11

BLOODWORK

I pushed the microscope toward Bobby Higgins, who had returned from his errand, his own discomforts forgotten in worry for Lizzie.

“See the round pinkish things?” I said. “Those are Lizzie’s blood cells. Everyone has blood cells,” I added. “They’re what make your blood red.”

“ ’Strewth,” he muttered, amazed. “I never knew!”

“Well, now you do,” I said. “Do you see that some of the blood cells are broken? And that some have little spots in them?”

“I do, mum,” he said, screwing up his face and peering intently. “What are ’ey, then?”

“Parasites. Little beasts that get into your blood if a certain kind of mosquito bites you,” I explained. “They’re called Plasmodium. Once you’ve got them, they go on living in your blood—but every so often, they begin to … er … breed. When there are too many of them, they burst out of the blood cells, and that’s what causes a malarial attack—the ague. The sludge of the broken blood cells sort of silts up, you see, in the organs, and makes you feel terribly sick.”

“Oh.” He straightened up, making a face of deep aversion at the microscope. “That’s … that’s pure gashly, that is!”

“Yes, it is,” I said, succeeding in keeping a straight face. “But quinine—Jesuit bark, you know?—will help stop it.”

“Oh, that’s good, mum, very good,” he said, his face lightening. “However you do come to know such things,” he said, shaking his head. “ ’Tis a wonder!”

“Oh, I know quite a lot of things about parasites,” I said casually, taking the saucer off the bowl in which I had been brewing the mix of dogwood bark and gallberries. The liquid was a rich purplish black, and looked slightly viscous, now that it had cooled. It also smelled lethal, from which I deduced that it was about ready.

“Tell me, Bobby—have you ever heard of hookworms?”

He looked at me blankly.

“No, mum.”

“Mm. Would you hold this for me, please?” I put a folded square of gauze over the neck of a flask and handed him the bottle to hold while I poured the purple mixture into it.

“These fainting fits of yours,” I said, eyes on the stream. “How long have you had them?”

“Oh … six months, mebbe.”

“I see. Did you by chance notice any sort of irritation—itching, say? Or a rash? Happening maybe seven months ago? Most likely on your feet.”

He stared at me, soft blue eyes thunderstruck as though I had performed some feat of mind reading.

“Why, so I did have, mum. Last autumn, ’twas.”

“Ah,” I said. “Well, then. I think, Bobby, that you may just possibly have a case of hookworms.”

He looked down at himself in horror.

“Where?”

“Inside.” I took the bottle from him and corked it. “Hookworms are parasites that burrow through the skin—most often through the soles of the feet—and then migrate through the body until they reach your intestines—your, um, innards,” I amended, seeing incomprehension cross his face. “The adult worms have nasty little hooked bills, like this”—I crooked my index finger in illustration—“and they pierce the intestinal lining and proceed to suck your blood. That’s why, if you have them, you feel very weak, and faint frequently.”

From the suddenly clammy look of him, I rather thought he was about to faint now, and guided him hastily to a stool, pushing his head down between his knees.

“I don’t know for sure that that’s the problem,” I told him, bending down to address him. “I was just looking at the slides of Lizzie’s blood, though, and thinking of parasites, and—well, it came to me suddenly that a diagnosis of hookworms would fit your symptoms rather well.”

“Oh?” he said faintly. The thick tail of wavy hair had fallen forward, leaving the back of his neck exposed, fair-skinned and childlike.

“How old are you, Bobby?” I asked, suddenly realizing that I had no idea.

“Twenty-three, mum,” he said. “Mum? I think I s’all have to puke.”

I snatched a bucket from the corner and got it to him just in time.

“Have I got rid of them?” he asked weakly, sitting up and wiping his mouth on his sleeve as he peered into the bucket. “I could do it more.”

“I’m afraid not,” I said sympathetically. “Assuming that you have got hookworms, they’re attached very firmly, and too far down for vomiting to dislodge them. The only way to be sure about it, though, is to look for the eggs they shed.”

Bobby eyed me apprehensively.

“It’s not exactly as I’m horrible shy, mum,” he said, shifting gingerly. “You know that. But Dr. Potts did give me great huge clysters of mustard water. Surely that would ha’ burnt they worms right out? If I was a worm, I s’ould let go and give up the ghost at once, did anyone souse me with mustard water.”

“Well, you would think so, wouldn’t you?” I said. “Unfortunately not. But I won’t give you an enema,” I assured him. “We need to see whether you truly do have the worms, to begin with, and if so, there’s a medicine I can mix up for you that will poison them directly.”

“Oh.” He looked a little happier at that. “How d’ye mean to see, then, mum?” He glanced narrowly at the counter, where the assortment of clamps and suture jars were still laid out.

“Couldn’t be simpler,” I assured him. “I do a process called fecal sedimentation to concentrate the stool, then look for the eggs under the microscope.”

He nodded, plainly not following. I smiled kindly at him.

“All you have to do, Bobby, is shit.”

His face was a study in doubt and apprehension.

“If it’s all the same to you, mum,” he said, “I think I’ll keep the worms.”