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The Anatomy of Deception

Chapter One

At Christmas 1887, fifteen months before this story began, the world was introduced to a fictional character destined for such immeasurable acclaim that he would overwhelm his creator’s efforts to be done with him. The essence of this character’s appeal was not derring-do, as in the dime novels of Beadle & Adams, but rather in his uncanny ability to unravel a set of data that had stumped lesser men and proceed to a logical and incisive conclusion. He was so coldly rational that he was often compared to a machine, the Analytical Engine of Charles Babbage. His name, of course, was Sherlock Holmes.

To those of us engaged in medical research, however, the remarkable methods of Conan Doyle’s consulting detective were not at all revolutionary---they were merely a popularization of the modus operandi we employed in our quotidian efforts to alleviate human misery. The connection of analytic detection to medicine was unmistakable. Doyle himself was a physician, as were both Joseph Bell, widely considered the model for the character, and Oliver Wendell Holmes, the man for whom the detective was named. And while Sherlock Holmes may have trod the back alleys of Victorian London to ply his trade, the scenes of our crimes were no less exotic and often even more grisly.

To make sense of nature’s felonies against the human body, you see, physicians are compelled to study not only the living, but also those who have succumbed. Our clues lie in internal organs, blood vessels, skin, hair, and fluids, and we need as much access to these as Holmes needed to footprints, handwriting, or hotel records. It is only through painstaking examination of the data wrung from this evidence that deductions may be made as to what has caused illness and death, which, in turn, aids immeasurably in the care and treatment of those who might still be saved.

As Holmes’ popularity soared, it thus became sport among physicians to match wits with the fictional detective, eager to demonstrate that if they applied themselves to murder, theft, and mayhem, they would achieve similarly sterling results. Although for most in the medical field, this exercise was nothing more than a diverting parlor amusement, for me, the game was to be all too real. It started early on a mid-March Thursday in 1889, when I strode through the gate in the high stone wall at the rear of University Hospital in West Philadelphia and entered the Blockley Dead House.

The Dead House, the morgue that served both University Hospital and Philadelphia General, was a squat, solitary brick building, a fetid vault filled with cadavers in various states of putrefaction. The air was thick and still, and heavy drapes were pulled shut day and night. It was a place of spirits, where the tortured souls of hundreds, perhaps thousands, who had died from abuse, disease, want, or ignorance would spend their last moments in the company of the living before they were removed for their solitary rest and placed in the ground forever. I have never been a believer in phantoms, but I could not walk through its door without feeling all of those abbreviated lives pressing down upon me.

But this grim way station was also a place of science. In this incongruous setting, Dr. William Osler, head of Clinical Medicine at the University of Pennsylvania Medical School, forced forward the boundaries of medical knowledge. Although not yet forty, Dr. Osler had transformed the Dead House into perhaps the most exciting and advanced laboratory for the science of morbid anatomy in the entire world. I had given up private practice in Chicago and come East specifically for the chance to work and study with this astounding man. Apprenticing to Newton or Boyle or Leeuwenhoek could not have been more exciting. Others would call Dr. Osler the modern-day Hippocrates, but to me he was simply “the Professor.”

I arrived at the hospital that morning poised for a journey into the unknown, no less than Stanley at the threshold of Zanzibar. In the changing room, I replaced my suit with the trousers, pants, and cap that were provided to the staff. The outfits were faded and blue, with a military air. A persistent rumor had them as leftovers from the late Civil War, and I often wondered if my father had once been dressed in just this way.

I was soon joined by those of my colleagues also invited to observe. There were nine of us that morning, a study in contrast. Some, like me, were experienced physicians; others had just begun internship. Most were products of Philadelphia or other large cities, although I myself had been raised on a small farm in southern Ohio. One of us was even a woman. Mary Simpson had been included at the Professor’s insistence, despite the extreme disapproval of anonymous members of the board of trustees who had been scandalized by such an affront to nature. Two Georges epitomized our differences. Farnshaw, at twenty-one the youngest of our group, had been raised in great wealth and came to study with the Professor after graduation from Harvard; Turk, at twenty-eight the oldest, was the product of an orphanage, and had worked his way through the university unloading merchant vessels on the Philadelphia docks.

We assembled in the staff room and found the Professor already present and in a jaunty mood. William Osler was small, a sprightly man, scarcely five feet five inches, but he moved with such energy, such spring, that he appeared larger. He was already significantly balding, the loss of hair provoking him to pay scrupulous attention to his mustache, which was full and walruslike, perfectly framing his mouth and reaching to the jawline on either side. The backs of both hands bore signs of a recent eruption of verruca necrogenica, anatomist’s warts, a red and raised tubercular infection that gave the skin an appearance of dyed leather. It was a vile condition with which the Professor was regularly afflicted from contact with necrotized flesh, but he blithely treated each new outbreak with oleate of mercury until it receded.

“Well, well, well,” he said, rubbing those reddened hands together, his speech, as whenever he was excited, lapsing into the flat Canadian cant that betrayed his origins, “this will be a fine day, a fine day indeed, eh? I believe there are five cadavers available. Let us not keep them waiting.”

