The Citadel (26 page)

Wandering round the garden she had made, he was struck, suddenly, by the dilapidated condition of the bridge. It offended him, seemed an insult to his absent Christine. He had several times spoken to the Committee about this, telling them the bridge was falling to pieces, but they were always hard to move when it came to repairing the assistants’ houses. Now, however, in an access of sentiment he rang up the office and pressed the point strenuously. Owen had gone away upon a few days’ leave but the clerk assured Andrew that the matter had already been passed by the Committee and referred to Richards the builder. It was only because Richards was busy with another contract that the work had not been put in hand.

In the evenings he betook himself to Boland, twice to the Vaughans who made him remain for bridge and once, greatly to his surprise, he found himself playing golf with Llewellyn. He wrote letters to Hamson and to Denny who had at last left Drineffy and was journeying to Tampico, as the surgeon of a tanker. His correspondence with Christine was a model of illuminating restraint. But he sought distraction, chiefly, in his work.

His clinical examinations at the anthracite sinkings were, by this time, well under way. He could not hasten them since, apart from the demands of his own patients, his opportunity for examining the men came as they went to the minehead baths at the end of the shift and it was impossible to keep them hanging about for any length of time when they wanted to get home for their dinners. He got through on an average two examinations a day, yet already the results were adding further to his excitement. He saw, without jumping to any immediate conclusion, that the incidence of pulmonary trouble amongst the anthracite workers was positively in excess of that existing in the other underground workers in the coal mines.

Though he distrusted text-books, in self-defence, since he had no wish to find afterwards that he had merely put his feet in footprints made by others, he went through the literature on the subject. Its paucity astounded him. Few investigators seemed to have concerned themselves greatly with the pulmonary occupational diseases. Zenker had introduced a high-sounding term, pneumonokoniosis, embracing three forms of fibrosis of the lung due to dust inhalation. Anthracosis, of course, the black infiltration of the lungs met with in coal miners had long been known and was held by Goldman in Germany and Trotter in England to be harmless. There were a few treatises on the prevalence of lung trouble in makers of mill-stones, particularly the French mill-stones, and in knife and axe grinders – ‘grinder’s rot’ – and stone cutters. There was evidence, mostly conflicting, from South Africa upon that red rag of Rand labour troubles, gold miners’ phthisis, which was undoubtedly due to dust inhalation. It was recorded also that workers in flax and in cotton and grain shovellers were subject to chronic changes in the lungs. But beyond that nothing!

Andrew drew back from his reading with excitement in his eyes. He felt himself upon the track of something definitely unexplored. He thought of the vast numbers of underground workers in the great anthracite mines, the looseness of the legislation upon the disabilities from which they suffered, the enormous social importance of this line of investigation. What a chance, what a wonderful chance! A cold sweat broke over him at the sudden thought that someone might forestall him. But he thrust this from him. Striding up and down the sitting-room before the dead fire long after midnight, he suddenly seized Christine’s photograph from the mantelshelf.

‘Chris! I really believe I’m going to
do
something!’

In the card-index he bought for the purpose, he carefully began to classify the results of his examinations. Though he never considered this, his clinical skill was now quite brilliant. There, in the changing room the men stood before him, stripped to the waist, and with his fingers, his stethoscope, he plumbed uncannily the hidden pathology of those living lungs: a fibroid spot here, the next an emphysema, then a chronic bronchitis – deprecatingly admitted as ‘a bit of a cough’. Carefully he localised the lesions upon the diagrams printed on the back of every card.

At the same time he took sputum samples from each man and, working till two and three in the morning at Denny’s microscope, tabulated his finding on the cards. He found that most of these samples of mucopus – locally described by the men as ‘white-spit’ – contained bright angular particles of silica. He was amazed at the number of alveolar cells present, at the frequency with which he came upon the tubercle bacillus. But it was the presence, almost constant, of crystalline silicon, in the alveolar cells, the phagocytes, everywhere, which riveted his attention. He could not escape the thrilling idea that the changes in the lungs, perhaps even the coincident infections, were fundamentally dependent on this factor.

This was the extent of his advance when Christine returned at the end of June and flung her arms round his neck.

