EPILOGUE

Seattle, Washington, July 3, 1933

The greater good. The one or the many. Should the life of one man be sacrificed to save thousands? Forty years later, will anyone care that an obscure young physician named George Farnshaw bled to death on a prison floor so that William Stewart Halsted might continue his brilliant work and in large measure invent modern surgery? Is one man’s murder the price that the human race must pay in order to progress?

Moral philosophers, I am certain, could wax eloquently on this issue, but moral philosophers rarely speak from their own experience. For all but a handful, George Farnshaw vanished into history within weeks of his death, but I was among that handful.

On the occasion of my seventieth birthday, as I reflect on the astounding changes that have accrued to mankind, I can only note that George Farnshaw should have been witness to those changes, should have grown and aged and marveled as I did at the progress in all forms of human endeavor, some exhilarating, some terrifying.

The world of 1933 bears almost no resemblance to that of 1889. It might have been four centuries rather than four decades since Rebecca Lachtmann, George Turk, and George Farnshaw died, for indeed centuries of tradition have been thrown over.

As a result of the Great War, monarchy ended in much of Europe: thus, Czar Nicholas of Russia was supplanted by the Bolshevik Lenin and now Stalin; King Victor Emmanuel of Italy by the Fascist, Mussolini; and Kaiser Wilhelm of Germany by a series of leaders, the most recent being a demagogue named Adolf Hitler. Change, yes, but it remains to be seen whether the new governments will be an improvement over the old.

In our own nation, women—including my own wife, daughters, and granddaughters—vote. Americans may again drink alcohol, after a tumultuous decade of prohibition. Our new president, Franklin Roosevelt, survived polio but, more astoundingly millions of Americans can listen to his voice as he speaks although they might be thousands of miles away. Radio, this new miracle of communication that sends electrical impulses through the very air we breathe, has made cable telegraphy seem ancient.

The West has been opened and, with the admission of Arizona twenty-one years ago, America now consists of an incredible forty-eight states. The great expanse of our nation has been rendered smaller, not simply by the profusion of railroads that now crisscross the landscape, but by travel through the air. Horse-drawn locomotion will soon disappear entirely as internal combustion vehicles come within the financial reach of all but the very poor.

Abigail once told me that art was changing the way men and women see their world, but in 1905, an obscure German physicist working in a patent office in Bern, Switzerland, created the same phenomenon in science. He postulated that we live in a world without absolutes, a theory scoffed at in popular circles, as had been Darwin’s, until, in 1919, observations during a solar eclipse proved to the world that he was correct.

The Bayer Company thrived. In 1897, one of its chemists, Felix Hoffmann, applied the acetylizing process that Wright had used on morphine to salicylic acid, thus synthesizing acetylsalicylic acid, which Bayer marketed under the trade name “Aspirin.” Aspirin had the analgesic, antipyretic, and anti-inflammatory qualities of the nonacetyl variety, but without the horrific side effects. Two weeks after he synthesized aspirin, the very same Felix Hoffmann finally succeeded in synthesizing an easily manufactured version of diacetylmorphine. The next year, 1898, the Bayer Company finally offered up a tacit admission of its experiments with the substance, when it sought patent protection for Hoffmann’s process under the trade name “Heroin.” Bayer then marketed Heroin, named for its miraculous and nonaddictive qualities, as a nonprescription pain reliever, cough remedy, harmless sedative, and cure for morphia addiction.

Heroin became the wonder drug of the early twentieth century. Bayer embarked on a worldwide sales campaign and soon, Heroin lozenges, tablets, elixirs, powders, and dietary supplements were all the rage, despite growing evidence among chemists that the substance was far more toxic than the morphia from which it was derived. Among its more popular applications was as a cough remedy for children. I was among the few doctors who opposed its use. I was scoffed at by my colleagues until, inevitably, its ravaging effects made themselves known and, in 1914, the United States Congress passed the Harrison Narcotics Tax Act to regulate opiates. Still, by 1920, there were 200,000 Heroin addicts in America. In 1924, the substance was banned entirely. Aspirin, Bayer’s stepchild invention, replaced Heroin; it has become the single most successful drug in history.

As for me, after I left his rooms on that early April day in 1889, I never saw Dr. Osler again.

I agonized whether or not to send the journal to Farnshaw’s parents with an explanatory note, so that they might pursue the matter and attempt to clear their son’s name. But would it have been genuine consolation for them to know how close their son was to being freed before he was murdered? I thought not.

I had been taught to distrust coincidence, but sometimes people are correct only by chance. Although he had made the statement simply to stifle my inquiries, Dr. Osler had spoken the truth when he opined that from the moment the cover of the ice chest was opened in the Dead House and its contents revealed, every time I tried to help, I had made matters worse. I vowed to do so no longer. Or perhaps I simply wanted to be free of everything to do with my life in Philadelphia. Whatever the case, I destroyed Turk’s journal and hoped that I had saved Farnshaw’s poor parents further torment.

I waited until the following evening and then called on Mary Simpson at the Croskey Street Settlement House. I informed her of my decision to decline the appointment at Johns Hopkins and of my intention to leave Philadelphia. Although I had settled on no firm destination, I had resolved to finally heed Reverend Audette’s advice and head West. I asked Mary to join me. I told her she was the finest woman I had ever known, and likely would ever know. I should be lucky and privileged if she would consent to be my wife. I promised to love her son as my own.

She refused.

“You don’t love me, Ephraim. You are fond of me, I know, and I think that you would be kind and generous to Samuel. But I’ve struggled too arduously to accept a proposal from a man who would have chosen another. Also, my work here in Philadelphia is far too important to me.”

My choice of Abigail over this exceptional woman was yet another of my mistakes that would have no remedy.