The Professor had every right to his enthusiasm. For all of his genius, it was rare he was given the opportunity to conduct a full day’s study in the Dead House. Like most of those who toil to advance human understanding, he was also engaged in a constant battle against human ignorance. Until the Anatomy Act in 1883, just six years earlier, the use of cadavers for teaching purposes was actually a crime. The great anatomist William Smith Forbes of Jefferson Medical College had only narrowly escaped a term in the penitentiary for “despoiling graves.” The liberalization of the law had done little to dispel the revulsion of many in society to the notion of cutting into a dead body, however, and resistance to the Professor’s researches remained strong. Although the more enlightened could occasionally be persuaded to allow Dr. Osler to determine the cause of death of a loved one or friend, for the most part our material was drawn, as it had been for centuries, from society’s most wretched classes.

Even here, however, there was opposition. A number of groups had recently been formed to attempt to end the “ghoulish practice” of dissecting the poor after death. The most prominent and vocal of these was Reverend Squires’ Philadelphia League Against Human Vivisection. Either unaware or unconcerned that “vivisection” referred to the living, Reverend Squires blithely employed innuendo, humbuggery, and outright lies to entice society matrons to support his cause. He then used the money to thrust himself into the public eye, creating an outcry against the postmortem abuse of society’s least fortunate. As a result, although we did not have to compete with wild dogs for the corpse of a convict, as had Vesalius centuries earlier, cadavers available for examination had become increasingly scarce.

Emboldened by the uproar, the official Blockley pathologist, Henri Formad, an eccentric, ill-tempered Russian, had taken to denying Dr. Osler use of the facilities. The Dead House attendant, a gaunt, lumbering creature whom the Professor had dubbed “Cadaverous Charlie,” had soon followed suit. Whereas Formad acted merely out of professional jealousy and spite, Charlie, buoyed by the stipend he had received from the League, refused the Professor access to cadavers out of what he termed, in his broken English, “bazic human decency.”

But Charlie was an enterprising sort, and he had also shown himself willing to accept a second stipend from the Professor to absent himself from the Dead House for hours at a time and leave us to our work. For an additional remuneration, Charlie, as he had done on this occasion, would actually inform the Professor when a promising supply of unclaimed cadavers became available. Dr. Osler seemed unfazed at the necessity of paying for what should have been provided by a grateful citizenry, but I was appalled that so brilliant a scientist was forced to skulk about like a criminal.

At seven-fifteen, when we exited University Hospital to begin our day, I strode quickly to overtake Turk. My colleague was not brilliant, but quick and clever, with an offhand wit I envied. I had made a number of overtures when he joined the staff, but Turk proved to be a man who resisted intimacy, and I had been unable to breach the wall of irony that he threw up around himself. The only member of the staff in whom he had shown any interest was the other George, Farnshaw, his complete opposite. But I continued to find myself drawn to Turk, even though my efforts at friendship were generally rebuffed.

“Five cadavers,” I whispered softly, looking up at him as we crossed the path. Turk was over six feet and quite thin. He had the manner of those who are very tall of leaning down slightly, and it gave him a predatory appearance. “Dr. Osler must think he has unearthed treasure.”

He nodded without turning to face me. “Yes. Treasure soon to go into the ground, instead of coming out of it. I hope he won’t keep us here through the night.” Turk was rumored to be well acquainted with the city’s more disreputable elements, although he was silent as to where and with whom he passed his free evenings.

“It would be time well spent,” I replied.

“You might think an evening elbow-deep in entrails is well spent,” Turk observed grimly. “I prefer the theater.”

At the Dead House, we paused just outside the heavy oak door that had seemingly been installed to prevent the dead from escaping. Pipes and cigarettes were lit. Even those who did not ordinarily take tobacco did so here in an effort to kill the stench. Still, as we entered the building, we were immediately overwhelmed by an ambiance so powerful that it seemed as if we had struck a wall. The first moments were always the most difficult, when eyes teared, breath came in gasps, and stomachs refluxed. These reactions soon passed, however. Human senses have a remarkable ability to adapt quickly to even the most objectionable stimuli.

The autopsy room was two stories high, with a gallery walkway on the second floor and a grimy skylight at the top. When the Professor attracted an especially large group of observers, the overflow stood upstairs, much as medical students in the 1530s had watched Sylvius perform his anatomies from the balcony of the operating theater at the University of Paris.

The room itself contained three large postmortem tables, the tops of which were soapstone, the legs iron. Shallow channels were cut into each tabletop, leading to a drain covered by a brass grating in the middle, which allowed the fluids released during the examinations to be discharged. The drain led to a ventilating shaft, which extended down into the floor and out of the building to a ditch in the rear that was regularly sprinkled with calcium oxide---quicklime.

A set of drawers with a zinc top was set against one wall, holding bottles of fixatives, sponges, basins, enameled dishes, empty bottles, and museum jars. Next to the drawers sat a capacious sink and, adjacent to the sink, a table held the scales used for the weighing of organs. A crude, high, red-painted desk stood on the other side of the room, upon which rested the book for recording autopsy findings. During each procedure, the Professor provided a steady stream of dictation and one of the students took down the information. Dr. Osler reviewed the notes at the conclusion of each postmortem to ensure that the record was complete and accurate. A coat rack abutted the desk and held aprons and gowns, next to a case on the wall housing autopsy instruments.