‘It’s so good to be back. Yes, I enjoyed myself, but oh! I don’t know – and you look pale, darling! I don’t believe Jenny’s been feeding you!’

Her holiday had done her good, she was well and her cheeks had a fine bloom upon them. But she was concerned about him, his lack of appetite, his perpetual fumbling for a cigarette.

She asked him seriously.

‘How long is this special work going to take?’

‘I don’t know.’ It was the day after her return, a wet day, and he was unexpectedly moody. ‘It might take a year, it might take five.’

‘Well, listen to me. I’m not reforming you, one in the family is enough, but don’t you think if since it’s going on so long as that you’ll have to work systematically, keep regular hours, not stay up late and kill yourself!’

‘There’s nothing the matter with me.’

But in some things she had a peculiar insistence. She got Jenny to scrub out the floor of the Lab., brought in an armchair and a rug. It was a room cool on these hot nights and the pine boards had a sweet resinous smell which mingled with the pungent ethereal scent of the reagents he used. Here she would sit, sewing and knitting while he worked at the table. Bent over the microscope he quite forgot about her, but she was there, and at eleven o’clock every night she got up.

‘Time for bed!’

‘Oh, I say –’ Blinking at her near-sightedly over the eyepiece. ‘You go up, Chris! I’ll follow you in a minute.’

‘Andrew Manson, if you think I’m going up to bed alone,
in my condition
–’

This last phrase had become a comic by-word in the household. They both used it, indiscriminately, facetiously, as a clincher to all their arguments. He could not resist it. With a laugh he would rise, stretch himself, swing round his lenses, put the slides away.

Towards the end of July a sharp outbreak of chicken pox made him busy in the practice, and on the 3rd of August he had an especially heavy list which kept him out from morning surgery until well after three o’clock. As he came up the road, tired, ready for that combination of lunch and tea which would be his meal, he saw Doctor Llewellyn’s car at the gate of Vale View.

The implication of that static object caused him to start suddenly, and to hasten, his heart beating rapidly with anticipation, towards his house. He ran up the porch steps, threw open the front door and there, in the hall, he found Llewellyn. Gazing at the other man with nervous eagerness he stammered:

‘Hello, Llewellyn. I – I didn’t expect to see you here so soon.’

‘No,’ Llewellyn answered.

Andrew smiled. ‘Well?’ In his excitement he could find no better words but the question in his bright face was plain enough.

Llewellyn did not smile. After the faintest pause he said:

‘Come in here a minute, my dear chap.’ And he drew Andrew into the sitting-room. ‘We’ve been trying to find you, on your round, all morning.’

Llewellyn’s manner, his hesitation, the strange sympathy in his voice, shot a wave of coldness over Andrew. He faltered:

‘Is anything wrong?’

Llewellyn looked through the window, his glance travelling towards the bridge, as if searching for the best, the kindest explanation. Andrew could bear it no longer. He could scarcely breathe, his breast was filled with a stifling agony of suspense.

‘Manson,’ Llewellyn said gently, ‘ this morning – as your wife was going over the bridge – one of the rotten planks gave way.
She’s
all right now, quite all right; but I’m afraid –’

He understood even before Llewellyn finished. A great pulse of anguish beat within him.

‘You might like to know,’ Llewellyn went on, in a tone of quiet compassion, ‘that we did everything. I came at once, brought matron from the hospital, we’ve been here all day –’

There was a bar of silence. A sob broke in Andrew’s throat, another, then another. He covered his eyes with his hand.

‘Please, my dear fellow,’ Llewellyn entreated, ‘who could help an accident like that? I beg of you – go up and console your wife.’

His head lowered, holding to the banister, Andrew went upstairs. Outside the door of the bedroom he paused, scarcely breathing, then, stumblingly, he went in.

By the year 1927 Doctor Manson of Aberalaw had a somewhat unusual reputation. His practice was not prodigious – numerically his list had not greatly increased since those first nervous days of his arrival in the town. But everyone upon that list had a convincing belief in him. He used few drugs – indeed, he had the incredible habit of advising his patients against medicine – but when he did use them he prescribed in shattering style. It was no uncommon sight to see Gadge drooping across the waiting-room with a prescription in his hand.

