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.