Beyond the sink, a doorway led into the mortuary, which contained a bank of cast-iron ice chests that could accommodate sixteen bodies. Charlie was responsible for maintaining the ice, which, even in early spring, required regular changing. A rear door led out to a gravel path where bodies and ice were received, and where wagons of undertakers took the remains away. Occasionally, simple services for the dead were conducted within the mortuary itself.

On the second floor, four rooms were set aside for study and research. It was here that we performed urine analysis, prepared culture media, and examined slides. One of the rooms was a small library and record storage area.

The Dead House held not only the deceased from the two hospitals, but also the bodies of paupers, criminals, and any unidentified, unclaimed corpse encountered within the city limits by the Philadelphia Police Department. Today’s subjects represented a typically diverse assortment. The five chests holding cadavers available for autopsy had been marked by Charlie with white chalk; he had also left a scrawled note detailing the particulars of each case. The Professor could choose from a carpenter who had succumbed to a respiratory disorder in the hospital, a male Negro and a young woman found dead in the streets, an elderly woman who had probably died of stomach cancer, and a Chinaman with a gunshot wound.

“Quite a bounty, eh?” he exulted, a wide smile disappearing under the ends of his mustache. “Who shall be first?” He moved to the nearest chest. “Let’s start with our carpenter.” He opened the top to reveal a bald man of about forty, heavily muscled about the arms. Three of us lifted him out of the ice onto a wheeled table and rolled him into the autopsy room.

After the carpenter had been transferred to a postmortem table, the Professor assigned tasks. “Who’ll take notes?” he asked. “Turk . . . no, you observe. Corrigan. You get the chore.” Corrigan, a stocky, goggle-eyed, bandy-legged young man from South Philadelphia, was eerily reminiscent of a bulldog. He possessed the talent to be a first-rate physician but his dedication was suspect. He had taken notes just two weeks before, and assigning him the tedious chore again so soon was the Professor’s way of chiding him to greater application.

As Corrigan sulked off toward the desk, Turk cast a grin his way. “Be sure to form your letters clearly,” he called.

The Professor laughed and the rest of us chuckled as well. He rarely tolerated sarcasm in anyone else, but seemed to give Turk extra latitude. Perhaps he admired, as I did, Turk’s rise from poverty. “Simpson,” the Professor went on, “you will handle weights and measures, and Carroll will assist.”

Simpson and I were almost always given the most responsible tasks. I was senior in experience, with almost five years in practice, and Simpson was without question the most devoted and hardworking young physician I had ever encountered. Fully cognizant of the risk the Professor had taken in including her on the staff, she seemed determined to leave not a scintilla of doubt that his decision had been the correct one. She was a square-faced, slightly thickset woman, three years my junior. Her speech, while lacking the lilt of the upper classes, was precise and well enunciated, indicating good schooling and, I assumed, an upbringing to match.

When we had all taken our places, the Professor doffed his coat, donned a heavy apron, removed the appropriate implements from the cabinet, and strode to the body. The jauntiness he had exhibited earlier had vanished, replaced by self-assured professionalism.

“We have here what you all can see is a large, powerfully built man, who the note says is German by extraction and was a carpenter by trade. He was admitted to the ward Wednesday last complaining of a cough and swelled feet. Chest measured eighty centimeters, with two-to-five centimeter expansion. Both sides functioned equally, percussion over lungs was normal, and there was nothing special on auscultation.

“After admission, he grew steadily worse, spending most of his time sitting up in bed to ease his breathing. Cough became hacking with expectoration of a bright red color and like currant jelly, dyspnea increasing. Feet became increasingly edematous, expectoration bloody, dyspnea exaggerated. Three nights ago, he became almost insensible with a highly weakened pulse. He was briefly roused with stimulants, but died late Tuesday.”

The Professor grasped the anatomist’s scalpel, larger and heavier than its surgical cousin. “We shall begin by opening the thorax.” Starting at each armpit, the Professor made a deep incision diagonally downward, so that they met at the sternum. He worked smoothly and quickly, the lines straight and true like a draftsman’s. There was a soft hiss as gases were released from the body, and the smell became almost overpowering. Each of us tried to remain stoic, but only the Professor seemed genuinely immune to the stench.

From this juncture, the Professor made a third incision down through the abdominal wall to just above the pubic bone, bypassing the umbilicus, leaving a Y-shaped cut. He then peeled back a fold of skin to either side of the rib cage and one over the face. The carpenter had been dead for thirty-six hours. That, combined with lying in the ice, kept the flow of blood minimal, although it was sufficient to cover the Professor’s hands and wrists. What fluid did escape, I quickly sponged into the channels of the autopsy table.

While the Professor rinsed his hands after the skin had been cleared, I grasped a set of rib cutters, which resembled large garden pruning clippers. I cut through the ribs at the far side of both lungs, just under the skin fold, each snap of the cutters making the sound of a breaking twig. When the ribs were free, the Professor removed the anterior chest wall to expose the organs underneath. From here, most anatomists used the Rokitansky method, extracting all the organs simultaneously after cutting off their connections to the body, but the Professor, although he had studied with Rokitansky at the Allgemeine Krankenhaus in Vienna, preferred the Virchow technique, removing the organs one at a time. Of course, he had studied with Virchow as well.

