Sunday, January 28, 2007

The birth of science

(It is good to be reminded now and then what things were like before modern scientific medicine, which is mosty an invention of the 19th century. Good to remember too the brave efforts of the ancients who anticipated empirical medicine, especially the followers of Galen of Pergamon. Their efforts were overwhelmed by the superstitious and god-befuddled spirit of their time. I tried to evoke some of that struggle in my newly published novel, Valentine. Herewith, the first few pages.)

                                              I

     Valentine runs through the streets of Alexandria. He is sixteen years old, of average height, with the gangliness of youth. His skin is dark. He has dark, almost black eyes, full lips, the hint of a beard, and a mop of curly black hair. Already one can see the good looks and thoughtful countenance that will later attract the matrons of Rome. He scampers through the crowded streets, dodging vendors, hawkers of charms, tradesmen and tourists, leaping a sleeping dog, darting between the legs of a laden camel. He arrives at last at the house of his master, the physician Theophrastus, and pounds on the door. Admitted by a household slave, he runs to the peristylum, where Theophrastus sits reading, taking the morning sun.

     The physician looks up from his scroll. He is 47 years old, but appears much older. His hair is thin and white. He has seen during the course of a long medical career his share of suffering and death, pestilence and human violence. He has reached an age when he prefers silence and solitude. He is not pleased to be disturbed by Valentine, but he shows no anger. He queries the panting boy.

     "The midwife bids you come," the boy gasps. "The baby refuses to be born."

     Theophrastus rubs his eyes. His near vision is failing. He asks: "Did the midwife administer the oral concoction I prescribed?"

     "Yes, sir."

     "And did she apply the balm of linseed and mallow?"

     "Yes, sir."

     "Did she inject the vagina with marrow and sweet olive oil?"

     "Yes, sir."

     "Theophrastus sighs wearily. "She is using the birthing stool?"

     "Yes, sir. The midwife says to tell you that the mother will die soon. She says to tell you that only cutting..."

     Theophrastus raises his hand and Valentine falls silent. The pregnant woman is the young wife of Julius Favus, Roman official, jailer, and supplier of gladiators for the Alexandrian games. At the first signs of labor, Julius had sent for the man who is reputed to be the finest physician in Alexandria, trained at Pergamum by disciples of the great Galenus. Theophrastus demurred from the summoning; it was not his habit to go rushing off to do a midwife's job. He sent instead his young assistant Valentine, with a potion and a balm to relax the mouth of the womb and hurry the infant on its way. But now he knows that he must rise up and go to the home of Julius Favus, who is after all an acquaintance of sorts, and, as an appointee of the emperor, a man of modest influence. Theophrastus rolls up the scroll and places it aside. He asks Valentine to fetch his surgical kit: the blades, scoops, traction hooks, clamps. He goes to his pharmaceutical cabinet and gathers the necessary drugs and herbals.

     "Hurry," says Valentine. "Hurry."

                                            II

     I am Julius Marius Favus, and it was my daughter who was forcibly torn into the world on that 23rd day of Maia in the year of Valerian's ascension to the throne. I make no apology for having called Theophrastus to the birthing room of my wife Fortuna. I could afford his services, the midwife was at a loss, and my wife suffered terribly. It was clear that if I did nothing Fortuna would die and the infant too. And so I availed myself of the person who was reputed throughout Alexandria to be a magician of medicine. But I also sent servants with silver coins to buy prayers and sacrifices at the temples of Juno Lucina and the Carmentes. Another servant I sent to an astrologer, to see what advice the stars might give for easing Fortuna's labor. And so we waited, myself and the frantic midwife -- who did not inspire confidence with her flushed cheeks and labored breath -- for the gods, the stars, and Theophrastus. Fortuna screamed, bit her knuckles until they bled, twisted her hands in the sweaty sheets, and looked at me imploringly through eyes as red and wide as beets. And still the infant battered its tiny head against the unopened door of her womb.

     Theophrastus came with his boy. The physician's calm demeanor immediately restored confidence to the birthing chamber. His toga was immaculately white and fashionably Roman in its cut. His beard combed and trimmed. His sandals soft and silent against the tiles. The midwife shrank into a corner of the room, and ceased her shuddering. Even Fortuna seemed to sense that an ordering principle had arrived to ease her torment. Theophrastus calmly apprised her anguish. Then he ordered the boy to sweep from the room clear all of the midwife's charms -- the snake sloughs, sticks, and vulture feathers. He pushed aside her foolish potions of goose semen and sow's milk. He held Fortuna's sopping cheeks between his palms and looked deeply into her eyes. He felt her pulse. He placed his hands on her belly and felt for the disposition of the infant within. He examined the mouth of her womb. All of this without a word, as the boy, the midwife, and I watched with interest and anxiety. Fortuna briefly ceased her wailing and latched onto Theophrastus's kindly face through eyes puddled with tears.

     The physician beckoned for me and the boy to step outside the room.

     He said, calmly: "Julius Favus, I can forcibly extract the child; the child will die, but your wife will likely survive. Or I can cut into the mouth of the womb and bring the child to safety, but the risk to your wife is considerable."

     That is all he said. He uttered these terrible words as if he were giving his cook a choice of menus for dinner, then waited for my decision.

     I stammered: "Cut the mouth of the womb? I have never heard of such a thing."

