Tumors and gunshot wounds…

The ill health of human kind continued as ever: tumors and gunshot wounds, epilepsy and syphilis, pneumonia and cirrhosis, scarlet fever and ulcers, tuberculosis… for many conditions treatment was much the same as Dr Epstein had used nine years ago, before he gave up practice out of grief and guilt.

However, he had to learn about the medical advances. His old enemy from Monastir and Pola remained a scourge, but at least smallpox vaccination was becoming more accepted by the public. Yellow fever still broke out in port cities, but the search for its microbes was narrowing. Childbirth, as always, presented risks, but puerperal fever was less common, theories of cleanliness taking hold. Lister’s carbolic acid solution now swabbed most surgical procedures, and a recent medical journal said a solution of iodine had proved a good antiseptic. Ephraim’s faith in himself as a physician began to return.

In his mountainous West Virginia backwater Ephraim is in full time country medical practice. He travels the rough roads far in his horse and buggy, often taking one of the children — now there are seven — for company and to talk with them to improve their minds. In Chapter 36, Whither Thou Goest, Ephraim and Helena also get descriptions from his daughter Sister Sadie of the Czar’s new repressive May Laws of 1891 which suddenly forced more than ten thousand Jews to leave Moscow. But she, like he, is now Christian.  Doctor’s buggy photograph from http://www.countrydoctormuseum.org ; the museum is located in North Carolina.

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Isolating existing cases…

…was paramount. They set up beds, carried in the sick, and, under Ephraim’s direction Rachel and the helpers ministered to them, sponging, cooling, getting liquids into them. There was no point in bleeding or cupping. At first ten a day died. After a week this slowed to four a day. By the end of a month, it was four a week. Those who survived were scarred, disfigured with pitted pocks all over the face where massage room at Royal Naval Hospital, Haslar. GJ Gordon. wellcome.ac.uk (2)the vicious disease always manifested most strongly. Some were blinded by smallpox, some crippled by its effect on joints. Overall a third of those infected would die. Among children Ephraim knew eighty per cent would die.

Ephraim is called to Macedonia to help in a smallpox outbreak. In Chapter 16, Epidemic, Rachel proves herself a worthy, skilful, kind assistant in the horrific and sad work. As the epidemic fades he has new respect for her. Despite her previous betrayals, perhaps the marriage can work…