“The body presents the appearance of a man dead of heart disease,” he began, as Corrigan entered the data into a journal. “There is a small amount of fluid in the abdomen.” Using a siphon, I drew off additional fluid in the lining over the lungs and heart, placing each in a graduated cylinder, which Simpson measured and noted.

“In the right pleura, sixty ounces of clear serum, thirty ounces in the left, and eight ounces in the pericardium,” she reported. The Professor then severed the coronary arteries, freeing the heart, which Simpson removed from the chest cavity and placed on the scale.

“Heart is large,” she said. “Seven hundred ten grams.” The heart was brought to an examining table and the Professor lanced it open. He spoke continuously as he cut, unmindful of the blood and other sera that once more drenched his bare hands, Corrigan scribbling furiously to get it all down.

“Right chamber distended with large, jellylike clots. Ventricle dilated, measuring twelve centimeters from pulmonary ring to apex. Tricuspid orifice dilated fifteen centimeters in circumference. Segments of heart healthy, pulmonary valves normal. Left auricle large and contains blood, with clots. Left ventricle dilated and contains gelatinous clots. Those about the trabecula”---he indicated the partition that separates auricle from ventricle---“are colorless.”

The Professor instructed Simpson to measure each chamber and the connecting valves, with the measurements then recorded in the journal. He noted where muscles were fibroid or pale in color or valves thickened at the edges. When the examination of the heart was complete, it was left on the table and the Professor removed each lung, one hand at the top, the other at the bottom, and repeated the dissection process. He observed that in both were large spots of apoplexy--- hemorrhaging---and the anterior borders were emphysematous. Tissue sections presented coarse appearance of brown atrophy. After the lungs, he examined the bowels, kidneys---on which there were several cysts---liver, and spleen.

The next step was to remove the brain, a delicate operation that only the most skilled anatomist could perform without mishap. Unfixed brain tissue has the consistency of gelatin and is notoriously difficult to handle. It had taken me months, but I finally mastered the technique and was now the only member of the staff to whom the Professor would delegate the task. After my first success, Turk had proclaimed me “Lord of the Runny Eggs.”

I made a transverse incision at the back of the head from ear to ear across the brain stem, then separated the scalp from the underlying skull and pulled it forward. After utilizing a bone saw to score the calvaria---the cap of bone at the top of the skull---I employed a skull chisel, known as a “Virchow skull-breaker,” to remove it. I then moved with great care to gently lift the brain out of the cranial vault. My hands were soaked with perspiration and my clothes clung to me in the still air, making delicate movement laborious. I managed to remove the brain, which, as Turk had so aptly noted, felt like a mass of undercooked eggs, and placed it in a large jar of formalin fixative. After soaking for a moment, the brain tissue coagulated and was removed to a table and sliced for examination.

“The brain, as we would have expected,” said the Professor after taking some cross sections, “presents nothing abnormal. The arteries at the base are opaque, but not rigid.”

The remainder of the autopsy went quickly. The intestines were opened with an enterotome, a large specialized pair of shears. The major blood vessels were examined, but nothing further of interest was discovered.

When the examination was completed, ninety minutes after we began, the Professor washed his hands in the sink and then returned to the table. “Well, not too much question of what did this fellow in, eh?”

Those of us familiar with the Professor’s teaching methods knew not to answer too hastily, but Farnshaw, four months removed from Harvard, rashly offered, “No, sir. Hypertrophy.” Farnshaw was tall, like Turk, with a smooth, clean-shaven face, and the innocence that is the inevitable result of an upbringing in which wealth is utilized to insulate life’s many pitfalls. So ingenuous was Farnshaw, however, that it was impossible not to feel affection for him. That he constantly stumbled in his barefaced attempts to prove himself worthy of our professional respect endeared him to us all the more. He was not, it must be said, a bad doctor, simply unseasoned, like newly hewn poplar.

“Indeed,” replied the Professor. “An enlarged heart. Now, Farnshaw, this chap entered the hospital in relatively decent shape. Some coughing, but no evidence of advanced disease. What might have been done for him to prevent this unfortunate result?”

“Digitalis,” replied Farnshaw triumphantly. My gaze met Simpson’s for a moment and her eyes rolled upward. Digitalis, derived from the otherwise poisonous purple foxglove, was known to strengthen contraction of the heart muscle, slow the heart rate, and help eliminate fluid from body tissues. It had been popular for a century and was prescribed by almost every physician in the nation for almost every heart problem. Every physician except the Professor, that is.

“Simpson,” said the Professor, “you do not seem to agree.”

“No, sir,” she answered, coughing slightly from being caught in the act. “I do not see how digitalis would have alleviated the symptoms or provided a cure.”

“What then, Simpson?”

Simpson considered this for a moment but finally admitted that she could think of no treatment that would have been effective. Such a response might have been treated harshly by many who taught medicine---doctors were supposed to have a response for everything---but the Professor preferred no answer to an incorrect one, and so merely nodded and moved on.

“How about you, Turk?”

“Perhaps showing him Farnshaw’s fee would have shocked him back to health,” Turk replied.

