TEN

 

DAY 3. FRIDAY, 9/22—2 P.M.

Two years before, Columbia College had moved from its home on Forty-Ninth Street and Madison Avenue to Morningside Heights, far to the north and west. The Ninth Avenue line, New York’s first elevated railway, had only recently been extended north to accommodate travel to the college. The project had required the tracks to be over one hundred feet off the ground and, at 110th Street, make a sharp ninety-degree turn that was quickly dubbed “suicide curve.” The Ninth Avenue line was now the most popular in the city, with New Yorkers of all ages often riding solely for pleasure. There was something remarkable about speeding north on two thin rails, tons of metal roaring so high above the vehicles and populace below as the train hurtled from station to station in a giant game of urban leapfrog.

Noah had not been on the elevated since the extension. Many of his fellow riders, even those seated, grabbed for handholds as the train neared suicide curve. Others, like Noah, stood at the windows, which had been opened from the top so that passengers might lean out a bit to greater appreciate the experience. The excitement in the car was as palpable as on the giant new Tilyou Ferris Wheel at Steeplechase Park in Coney Island.

The train slowed almost to a crawl, but still women gasped as it turned. Noah leaned out as well, not as far as some of the adolescents who rode the train for excitement, but sufficiently that he felt suspended in the air twelve stories above the ground. He was focusing on two men, their hats so far away as to be reduced to dots, when he felt a shove in his back. The window was not open near enough to present danger, but with his attention on the street below, the sensation caused him to reach out blindly for something to grab.

Noah whirled about and was confronted by a ruddy, thick-featured man with a handlebar mustache.

“Sorry, mac,” the man said. “The car lurched.”

Noah had not felt the lurch, but accepted the man’s apology.

“Still,” the man added, “I suppose it is best not to take foolish chances.” With that, he tipped his hat and walked to the far end of the car.

When the train finally pulled into the station at 116th Street, most of the riders were chattering in exhilaration and relief. As Noah got off, the man who jostled him smiled and gave a small wave. Perhaps there had been something to Turner McKee’s tale after all.

Minutes later, Noah stepped inside the wall of Columbia’s beautiful, manicured quadrangle. A wonder. McKim, Mead & White’s creation had certainly satisfied university president Seth Low’s desire for an “academic village” modeled after an Athenian agora. New York University, where he had attended medical school, had consisted of a series of timeworn buildings on which his fellow students had bestowed the epithet The Dungeon.

Abraham Jacobi’s office was in the eastern wing on the second floor, guarded by an unsmiling, middle-aged woman with thick spectacles, a severe bun, and the posture of a Prussian colonel. When Noah gave his name, she told him curtly that he was expected and ushered him through the door. Jacobi was standing at the window, looking out over the campus. He turned as Noah entered.

“So what is this mystery Alan De Kuyper tells me only the great Jacobi can solve?”

He was a small man, bald on top, with a wild fringe of white hair around the sides. His jowls sagged and pouches protruded under his eyes. He walked with a slight limp. But even with all these signs of age, Jacobi exuded vibrancy, as if a much younger person lay inside a deteriorating shell.

“A child died in my care. The circumstances seemed singular. Alan feels certain that you are the only man in New York who can help me pinpoint the cause.”

The pediatrician emitted a single snort. “Just give me the details, young man. Without the treacle.” Although he had been in America for almost four decades, Jacobi’s accent, while vestigial, was guttural, distinctly German.

Noah told his story quickly and concisely.

“Encephalitis?” Jacobi’s face puckered as if he had imbibed pure lemon juice. “Alan De Kuyper suggested that these symptoms were manifestations of encephalitis?”

“I think it was more a wish than a suggestion.”

“I certainly hope so. The cause of the boy’s death seems obvious. Why do you avoid it?”

“Morphia poisoning?”

“Of course.”

Noah felt his heart sink. “So you believe my administration of laudanum—”

“No, no. You are not culpable. The laudanum you administered could not have caused the boy’s death.”

“It is kind of you to say so.”

“I’m never kind. Except to children, of course. I simply state fact.”

“How can you be so sure, Dr. Jacobi? What if somehow I gave the boy more than I thought?”

“How much more?”

“Four drops. Even six.”

“You don’t know the difference between two and six? Even so, it wouldn’t have made a fig of difference. If you had given a five-year-old boy a sufficient dose to cause respiratory failure, he would have died in less than three hours. Children do not have the same responses as adults, you know.”

“Could the boy have had an allergic reaction? One that delayed the effects of the drug?”

“An allergic reaction that delayed the effect of the drug? Where did you attend medical school, young man?”

“New York University.”

“I must make a note to pay them a call and ask about their teaching methods.” Jacobi heaved a sigh, then gestured to a chair. “Have a seat . . . Whitestone, is it not? Like the village in Flushing?”

“Yes.”

“Have a seat, Whitestone.” When Noah sat, Jacobi walked around to the front of his desk and leaned against it. His hands, thick and gnarled, like a laborer’s, braced on the top edge. “I realize that you are trying to find an explanation for your patient’s death. I am impressed that you are even testing hypotheses that would leave you at fault. All I can tell you is this: There is no pathogen or disease that I have heard of that would have accounted for the array of symptoms you encountered. No published case history anywhere. Any condition that could have been responsible for the first set of symptoms could not have also been responsible for the second.

“Morphia, as I think we agree, seems to be the only answer. First in its absence, then in excess. But as I said, the laudanum you administered could not have been the cause of that excess. I should also tell you that I would have done as you did. If I had encountered a similar pathology on my first visit and if I were forced to leave the patient for a number of hours, I, too, would have administered two drops of laudanum to alleviate the symptoms. In one so young, the risk of dehydration from diarrhea would exceed that of a small dose of the opiate. You were also correct in trying to coax water into the boy. If the authorities are fool enough to pursue the matter, I will be pleased to testify as such.”

