第1章 The Slope Above Craddon

The new block stood at the top of the slope with its face turned away from the city, and Dr. Ardle Fenmore accounted that the first of many mistakes. He had argued for the lower ground beside the canal, where the mill hands already walked to work and would find the door without being told. The governors had overruled him. Now the Marrowden Infirmary looked down on the slate roofs of Craddon as though it had been built to inspect the poor rather than to take them in. He had come up from the old house of industry at the foot of the slope, a long low shed of brick and slate with a courtyard at its middle that stayed dark even in July. Eleven years he had served there, since he was twenty-six and newly qualified, and in those eleven years he had learned the arithmetic of a building where the sick, the old, and the destitute were kept under one roof and sorted by no principle but the size of the room they could be given. A pauper with a broken leg lay beside a woman whose mind had gone. A boy with a fever lay beside a man who had been dying for a year. There was no cure in the old place and very little nursing. There was custody, and broth, and a doctor who came twice a week and did what could be done in the hours allowed him. The new building had four wards and a maternity room and an operating theatre with a glass roof, and at the back, past the kitchens, a mortuary with a stone floor and a drain in the corner. Fenmore walked it on the morning of the opening with the chairman of the governors at his elbow and a printed order of proceedings folded in his pocket, and he said the things that were expected of him, and all the while he was counting beds. Sixty-two. He had asked for eighty. The difference was a corridor that had been built instead of a ward, because the plans the architects preferred had a corridor down the centre of the building and the plans the doctors preferred had beds down the centre of the building, and the architects had won, as they always did, by being cheaper and by being able to draw. "Sixty-two beds," he said to Councillor Tredgold, who chaired the governors, had made his money in dyeworks, and gave it away in the manner of a man paying a debt he did not enjoy owing. "Sixty-two is a great advance on the old place," Tredgold said. "It is an advance of eleven beds. We are to nurse the sick of a city of ninety thousand with eleven more beds than a workhouse." Tredgold did not answer. He had a habit Fenmore had come to recognise: he treated an inconvenient figure as though it were a rude remark, and let the silence stand until the rudeness passed. They went through the wards in the order the architect had drawn them, and the wards were clean and pale and smelled of limewash, and Fenmore could already see what the winter would do to them. Four iron beds to a bay, twelve to a ward, the beds high and narrow with rails at the foot, the windows set low so that a patient could look out at the weather but not, from a lying position, at the sky. A coal stove at each end of the ward and a nurse's table in the middle where the light was best. He had asked for a bathroom adjoining each ward and been given a single bathroom on the landing, which meant that twelve men would be carried or walked down a corridor to it, and the corridor, no doubt, would be where the infections would travel, the way they travelled everywhere, quietly, on the hands of people who meant well. The matron met them at the door of Letham Ward. Hespera Selvine was forty-one and had been matron of the old house for six years, and she had been chosen over two better-qualified women because she was known to be hard and because the governors believed that hardness in a matron saved money. She wore a grey dress and a white cap and carried a bunch of keys on her belt that Fenmore had heard described, more than once, as the government of the building. "You have seen the wards," she said. "I have counted the beds." "Counting is a comfort. I have been counting linens." She led them through Letham, where a woman with a broken wrist sat up and watched them pass, and another woman, older, lay with her face turned to the wall. "The laundry is not finished. We have two coppers and a mangle and a well in the yard, because the water main was laid to the wrong side of the building, and the washhouse has no drain to the sewer, only to the surface water, which will be a matter for the board when the first fever case has to be isolated." "How long?" Fenmore asked. "Until the pipes are laid correctly, I am told, five months," Selvine said. "Until the board agrees to pay for it, I am not told anything at all." Tredgold made a small sound that was neither assent nor denial, and they went on. The first patient came in that same afternoon, before the paint in the entrance hall was dry. He was a rope-works hand named Yarwood, forty-three, who had been caught by a length of tarred cable and dragged along a floor of flagstones for the length of a shed, and who arrived on a hand-cart because there was no ambulance yet and the nearest was kept at the workhouse and lent only for paupers. His shoulder was out of its socket and three ribs were broken and he was conscious the whole time and apologising for the trouble. Fenmore set the shoulder in the operating theatre with the glass roof while the man's wife waited in the corridor with her hands folded, and when it was done Yarwood asked whether he would still be able to work the cable, and Fenmore said he would, not knowing whether it was true. "Write him in the book," Selvine said, when they came out. "His name and his trade and the name of his wife. If he dies I want to be able to tell the board whose wife we told." Fenmore wrote the names himself that first week, because there was no clerk yet and because he did not trust anyone else to do it properly. He wrote in a long ruled volume that the governors had bought for the purpose, and in the front of it, on the first page, he set down the rules of admission in his own hand: that the sick poor of Vessock would be received without payment; that patients able to pay a weekly sum would be received upon the upper floor and treated as lodgers; that no patient would be refused in an emergency of any kind. He read those three lines over when he had finished them, and he understood, because he had been a doctor in a city for eleven years, that the third line could starve the first, because the sick poor of a city are not a number but a rising water, and a building that admits everyone admits them into corridors. The governors' next meeting was fixed for the fifth of April. Fenmore went home through the dusk by the lower road past the canal, where the water lay flat and black between the mills, and the hands were coming off the evening shift in a straggle of men and women with their collars up, and he walked among them unremarked, a tall man in a black coat with his hands behind him, and he thought about the eighty beds and the corridor and the washhouse and the woman in Letham Ward with her face to the wall, and he did not, that evening, feel like the author of a great advance.