“Ha! Quite right, Turk.” The Professor chortled. “That is one aspect of medical education that Harvard does not ignore.” He turned to the unfortunate Bostonian. Farnshaw’s face had gone a deeper red than his hair. “Digitalis would no more have prolonged this man’s life, Dr. Farnshaw, than would standing on his head. There was nothing we could have done for this man short of manufacturing him a new heart.”

The Professor began to pace about the room, the fingers of his right hand tapping into his left. “All we know here, Farnshaw, is that we don’t know. We have permutated disparate pieces of data, but can come to no definitive conclusion. This patient died with all the symptoms of chronic coronary valve disease, but we find no affection of the valves and only moderate arterial degeneration. The kidneys are not especially fibroid and there was not sufficient pulmonary distress to account for the hypertrophy and dilation of the heart.”

The Professor returned to his place at the center of the table and gestured at the cadaver, hand opened, palm up. “So what do we do, Farnshaw, when faced with a mystery?”

As so often occurs in youth, Farnshaw’s reckless enthusiasm had been supplanted by abashed reticence.

“After we have recorded each bit of data, no matter how seemingly inconsequential or tangential to the case,” expounded the Professor, now addressing all of us, “we form hypotheses and then pursue and test each one without prejudice or preconception until it is disproved. We distrust coincidence.

“In this case,” the Professor continued, “there is evidence that circumstances that tend to produce and maintain a high degree of tension in the arterial system may lead to hypertrophy and dilation. Here, we have a subject whose occupation often involved intense exertion, and who had no history of syphilis, so it may be possible to connect his habits to the life of the disease. Still, as we cannot definitively account for the hypertrophy, we will simply chronicle the evidence so that we may compare it to similar instances in the future and seek correlations that may lead us to solve this riddle.”

“Not a very satisfying conclusion,” remarked Turk.

“On the contrary,” replied the Professor. “We have discovered a case whose particulars do not correspond to accepted data, an illness or condition from which this man died that is not yet recorded in the literature. What I see here, Turk, is an opportunity, and hardly unsatisfying.”

“Of course, Doctor,” said Turk. “As you say.”

“You are a good doctor, Turk, but I’m not sure that research is your métier,” observed the Professor. “Perhaps you and Farnshaw should join in private practice. That way you may partake of those legendary Harvard fees.”

Farnshaw again reddened, but Turk guffawed. “An excellent suggestion,” he replied cheerily.

We all grinned, grateful for the break as the Professor strode over to check Corrigan’s notes. As Simpson and I made to deposit tissue samples in specimen jars and return the removed organs to the body, I noticed her eyes on me, but her gaze flitted quickly away. For a time, Charlie had been responsible for putting things back in what order he could, and then stitching up the cadavers before burial. But Charlie, who had been known to tipple the alcohol in the specimen jars, was not always reliable. On one occasion, some months ago, a male cadaver ordered exhumed because of suspicion of foul play was found by Formad to have three livers. We now performed the chore ourselves.

After all was in order and the carpenter had been returned to the ice chest, the Professor moved to the next subject that Charlie had marked for him. This was the male Negro.

Following the same procedure, it soon became apparent from an extensively cirrhotic liver that the man had died of alcohol poisoning. The case was undistinguished except the Professor declared that the condition of the left lung was extraordinary. “I have never seen an organ so infiltrated with bloody serum.” The fluid had a uniform purplish red, viscous appearance. The Professor was at a loss to account for it, except to hypothesize that the subject, under the influence of drink, had gone to sleep coiled on his left side so that, while he was senseless, his gradually weakened heart propelled feeble charges into the pulmonary artery. By hypostasis, an increasing volume had reached the left lung until a state of extreme congestive edema was produced.

For our third specimen, the Professor chose the elderly woman with stomach cancer. Her case was equally unremarkable and, when we had finished with her, it was only two o’clock. “Well,” said the Professor eagerly, “it looks as if we’ll have time for another.”

As the rest of the group returned the dead woman to the ice, I remained in the dissecting room to wipe down the table more thoroughly. When I got to the mortuary door, the Professor was standing at the chest that held the girl found dead on the streets of unknown causes.

“A bit of a mystery here, eh?” he said, and swung open the lid.

Only because I was standing away did I notice Turk’s reaction. For an instant, his body stiffened and his gaze froze on the cadaver. I stepped in hastily to see what had caused his reaction, and got a brief glimpse of a young, light-haired woman of perhaps twenty years of age. Although she had been dead for some days, she looked nothing like the street urchins we generally encountered. She had a beautiful figure and what seemed to have been clear, unblemished skin, marred only with distinct bruising to the upper left arm and milder trauma at the lower abdomen. As I leaned forward for a closer look, the Professor slammed the lid shut. The crack of metal on metal reverberated through the room.

“I’ve changed my mind,” he said quickly. He took a deep breath and then smiled stiffly. “We’ve been at this for quite some time. No need to overdo, eh?”

Turk had recovered his equilibrium, but remained staring, his brow furrowed, at the closed cover of the chest.


