Pestilence (22 page)

“The main thing is that it is over,” said Saracen.

“I suppose you’re right,” conceded Jill but her voice still harboured doubts. “About your suspension?” she began.

“It’s over. I’ll be back on duty tomorrow.”

Jill smiled for the first time and said, “Well that’s one good thing.”

“Maybe we should celebrate. Go out to dinner?”

“Chinese or Indian?” asked Jill.

“Neither. How about the Station Hotel?”

Jill’s eyes widened. “Little ol’ me at that big ol’ Station Hotel,” she mimicked. “Won’t I have to dye my hair blue and dress up like a Christmas tree?”

“It might help,” agreed Saracen. “But if we talk posh they might let us in.”

“I’ll have to change.”

“I’ll run you round. But first I’ll phone for a table.” Saracen walked over to the phone but it started to ring before he had reached it. It was Dave Moss at the County Hospital.

“I know this is going to sound ridiculous but I had to talk to someone,” said Moss.

“Shoot.”

“One of my patients died this evening.”

“Go on.”

“He died of pneumonia only four hours after admission.”

“Old people often succumb quickly, you know that,” said Saracen.

“But he wasn’t old. He was a strong, thirty year old man. I gave him a million units of penicillin on admission and expected him to be stable by this evening but he went downhill like a lead balloon. The cyanosis was something to behold. By the end his skin was almost black.”

Saracen felt the hairs on the back of his neck begin to rise. He had an awful sense of foreboding. “I agree, it’s unusual,” he said slowly.

“I know it sounds crazy and I know you will laugh but I think he died of…pneumonic plague.”

Saracen closed his eyes. It wasn’t over after all. Plague was still in Skelmore.

“James? Are you still there?”

“I’m here. Did your patient live in Palmer’s Green?”

“One moment.”

Saracen heard the receiver being laid down and paper being shuffled.

“No, he didn’t. Why do you ask?”

“Where did he live?” asked Saracen.

“Madox Road. But why?”

“Christ almighty,” said Saracen softly on hearing an address that was on the other side of town from Palmer’s Green.

“What are you not telling me?” demanded Moss.

“Myra Archer and Leonard Cohen both died from plague. Garten covered up the deaths believing that they were isolated cases and that would be the end of it. They lived in the flats on Palmer’s Green. If you have had a case from the other side of Skelmore we could be in real trouble.”

Moss spluttered in disbelief. “How in God’s name did we come to get plague in Skelmore?” he exclaimed.

“Myra Archer had newly arrived here from Africa. She must have brought it with her. Cohen was one of her neighbours down at Palmer’s Green.

“And Garten covered it up?”

“He thought the press coverage would destroy the Skelmore development plans. He thought the Japs might pull out and his father in law would go bust over his housing investments.”

“Good old Nigel,” said Moss. “Self, self, self.”

“Have you told anyone else of your suspicions about your patient?” asked Saracen.

“I wanted to try it on a friend first.”

“Lab tests?”

“I sent them off in the usual way, giving severe pneumonia as the provisional diagnosis.”

“Maybe you should warn the lab about the specimens?” suggested Saracen.

“I will do. I’ll arrange for the staff to have cover too. Any idea what the recommended drugs are?”

“I think it’s streptomycin and tetracycline but we had both better check. All I can remember for sure is that penicillin is no use at all against plague.”

“That would explain my patient’s failure to respond,” said Moss quietly.

“You weren’t to know. We would all have gone for penicillin in the circumstances,” said Saracen.

“Thanks.”

“Will you notify the health authorities or will I?” asked Saracen.

“I will. We will have to get to the family quickly.”

“I’ll inform the powers that be here at the General and then I’ll get back to you.” Saracen put down the phone then picked it up again and called Saithe.

“And Moss is quite sure?”

“He doesn’t have the results of the lab tests yet but it sounds like the real thing.”

“Damnation,” muttered Saithe. “But we must be careful not to cross our bridges until we come to them. We don’t want to cause unnecessary panic.”

“No sir, but Dr Moss is calling the Public Health people anyway.”

“I see,” said Saithe distantly as if he were thinking about something else. “I think what we must do,” he said slowly, “Is set up an ad hoc committee to monitor the situation.”

Saracen raised his eyes to the ceiling. “If you say so.”

“Now who should we have on it…” continued Saithe as if Saracen were no longer there.

“An expert on plague,” interrupted Saracen.

“What was that? What did you say Saracen?”

“I suggested that we find an expert on plague for your committee. None of us know anything about it bar what we read in our text books years ago.”

“Good point,” said Saithe. “There can’t be too many experts on plague around.”

“And certainly not in Skelmore,” added Saracen.

Two hours later Saithe called back to say that an emergency committee had been decided on. Saracen was invited to join. The committee was to comprise Saithe himself, Braithwaite, the medical officer for the county, Chief Superintendent Carradyce, David Moss, John Laird, the medical superintendent at the County Hospital, the hospital secretaries of both the General and County Hospitals and their senior nursing officers. In addition, and more importantly to Saracen’s way of thinking, a man named MacQuillan would be coming up to Skelmore from the government’s research establishment at Porton Down. He was due to arrive in the town at around eight fifteen. The first meeting of the committee was scheduled for nine pm. Saracen said that he would be there.

At ten minutes to nine Saracen left A&E where he had called in to see Alan Tremaine and inform him that he would be coming back on duty in the morning. He was thinking about Tremaine as he pulled his collar up against the drizzling rain and waited for an ambulance to pass before crossing the quadrangle to the East wing of the hospital. Tremaine was looking tired, too tired thought Saracen, unless anything came up at the meeting to prevent it he would go back to A&E and work the night shift. Tremaine could go home and get some sleep. Saithe had said something about getting locum housemen for A&E; Saracen made a mental note to remind him; the matter was now urgent.

