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Extra

Historical background: Behind The Bone Garden

I t was an era of filthy knives and infected hospital wards, an age when doctors committed gruesome atrocities -- all in the name of healing. Although I’m a doctor myself, I was not well acquainted with this dark and tragic history of medicine. But several years ago, while preparing for a speech about Mary Shelley’s novel Frankenstein, I discovered that the author’s mother had died of “childbed fever,” which was rampant in maternity wards during her time. Curious about the disease, I delved deeper into the subject of childbed fever.

What I learned horrified me.

In the early 1800’s, a pregnant woman admitted to a hospital’s lying-in ward knew there was a good chance she might not survive the experience. Childbirth alone was a risky and frightening prospect, but even if a woman delivered safely, the danger was not yet over. Soon after giving birth, the new mother might develop fever, chills, and a foul uterine discharge. Bacterial gases would cause her abdomen to swell until her belly was taut as a drum and the pain was so excruciating that just stroking her skin elicited shrieks. For days she might linger in agony, vomiting and shaking, her bedsheets soaked with sweat, until circulatory collapse at last led to death. During epidemics of childbed fever, women died so quickly that coffin-makers couldn’t keep up with the corpses, and victims had to be crammed two to a casket. In some hospitals, 25% of all new mothers died.

The most disturbing fact of all: The disease was unwittingly spread by doctors.

Scientific articles written during the early 1800’s reflect the primitive state of medicine at a time when the standard treatment for almost every illness was to slit open the patient’s vein and bleed her. Ignorant of the existence of microbes, a doctor might rush straight from the autopsy room to the lying-in ward without washing his hands. Working his way down the row of beds, he’d examine patient after patient with his bare hands, spreading contagion – and death -- through the wards. Most doctors refused to believe that they themselves might be responsible for so many deaths. They were gentlemen, and gentlemen did not have unclean hands! Instead they blamed the epidemics on “bad air” or weak constitutions or even “the ladies’ wounded modesty”. Only an enlightened few realized that the fault lay with the doctors.

In America, it was a brilliant young doctor named Oliver Wendell Holmes who first realized how the contagion was spread, and he urged his fellow physicians to wash their hands. Today his recommendation seems obvious, but in Holmes’s day, it was revolutionary. I began to wonder how Holmes came to his conclusions. What inspired his theories? Had there been a particular case, a particular incident, that made him suddenly realize infection was transmissible?

In my search for the answer, I explored a nightmarish era in medicine. I read accounts of battlefield amputations performed on fully conscious and screaming patients. I read descriptions of gangrene and lockjaw. I read that medical students were forced to secretly dig up half-rotten cadavers to learn anatomy. To be a doctor in Holmes’s time was to see death and pestilence at every turn.

Then I imagined a twisted killer inhabiting that same grim world, a killer who slaughters the very people who are trained to heal.

In my new book THE BONE GARDEN, a penniless medical student named Norris Marshall has found ghoulish employment after dark. He is a “resurrectionist”, one of the local grave-robbers who supply medical schools with cadavers. Yet even the horrors of his job pale beside the shocking murder of a nurse found mutilated on the hospital grounds. When a second nurse meets the same fate, Norris becomes the prime suspect.

To prove his innocence, he must turn to a 17-year-old seamstress named Rose Connolly, the only other witness who has seen the killer known as the “West End Reaper.” Despite her impoverished Irish roots, Rose is a cleverer girl than anyone gives her credit for. Joined by a keenly intelligent young medical student named Oliver Wendell Holmes, Norris and Rose follow the killer’s trail through graveyards and autopsy suites, through glittering ballrooms and luxurious parlors. Together, they will track down the most notorious killer of their time.

While THE BONE GARDEN is a crime thriller, it’s also a journey into a frightening time when doctors killed as many patients as they cured, and when brilliant men like Oliver Wendell Holmes were just beginning to understand contagion. I wanted to give my readers an inspiring look at the first glimmerings of microbial theory. When you read THE BONE GARDEN, I hope you’re more than merely entertained; I hope you’ll also be enlightened by this glimpse at one of the brilliant men who changed the face of modern medicine.