Chapter Two 

We returned to the dissecting room to clean up and put things in order for Charlie. When we were about to leave, we waited for the Professor to lead us back across to University Hospital. Instead he said somewhat brusquely, “I wish to remain here for a bit and check some notes. I’ll see you all tomorrow. Thank you for your participation.” 

I lingered briefly, wondering if the Professor would wish to talk with me privately, as he often did. But he had busied himself poring through an old journal, so I made for the door. 

Turk was waiting for me outside, hands in his pockets, his weight on his left leg, the very picture of ease. “Well, Carroll,” he said, smiling affably to reveal a set of uneven teeth, “it seems that we’re all free for the evening.” 

“Your wish granted,” I replied. “Now you can go to the theater.” 

“What about you?” he asked. “You’re not going to spend the night prowling the wards, are you?” 

“I haven’t decided,” I told him, although that was probably my intention. There was always something more to do and, in truth, I lacked an alternative. 

“Well, then, why don’t you join me?” 

“At the theater?” I wondered briefly at the coincidental timing of Turk’s intriguing reaction to the young girl in the mortuary and his unexpected cordiality, but could not see how the two could be related. Perhaps it was simply that my overtures had borne fruit after all. 

“Absolutely. I’ll call for you at seven-thirty.” 

As Turk ambled back to the hospital, I turned to see Simpson standing next to me. A strand of hair had fallen out from underneath her cap, and she absently shoved it back into place. “So, you’re spending the evening with the mysterious Turk?” She watched him recede down the path. “I suspect you will never be seen again in this hemisphere.” 

“I’m told white slavers generally prefer women,” I replied. 

“Fortunate, then, that he didn’t ask me,” said Simpson. “Although,” she added, “I expect that I would not be to Dr. Turk’s taste even in that capacity.” 

“Nonsense,” I said quickly. “You’re a very appealing woman.” 

“Appealing,” Simpson repeated with a knowing smile. 

When she smiled, which was all too infrequently in the hospital, it altered her face utterly. “Now, there is an ambiguous word.” 

I began to babble a clarification, but she interrupted. “It’s perfectly all right, Ephraim. I’m naturally cantankerous. Where are you going tonight, by the way?” 

When I told her, she said, “The theater? What are you going to see?” 

“I forgot to ask.” 

We started back along the path, not speaking for a few moments. I became increasingly uncomfortable in the silence, a symptom of my awkwardness in the presence of women, which I found odd, as I never thought of Simpson in those terms. 

“We seem to have some time,” I said, the words tumbling out by reflex rather than intention. “Would you like to join me in the doctors’ lounge? I was going to have tea.” 

Simpson stopped, uncertain, her head cocked to one side. “All right,” she replied with a mixture of curiosity and suspicion, her reaction to my invitation much the same as mine to Turk’s. “I’ll meet you there after I change.” 

When I had first gone on staff, “doctors’ lounge” had conjured up the image of a commodious, collegial, high-ceilinged chamber, furnished with wing chairs and divans, similar to the illustrations of English men’s clubs that I had seen in The Saturday Evening Post. In actuality, however, the room was small and uninviting, tucked into the southwest corner of the first floor, above the laundry. The only touch of gentility was Jefferson, the ancient, white-jacketed Negro attendant, on duty from eight in the morning until ten at night, serving tea or java, as well as surprisingly tasty biscuits. 

I arrived first, obtained a cup of Earl Grey and two shortbreads, and then repaired to one of a pair of ocher club chairs in the far corner to wait. Only two others were in the room, Drs. Peters and Dodd. Both were elderly, from a generation of physicians that would soon pass into history. Each nodded to me perfunctorily. 

Simpson arrived minutes later, wearing a dark blue wool dress with a high lace collar. While her garb was hardly à la mode, it was proper and not unfeminine. She had repined her sorrel brown hair, which sparkled slightly in the afternoon sunlight that poured in through the west window. As she walked past, Peters leaned over to Dodd and whispered something. Both stared at her with undisguised distaste. 

I stood and offered to fetch a beverage. I realized I probably would not have done so if we were both still on duty, but meeting Simpson thus, it would have been discourteous not to. She declined my offer, however, and got her own, not even glancing at the other two doctors as she walked across the room. 

When she returned, she sat in the other chair and placed her cup on the table between us. After a few seconds, when she did not speak, I realized that it was I who would be forced to begin the conversation. I had too much respect for Simpson to open with platitudes, and so chose instead to say what had been on my mind. 

“You puzzle me.” 

“Why?” she asked, looking me straight on. Her eyes were flecked with amber. I found it odd that I had not noticed previously. “I don’t think of myself as an especially puzzling person.” 

“You are so diligent . . . as dedicated to medicine as any man, yet . . .” 


“Perhaps I am perplexed that you seem to believe that you can achieve personal fulfillment without those domestic qualities from which most women acquire satisfaction.” Simpson’s lips curled slightly, as if I had committed some terribly amusing faux pas at a social occasion, but she did not wish to embarrass me. 

“I am not sure how to respond, Ephraim. How do you know that I have not achieved domestic fulfillment?” 

“I don’t,” I replied, stumbling over the words. “I just assumed that . . . well, with the hours you spend here . . . and you are not married . . . do not have children . . .” 