Dave Moss was getting out of his car as Saracen reached the East door. He held it open for him and asked, “How are things?”

“Not good. The dead man’s wife has been admitted.”

“Same thing?”

“Looks like it.”

Saracen cursed softly.

“It gets worse,” said Moss. “She worked as a cook at Maxton Primary School.”

They had reached the East Lecture Theatre where the meeting was being held. Moss opened the door and allowed Saracen to enter first.

“Good evening,” said Martin Saithe, looking over his glasses and then at his watch. “I think we are all here now.” He exaggerated the act of looking at everyone present to confirm it.

Saracen disliked the lecture theatres in the General for there never seemed to be enough light in them, especially at night when single bulbs hanging beneath metal shades seemed to provoke more shadow than illumination. Apart from the installation of projection equipment no concession at all appeared to have been made to the modern era. The dark, wooden bench seating rose steeply to the ceiling and curved in a hemisphere round a central podium as it had done when Victorian medical students had filled it. Saithe was standing behind a table that had, in its time, witnessed a continual stream of embarrassed and hapless people, there to display their afflictions for the education of the ‘young gentlemen’.

Saithe said, “I must apologise for our surroundings this evening but Dr MacQuillan has some slides for us; we need the projector.”

A small, balding man with a dense black moustache and wearing a tweed suit took this as his cue and got to his feet. He joined Saithe behind the table and picked up an automatic slide changer. Saracen thought he recognised a slightly aggressive air about the man, in the way he stood with his feet well apart and the way he held the slide changer at a distance from his body.

Saithe said, “Dr MacQuillan is an expert on Yersinia pestis, the organism that causes plague. He has kindly agreed to fill in the gaps in our knowledge.”

MacQuillan gave a little grunt of acknowledgement and took the floor from Saithe. He picked up a pointer from the table and clicked on the first slide. “First the culprit.”

MacQuillan’s Scottish accent and clipped words matched his stance, thought Saracen, who had now classified him as a pugnacious, no nonsense Scotsman. Good, he thought, the absence of bullshit should speed things up considerably.

MacQuillan slapped the pointer against the screen and said, “This is
Yersinia pestis,
a rod shaped bacterium less than two thousandths of a millimetre long. It looks like any other bacterium you might say and you would be right but, in the fourteenth century, this little fellow wiped out one quarter of the entire population of Europe.” MacQuillan paused but found his audience too sophisticated to gasp out loud. “Ironically,” he continued, “Man is infected as an unwitting interloper between infected rats and their fleas. An infected rat dies, its fleas look for a new host. A human being is nearby, Bingo, he gets plague.

MacQuillan clicked the slide changer and a monster from science fiction leapt on to the screen. “Xenopsylla cheopis,” said MacQuillan, “The rat flea. The cycle is as follows. Flea bites infected rat and picks up the organism. The bacteria multiply inside the insect’s gut. It regurgitates them and, mixed with its saliva, it passes on the disease to its next victim, usually another rat…but not always.”

“But surely plague can be transmitted in other ways,” said Phoebe Kendal, the General’s senior nursing officer.

“Indeed it can,” replied MacQuillan. “The process I have described is for the transmission of bubonic plague. There is another form of the disease termed, pneumonic plague which is what we are seeing here in Skelmore. In advanced stages of the illness the patient produces copious amounts of bloody, frothing sputum containing myriads of plague bacteria. This gives rise to highly infectious aerosols produced when the patient coughs or sneezes. People in the vicinity inhale the infected particles and contract pneumonic plague.”

“Thank you Doctor,” said Phoebe Kendal.

MacQuillan changed the slide. “The bubonic form,” he said. “The patient shown here is close to death. Note the swollen lymph glands and here,” he slapped the pointer once more against the screen, “in the inguinal region is the primary bubo, the most common site for it.” Another click of the changer and a different patient appeared. “This man has pneumonic plague; he is about three hours from death. Note the skin colour; he’s almost black, hence the nickname, Black Death.”

“What’s the mortality rate?” asked Moss.

“In untreated cases of pneumonic plague mortality is almost one hundred percent. In untreated bubonic cases, between fifty and seventy-five.”

“You said ‘untreated’,” said Saracen.

“Yes, the use of modern antibiotics can alter things dramatically. Tetracycline therapy will reduce bubonic plague fatality to around one percent. It is also extremely effective against the pneumonic form if the time factor is right.”

“Time factor?”

“After twelve hours nothing will save you.”

Saithe asked about incubation time for the disease.

“One to six days depending on the infecting dose,” said MacQuillan.

Saracen was beginning to wonder why Braithwaite, the county medical officer was saying nothing, and was about to say so to Moss, when MacQuillan answered his question for him.

“I have spoken to Dr Braithwaite and his people are currently taking appropriate action to contain the outbreak. I don’t think I am being too optimistic when I say that this should all be over in the very near future.”

“Can I ask what ‘appropriate action’ means?” said Moss.

“Over to Dr Braithwaite,” said MacQuillan and sat down.

Braithwaite got to his feet with the usual difficulty of a very fat person and turned to face his audience. He wrinkled up his nose and eyes as if he had suddenly been exposed to light and thrust his hands deep into the voluminous pockets of his trousers. “Well, basically,” he began, pausing to clear his throat unnecessarily; “It’s a question of tracing contacts quickly and treating them.”

“With what?”

“Tetracycline.”

“And if they are children?” asked Moss.