deaf. There were three people with goiters, two with diarrhea, and five with fevers, all of which Carroll attributed to malaria. From each of the feverish patients, he drew a drop of blood and placed it on a slide and examined it beneath a small microscope that reflected light from the window up through the eyepiece.
“What are you looking for?” asked Edgar, still shaken from seeing the amputation. Carroll let him look through the microscope.
“Do you see the small circles?” he asked.
“Yes, everywhere.”
“Those are red blood cells. Everyone has them. But if you look closely, you can see that inside of the cells are darker objects, like blemishes.”
“I don’t see anything,” Edgar said, and sat back in frustration.
“Don’t worry, it is difficult at first. Until about seven years ago, no one knew what they were, until a Frenchman discovered that they are the parasites that cause the disease. I have been very interested because most Europeans think that the disease is caused by breathing bad air from the swamps, that is why the Italians named the disease mala aria, ‘bad air.’ But when I was in India, I had a friend, an Indian doctor who translated for me some of the Hindu Vedas, where they call malaria ‘the king of diseases’ and attribute it to the anger of the god Shiva. As for transmission, the Vedas implicate the lowly mosquito. But no one has found this parasite in the mosquito yet, so we can’t be certain. And since mosquitoes live in the swamps, it is difficult to dissociate the two. Actually, it is difficult to dissociate any of its possible sources in the jungle. The Burmese, for example, call it hnget pyhar, it means ’bird fever.‘”
“And what do you think?”
“I have been collecting mosquitoes, dissecting them, grinding them up, peering at their innards through the microscope, but I haven’t found anything yet.”
Carroll gave each of the malaria patients quinine tablets and an extract of a plant he said came from China, as well as a local root to ease the intensity of the fevers. For the diarrhea, he gave laudanum or ground papaya seeds; for the goiters, tablets of salt. He instructed the man with a limp how to make crutches. For the pregnant woman, he rubbed an ointment on her swollen belly. For the deaf child he could do nothing, and told Edgar how seeing such a child saddened him like almost no other disease, for the Shan had no sign language, and even if they had, the boy could never hear the songs of the night festivals. Edgar thought of another little boy, the deaf son of a client, who would push his face against the piano case when his mother played, to feel the vibrations. He thought of the steamer to Aden as well, and of the Man with One Story, There are causes of deafness that perhaps even medicine cannot understand.
For the woman who could not conceive, Carroll turned to Nok Lek and spoke at length. When Edgar asked what he had recommended, Carroll said, “This is confusing. She is barren, and she walks through her village muttering to a make-believe child. I do not know how to cure her. I have told Nok Lek to take her to a monk in the north who specializes in cures for such diseases. Maybe he can help.”
Close to noon, they saw their last patient, a thin man who was led to the chair by a woman who looked half his age. After talking briefly to the woman, Carroll turned to the room and announced something in Shan. Slowly, those waiting rose and filed out of the room. “This could take some time. It is a shame I cannot see them all,” he said. “But there are so many who are sick.”