Simpson suddenly flushed. “You know nothing of my private life,” she snapped. “Nothing.” She paused, regaining her poise. “I think, Dr. Carroll,” she continued evenly, “that you shall be forced to accept that the nature of womanhood is changing. You can expect to find the Mary Simpsons of the world becoming more commonplace.” 

“Of course,” I replied hastily. “I’m sorry. I had no intention of insulting you. I value you highly. I would rather work with you than anyone else on the staff.” 

“Thank you,” she answered, seemingly assuaged but yet not prepared to grant full absolution. “I as well. And I am not insulted. I’ve become inured to the shortsightedness of men, although I did not expect such Paleolithic sentiments from you.” She sighed and her expression softened. “I expect, however, Ephraim, that in your case, ignorance is vestigial.” 

“I suppose I should accept that as a compliment of sorts.” 

“It is.” 

“Surely you consider Dr. Osler an exception,” I said. 

“Of course,” Simpson replied, taking a sip of tea. “I expect we both owe Dr. Osler more than we can ever repay. But what of your own domestic fulfillment? Do you expect to find it stepping out with Turk?” 

“Not fulfillment, perhaps, but at least a relief from tedium.” 

“Is your life tedious, Ephraim? I would not have thought so.” 

“Each of us seems to have misjudged the other, then,” I replied. “I’ve lived in Philadelphia for almost two years and have not succeeded in establishing any society outside of my profession, and not a good deal within it.” 

“But you are young and successful. There must be no shortage of opportunities.” 

“I prefer to live simply. I rent a small sitting room and bedchamber on Montrose Street from a widow named Mrs. Mooney. Most of my free evenings are spent in my rooms with a book or journal.” 

I looked carefully to see what sentiments my confession of dullness would engender, but Simpson seemed unperturbed. 

“Dedication to self-improvement is certainly admirable.” 

“Admirable perhaps, but hardly gratifying,” I rejoined, encouraged by her response. “Except for those times when I am invited to dine with Dr. Osler or other members of the staff, or occasional visits to lecture halls or museums, my existence away from medicine is reminiscent of that of an aging widower or cloistered monk.” 

“So your monasticism is not altogether by choice?” 

“Is your life so different?” I asked. 

To my surprise, Simpson paused, considering her response. 

“Yes,” she said after a moment. “It is. One is not required to seek self-improvement in isolation. But I daresay my ardor is no less than yours.” 

I began to ask her for elaboration, but she stood to leave before I could speak. “I have enjoyed this, Ephraim, but I must go now. I have other commitments.” 

“Are you sure?” I found myself not wanting our conversation to end. 

“Another time perhaps. I really must go.” Her expression turned serious. “Be careful tonight,” she said. “With Turk, I mean.” 

I thanked Mary but assured her that there was no reason for concern. 

As she left the lounge, I watched until the door had closed behind her.

Chapter Three 

I preferred that Turk not wait in Mrs. Mooney’s drab parlor, so I was downstairs at the door as the hour for his arrival approached. I had been unsure of how to dress for the evening, but finally decided on a dark wool suit, coat, and silk Gibus topper. As the hansom pulled up, drawn by an aging bay and driven by a swarthy man in a shabby black coat, I realized I had blundered. The driver gestured from his high perch at the rear of the coach for me to step in. Turk sat on the far side, dressed in a worsted jacket of broad checks, brown trousers, brown overcoat, and a low derby. 

“My, my,” said Turk with a smirk, as I took the seat next to him, “aren’t you the boulevardier? You best take care in that getup, Carroll. Every pickpocket and prostitute in Philadelphiawill be after you.” 

“You said the theater,” I replied coldly. “Shall I change?” 

“No time,” he replied, and signaled the driver to be under way. 

“When does the show begin?” I asked. 

“Starts at ten,” he said. “We’ll dine first.” 

“Ten? What show is it?” 

Turk sighed. “Carroll, you are the most incurable prig. We are attending Bonhomme’s Paris Revue. It is not Hamlet, Edwin Booth will not be in attendance, and no one will dust off your seat before you sit down. If someone offers to take your hat, don’t give it to him unless you wish never to see it again.” 

The carriage headed north, eventually turning east on Market Street, toward downtown. The electric street lighting and macadam roads of Center City were in acute contrast to the gas lamps and worn cobblestones still in use in most of the city. Streetcar tracks branched off onto almost every cross street and, on Market Street itself, stanchions had been constructed for the imminent conversion of the streetcar line from horse to electric power. Carriage and foot traffic were heavy as we reached Center Square, with city officials, lawyers, businessmen, and younger, less well-dressed clerical and stenographic staff bustling about well after official closing time. As we rode around the square, the still unfinished City Hall, already seventeen years under construction, loomed over us. If ever completed, the monstrous granite edifice was destined to be the tallest and most expansive public building in the nation, larger than the United States Capitol. Mayor Fitler had recently moved in to great fanfare—perhaps to counter persistent allegations of massive graft in the granting of construction contracts—and the entire building was currently being wired for electric lighting. 

We continued east on Market Street, passing Independence Hall. When we neared the waterfront, the cab once again turned north. Out of Old City, conditions fell off sharply. 

After more twists and turns, we were soon into a seamy area, the narrow streets closely lined with warehouses and small storefronts behind which questionable commerce and illicit activity were surely the norm. 