‘What’s all this, Doctor Manson?
Sixty
-grain doses of K Br for Evans Jones! And the
Pharmacopoeia
says
five.
’

‘So does Aunt Kate’s dream-book! Go ahead with sixty, Gadge. You know you’d really enjoy knocking off Evan Jones.’

But Evan Jones, epileptic, was not knocked off. Instead he was seen, a week later, his fits lessened, taking walks in the Public Park.

The Committee ought to have cherished Doctor Manson tenderly because his drug bill – despite explosive incidents – was less than half that of any other assistant. But alas! Manson cost the Committee three times as much in other directions, and often there was war because of it. He used vaccines and sera for instance, ruinous things which, as Ed Chenkin heatedly declared, none of them had ever heard of. When Owen, defending, instanced that winter month when Manson, using Bordet and Gengou vaccine, had arrested a raging epidemic of whooping cough in his district when all over the rest of the town children were going down with it, Ed Chenkin countered: ‘How do we know this new-fangled thing did it! Why! When I tackled ’im myself, he said nobody could be
sure
!’

While Manson had many loyal friends, he also had enemies. There were those on the Committee who had never completely forgiven him for his outburst, those agonised words hurled at them, over the matter of the bridge, as they sat in full session three years before. They sympathised, of course, with Mrs Manson and himself in their bereavement, but they could not hold themselves responsible. The Committee never did things in a hurry. Owen was then on holiday, and Len Richards, who had been given the job, was busy at the time with the new houses in Powis Street. It was preposterous to blame them.

As time went on Andrew had many heartburnings with the Committee for he had a stubborn desire for his own way which the Committee did not like. In addition there was a certain clerical bias against him. Though his wife often went to church he was never seen there – Doctor Oxborrow had been the first to point this out – and he was reported to have laughed at the doctrine of total immersion. He had, moreover, a deadly enemy amongst ‘the chapel’ folk – no less a person than the Reverend Edwal Parry, pastor of Sinai.

In the spring of 1926 the good Edwal, newly married, had sidled, late, into Manson’s surgery with an air, thoroughly Christian, yet ingratiatingly man of the world.

‘How are you, Doctor Manson! I just happened to be passing. As a rule I attend with Doctor Oxborrow, he’s one of my flock, you know, and he’s handy at the East Surgery also. But you’re a very up-to-date doctor by all accounts and purposes. You’re in the way of knowin’ everything that’s new. And I’d be glad – mind you I’ll pay you a nice little fee too – if you could advise me –’ Edwal masked a faint priestly blush by show of worldly candour. ‘You see the wife and I don’t want any children for a while yet anyhow, my stipend bein’ what it is, like –’

Manson considered the minister of Sinai in a cold distaste. He said carefully:

‘Don’t you realise there are people with a quarter of your stipend who would give their right hand to have children. What did you get married for?’ His anger rose to a sudden white heat. ‘Get out – quick – you – you dirty little man of God!’

With a queer twist of his face Parry had slunk out. Perhaps Andrew had spoken too violently. But then, Christine, since that fatal stumble, would never have children, and they both desired them with all their hearts.

Walking home from a call on this, the 15th of May, 1927, Andrew was inclined to ask himself why he and Christine had remained in Aberalaw since the death of their child. The answer was plain enough: his work on dust inhalation. It had absorbed him, fascinated him, bound him to the mines.

As he reviewed what he had done, considering the difficulties he had been obliged to face, he wondered that he had not taken longer to complete his findings. Those first examinations he had made – how far removed they seemed in time, yes, and in technique.

After he had made a complete clinical survey of the pulmonary conditions of all the workmen in the district and tabulating his findings, he had plain evidence of the marked preponderance of lung diseases amongst the anthracite workers. For example, he found that ninety per cent of his cases of fibrosed lung came from the anthracite mines. He found also that the death-rate from lung troubles amongst the older anthracite miners was nearly three times that of miners employed in all coal mines. He drew up a series of tables indicating the ratio-incidence of pulmonary disease, amongst the various grades of anthracite workmen.