“Thank you, Dr. Jacobi. I am flattered.”

Jacobi waved off the compliment. “Nonsense.”

“If it was not the laudanum, what did kill the boy?”

“Only one conclusion is possible. The boy was given another morphiate during your absence. Your faith in his mother’s veracity seems to have been misplaced.”

“I was with Mrs. Anschutz, Dr. Jacobi. I simply cannot believe she was being duplicitous.”

“Have you read any of the writings of the Austrian, Freud, young man?”

Noah had not.

“Freud writes about the mind, particularly how delusion or repressed memory can affect behavior. Fascinating hypotheses. Much of it will turn out to be rubbish, I expect, but there is certainly some truth in his work as well. Freud would assert that this Mrs. Anschutz, racked with guilt over providing the substance that caused her son’s death, forced the memory into what he calls the unconscious mind. In other words, she now believes her lie, her delusion and, in believing it, can then convince others that she is not being untruthful at all.”

“I am certain I would have spotted signs of madness, Dr. Jacobi, no matter how convincing the delusion was to Mrs. Anschutz.”

“But this isn’t madness, at least not in the sense we generally think of. The manifestation would be limited to this one incident. In all other aspects, the woman would appear to be quite normal.”

“Do you subscribe to this theory, Dr. Jacobi?”

Jacobi shrugged. “He has produced some very impressive case studies to back up his assertions. At worst, my boy, don’t rule out the possibility. If correct, you would simply need to confirm that the mother had medicated the child in your absence.”

“How would I go about confirming that?”

“They have categorically refused an autopsy?”

“Yes.”

“Then I cannot tell you. Detective work is not my province.”

Noah stood but did not move for the door.

“Yes, Whitestone? Is there something more?”

“If the child was given a morphiate by his mother, she would have been unaware of the contents. Does that not follow?”

“Yes,” Jacobi allowed. “I suppose it does. The mother, unless homicidal or a nincompoop, would not have knowingly dosed her son with an opiate after you had already given him one.”

“Then assuming that the family did not use patent medicines . . . and, other than Bismosal, I’m convinced they did not . . . what morphiate prescribed by a physician would she have given her son unaware of the contents? Does that not imply that her physician did not tell her?”

Jacobi tugged at his beard. “An implication I am not pleased to acknowledge. But, yes, that is a possibility.”

“Do you believe it equally possible that her son’s physician prescribed a medication . . . a new medication . . . something experimental . . . not telling her of the composition because he was part of a test to determine whether or not the drug was safe?”

Jacobi’s face darkened. “I am not sure I like the direction of your argument, young man.”

“But how else to test drugs if not on subjects?”

“No physician I know would test a morphiate on a child without extreme safeguards. In a hospital, under constant observation, and only in doses so small as to not cause harm. If those doses are tolerated, they would be increased slowly. The notion that a physician would conduct a test as you have suggested is more than harebrained. It is criminal. I am certain you are mistaken.”

Having come this far, Noah would not retreat. “Dr. Jacobi, do you believe there is a Patent Medicine Trust? That the liquor dealers, pharmacists, and proprietary drug associations have banded together to prevent government regulation of pharmaceuticals? That they ignore public welfare simply to amass profits?”

“I do not.” Jacobi seemed on the verge of asking Noah to leave. “Where did you acquire such a notion?”

How much to tell? There seemed no point in withholding anything. “I was approached by a journalist. From New Visions. He wanted me to help him investigate graft he claims is given to doctors by pharmaceutical concerns. I told him that I was already in sufficient difficulty and would not become involved with his magazine.”

Jacobi blew out a breath, then took two steps forward and patted Noah on the shoulder. “Very wise, my boy. I’ve learned that it is a good deal more important—and more difficult—to be among those who build rather than those who tear down. I am still passionate about improving the lot of the poor and the working class, but I no longer subscribe to the notion that to do so one must destroy society. Steering clear of the New Visions crowd will stand you in good stead.”

The old pediatrician smiled. “I corresponded with Karl Marx, you know. Until about twenty years ago. His children were always afflicted with one ailment or another—Marx never had any money—but mostly we wrote to each other about politics. Karl was a very bright man, God rest his soul, extremely adept at honing in on the flaws of capitalism. His theories on with what to replace it, however, are twaddle.”

“So you are not still radical?”

“Radical? What does the word mean really? To some it is merely an excuse to exercise distaste for those who succeed.” Jacobi swept his arm toward the window and the magnificent quadrangle beyond. “For me, this is radical. A radical step forward in education. This institution will provide more good than a thousand articles in New Visions. Had I only known that in my youth.”

“Was it difficult? Escaping from prison? Stowing away?”

“Ah, yes. My hairbreadth escape. My passage across the Atlantic in the belly of a steamer.” He smiled wistfully. “Both are somewhat overstated, I’m afraid. I seem, despite all my efforts to the contrary, to have acquired a legend. But life, I am sad to say, is not nearly so romantic as fantasy. While I did spend two years in prison, I did not exactly escape. Nor was there a death sentence. I was a radical and a Jew . . . the authorities were perfectly content on both counts to allow me to leave. Nor was I forced to work my way over on a tramp, although I daresay my accommodations were none too sumptuous. The irony is that for the past ten years Germany has been attempting to persuade me to return. ‘We would be honored if you would come home,’ is how the letter read. Signed by the Kaiser’s secretary himself. ‘Home.’ How hypocritical. I have refused, of course.

“So, Dr. Whitestone, the legend of Jacobi, derring-do pediatrician, a pistol in one hand, a stethoscope in the other, turns out to be silly hyperbole. The lesson from this, I suppose, is that when a tale stretches credibility, seems preposterous, it generally is.”