Eventually, the carriage pulled up at a dimly lit establishment, with the words “Barker’s Tavern” in chipped paint on each of two large, darkened windows framing a faded green wooden door. I was surprised to see a number of private carriages idling along the rutted street—broughams, even a landau or two. 

“Ever been here before, Carroll?” my companion inquired. 

I told him I had not. 

Turk opened the trap and we alit, our carriage remaining with the others near the front of the restaurant. Once inside, however, I pulled up short. Rather than the den of iniquity I feared, filled with voluble drunks and questionable women, before me lay a bustling eating establishment. Not Society Hill, perhaps, but, with its large, open room, sawdust floors, checked tablecloths, boisterous young clientele, and aroma of broiled meat, Barker’s environment was quite agreeable. 

“Well, it doesn’t look like much on the outside, but I’ll warrant there isn’t a better steak to be had in the entire city.” 

Turk was obviously well-known, because the man at the door, who wore a striped vest, arm garters, and boater, greeted him with enthusiasm and quickly led us to a table in the center of the room. While most of our fellow diners were male and, like Turk, casually but not inexpensively dressed, there was also a liberal sprinkling of women present. Most were young and attractive. They seemed to be enjoying the atmosphere without inhibition. As we walked through the room, an auburn-haired woman with startling blue eyes caught me staring and smiled back, causing me to avert my gaze, which seemed to amuse her all the more. Her companion, a touslehaired man with his back to me, did not turn about. 

Turk ordered two pints of Pabst. When our waiter left menus and departed, Turk leaned forward slightly in order to be heard and asked what I thought of the establishment. 

“A good choice,” I replied, “and a pleasant surprise.” 

“Thank you.” He seemed genuinely pleased. 

The beers arrived in iced mugs. Turk lifted his. “To the enjoyment of life,” he said. 

I nodded, then clicked his glass and drank. The beer was cold and went down smoothly. 

Turk downed half his pint with the first quaff. “You don’t get out much, do you?” he asked. 

“I don’t have the time,” I replied. “Nor the means.” I glanced down at the menu and saw the prices were extremely reasonable—only fifty cents for a porterhouse dinner, thirty- five cents for pigeon pie or grilled trout. Still, to dine at restaurants with the frequency that Turk seemed to would have placed an unbearable strain on my resources. 

“How do you manage?” 

“I make the time,” he answered. “And the means.” He downed the remainder of his beer. “Go ahead, Carroll. Drink up. I’m paying for dinner.” 

“Not a bit of it,” I replied. 

“Nonsense,” he said. “My invitation, my treat. You can make it up to me later.” 

Turk would not countenance further protest, so I thanked him for his generosity. When the waiter appeared, he ordered a porterhouse with potato and onions for us both, and also asked for another round of Pabsts, although mine was still half full. 

We chatted idly for a while, until Turk abruptly asked, “So, what brought you to Philadelphia, Carroll? You’re from out west, aren’t you? Chicago, was it?” 

“Ohio,” I replied. “I went to medical school in Chicago and practiced there for more than three years.” 

“You must have made an excellent living in such a thriving city.” 

“Not really,” I replied. “I worked with a doctor on the West Side. No one had much money.” 

“Healing the poor,” said Turk. “Very commendable.” 

“Commendable or no,” I said, “the experience was invaluable. 

I learned a great deal.” 

“Then you came here.” 

I was about to ask what he meant when our dinner arrived. 

The steaks were thick, large, buttered on both sides, and prepared to perfection. Turk was correct. I had not sampled a better piece of meat since I had arrived in Philadelphia. 

“Where in Ohio?” 

I looked over at him, attempting to gauge the source of his continued interest, but the questions seemed innocent enough. Perhaps he simply hated talking about himself. 

“Near Marietta,” I replied. “On the Ohio River. It is the only city in America named after Marie Antoinette.” 

Turk chuckled. “An interesting distinction. But you don’t sound like someone from southern Ohio.” 

“I make an effort not to,” I said. 

“Very wise,” Turk agreed. “And what made you choose medicine?”

“It was because of my father.” 

“He was a doctor?” he asked, taking a bite of his porterhouse. 

Turk used his knife to slice his meat in the rapid back-and-forth manner of the lower classes. He chewed and swallowed quickly. 

I shook my head. “No, but he was in the war, and was wounded in 1862 fighting with Grant at Fort Donelson.” 

“Wounded how?” 

“His brigade was caught in a cross fire during a skirmish in the woods. My father and two other men snuck in behind the Confederates and attacked. They were terribly outnumbered. My father was struck by a minié ball above the right elbow. The two other men were killed but the brigade was saved.” 

“He was a hero then?” 

“Yes,” I said, taking another drink. “I suppose he was.”

Excerpted from THE ANATOMY OF DECEPTION © Copyright 2011 by Lawrence Goldstone. Reprinted with permission by Delacorte Press. All rights reserved.

The Anatomy of Deception
by by Lawrence Goldstone

  • Genres: Fiction, Thriller
  • hardcover: 352 pages
  • Publisher: Delacorte Press
  • ISBN-10: 0385341342
  • ISBN-13: 9780385341349