     "You must trust me."

     From the birthing chamber, Fortuna resumed her wailing. I asked, "Likely. Considerable. What do these words mean?"

     "You are asking me for a calculus?" Theophrastus was impatient.

     "I am a practical man."

     "Very well. If I kill the child, the odds that your wife will live are three in five. If I cut into the portal, the child will almost certainly be saved, but your wife's chances diminish to one in five."

     I watched the boy Valentine's eyes gape wide. I saw that he understood the magnitude of the decision I was being asked to make. It was not a decision that any human soul should willingly embrace; these matters of life and death properly belong to the gods, or to the fates. I thought briefly of waiting until my servant returned with word from the astrologer. Perhaps the stars might signal the course of my action.

     Theophrastus read my mind; he too was a practical man. "We have only moments to decide," he said, "or all is lost."

     Fortuna was young, this child her first. We had been married in Rome on the eve of my posting to Alexandria. For the year and a half since we sailed from Ostia, she had been my boon companion, my heart's desire. At first glance, then, the decision seemed simple: save Fortuna at all costs. But, as I said, I am a practical man. Who am I to measure the value of a life, or place my own happiness or unhappiness in the scales of fate? Let us assume that the gods weigh equally the souls of Fortuna and the child. Then by Theophrastus's arithmetic, the joint probabilities for life were three in ten if he killed the child, and six in ten if he employed the knife. I considered what Fortuna would choose if presented with the same choice. Cut, she would unhesitantly say, save the child. But still I dithered, paralyzed by the unpalatable consequences of either decision.

     "You must choose," urged Theophrastus, and indeed Fortuna's terrible cries from the chamber within would have wrung tears from the gods.

     I am a man whose career required daily decisions concerning life and death. Ten men, say, are required for combat in the arena. One hundred men are in my custody. Who do I send to almost certain death? I peruse the roster of potential gladiators. I consider each man's vigor, his probable fighting skills, the magnitudes of his crimes. A tick by this name, and another, and another. Ten men sent to fight and die in the sand with no more anguish on my part than if I were sending them off on a pleasure trip to Rome.

     "Hurry."

     I knew that the consequences of whatever decision I made would be with me all of my life. "Cut," I said.

     I did not reenter the birthing room. I went instead to the shrine of the household gods and prayed. Meanwhile, Theophrastus placed a clean white cloth on a table by the birthing stool. He arranged his instruments one by one in a gleaming row. He asked for fresh olive oil, warm water, clean sea sponges, and freshly laundered cloths. He administered a powerful concoction of mandrake in wine to Fortuna, forcing it between her lips. He lashed her legs more firmly to the posts of the birthing stool. Then he asked the boy and the midwife to hold his patient down.

     And so it was that Valentine saw my darling daughter swim into the world on a tide of blood, her face auspiciously covered with her caul; his life and hers, it seems, were fated from her birth to intertwine. The child expelled, Fortuna lapsed into a faint, exhausted. Theophrastus removed the caul and cut the baby's cord and tied it with white woolen yarn. He placed the infant into Valentine's unsteady hands. The boy held the infant gingerly, astonished at its miniature perfection, the miracle of birth. Never before had he been present at the birth of a child; he felt somehow an immense gratitude, though the child was not his. Then, suddenly, he was unaccountably frightened. He passed the curiously silent infant to the midwife, who placed it on a pillow and sponged it clean. The baby's eyes were bathed with drops of olive oil to wash the residue of birth from the lenses. The limbs, digits, and body cavities were examined. What the midwife did not discern in her inspection was that the infant's eyes were blind; those little windows of the soul were open wide but utterly opaque. It would not be until several days after the birth that the child's nurse would begin to suspect that something was amiss, weeks more until we knew with certainty.

     My wife survived but three days after the birth. For most of that time she was unconscious, racked with fever. I did not blame Theophrastus for her death. I saw that he had employed his skill as best he could. He had given me the odds. I blamed the gods. I blamed the stars. But most of all I blamed myself, for having made the fateful decision. For the rest of my life Fortuna's death would rest upon my conscience. But how could I regret that my darling daughter had been saved, my blessed Julia, who would bring such joy to her father's heart, who in her sweet darkness would reach out with her tiny hands for mine, who would smother me with kisses, pamper me with love? My slaves and colleagues sometimes questioned why, when Julia's blindness was confirmed, she was not exposed to die. Every day, babies with lesser infirmities, especially baby girls, were placed alive beyond the city walls. Such a thought never entered my mind. The pretty child was all that remained of my adored Fortuna; she was the receptacle of her mother's beauty and virtue. I clasped little Julia to my heart and prayed that the gods would lead her unharmed through a lightless world.

     The boy, Valentine, never forgot the drama of that terrible birthing, the first he experienced in the service of his master Theophrastus. As he held the silent baby briefly in his hands, he marveled at the skill that had guided Theophrastus's hand, at the gleam of the keen edge cutting flesh, the balms and potions. He thought too what a wonderful thing it was to save a human life. He passed the child to the midwife, then stood staring at the blood on his hands until ordered by Theophrastus to assist at closing Fortuna's wound. During that brief moment of enraptured contemplation Valentine decided to become a doctor. At that moment his soul was taken from the gods and given to philosophy.

Further Reading

Valentine: A Love Story.

Discuss this essay and more over on the Science Musings Blog.