In the end, I put as much distance as I could between myself and Philadelphia, settling in the small but growing city of Seattle, Washington. Physicians were scarce and I was welcomed without question. There, I courted and married a lovely woman. She was not mercurial and intoxicating like Abigail Benedict, nor formidable and determined like Mary Simpson, but she is kind, gentle, and accepting of my faults. We have been married forty-one years, and have three sons, two daughters, eleven grandchildren, and, as of last year, a great-grandson. I will retire as a physician this year—my eyes and my hearing are not what they were—but the children’s hospital I helped found, the most progressive institution of its kind in the West, I am proud to say, will continue here under the guidance of others.

With age, I have come increasingly to gaze at progress from afar. Air travel astounds me. While my scientist’s mind can accept Bernoulli’s principle in theory, I will never consent to sit inside a metal tube shooting through the clouds with nothing to keep it from hurtling to earth except forward motion. My son George, however, flies often, and my grandson Ephraim, all of sixteen, insists that he will be a pilot. I am more sanguine about earthbound conveyance and love my Nash.

I followed Dr. Osler’s remarkable life almost to obsession. He took his position at Johns Hopkins and was so instrumental in altering the manner in which physicians viewed their work that his life could be considered the fulcrum upon which the science of medicine pivoted. During the next decade, he completed his textbook, Principles and Practice of Medicine, which is still the standard by which all similar works are judged. In 1892, Dr. Osler was named president of the American Pediatric Society. He has received honors and awards sufficient to fill a volume of their own.

In 1905, he left Johns Hopkins to accept the Regius Professorship of Medicine at Oxford University, the most prestigious medical appointment in the English-speaking world. At Oxford, although it seems impossible, his achievements were even greater than those in America. In 1911, he was knighted by the king, Edward VII.

Dr. Osler did indeed marry the widowed Mrs. Gross, and the couple had one son, Edward Revere. When young Lieutenant Osler was killed in Flanders in 1917, it broke the Professor’s heart. He died a mere two years later. He did, in fact, order a postmortem on himself and his prediction of what would be found—thoracic empyema, pus in the right pleural cavity, a massive pleural infection—turned out to be exactly correct.

In addition to his professional achievements, Dr. Osler amassed one of the most astounding personal libraries in the world, over eight thousand volumes, the majority devoted to the history of science and medicine, including the most exhaustive collection of material on Servetus ever compiled. He spoke of Servetus often, even using him as the subject of his annual address to the Johns Hopkins student body, and he was among the benefactors of a monument that was erected in Annemasse, France, just across the border from Geneva, where Servetus had been burned at the stake.

William Stewart Halsted remained at Johns Hopkins for the rest of his life. Although always a brilliant surgeon and teacher, he was responsible for few surgical innovations after the early 1890s. Perhaps morphia had sapped his genius. Still, it is fair to say that every great surgeon of the first three decades of this century has walked in Halsted’s footsteps. He married Caroline Hampton, the nurse who had been the inspiration for his invention of surgical gloves, and they lived something of a reclusive life together. Although there is no evidence in either direction, I suspect he remained addicted for the rest of his days. In one of medicine’s great ironies, Halsted died in 1922 after complications from the same gallstone surgery that he had invented forty years earlier to cure his mother. Two of his former students performed the operation.

After Dr. Osler left for England in 1905, Mary Elizabeth Garrett, Hopkins’ major benefactor, commissioned a group portrait of Osler, Halsted, Welch, and the gynecologist Howard Kelly, to be called “The Four Doctors.” For this task, she engaged not Thomas Eakins, but the expatriate American John Singer Sargent. Only Dr. Osler lived in London, where Sargent’s studio was located, so the other three crossed the Atlantic to sit. During the process, Sargent found Halsted so unpleasant and overbearing that he was rumored to have painted his image so that it would fade over time.

Neither Abigail Benedict nor her brother ever returned to America. Albert died in a traffic accident, run down by a carriage in Zagreb in 1892. The driver was never apprehended. After her father’s return to America later that year, Abigail lived in London for a time, then in Florence. In 1895, she married a French count twenty years her senior. The couple, childless, spent much of their time traveling about in Europe and Asia. When Abigail’s husband died of esophageal cancer, Abigail retired to his ancestral home near Avignon, where she lived as a recluse until her own death last year. As far as I could learn, she never exhibited any paintings. I was saddened at her death, but more at what seemed to be a lonely and unfulfilled life.

Thomas Eakins remained at his home on Mount Vernon Street until he died there in 1916. Although the Pre-Raphaelites he despised slipped from public acclaim, Impressionists did not. Art continued to retreat from realism and, with the rise of abstractionists like Picasso, Eakins saw his reputation wane even further. After the Lachtmann affair, Eakins devoted himself almost entirely to portraiture. He could not hide his bitterness, however, and his subjects were almost always rendered in an unflattering light, often as much older than they were. In desperation, he even attempted to incorporate some of the modernists’ techniques into his later paintings, but was nonetheless no more than a footnote in American art at his death. Susan Eakins still lives in Philadelphia, an indefatigable champion of her husband’s work. Whatever Eakins’ faults, I can only hope that one day his great talent will finally be appreciated by a nation that has spurned him.

Mary Simpson never married. The Croskey Street Settlement House thrived and became the model for similar institutions. During a speaking engagement in 1912, Mary was approached by a woman who claimed to admire her work greatly, and sought to create even more progressive enterprises for women. That woman’s name was Margaret Sanger. I corresponded with Mary from time to time, and I hoped that we would always think of each other as friends. She died peacefully of congestive heart failure four years ago, surrounded by friends and admirers. I can only hope that when it is my time, I will be so fortunate.

Haggens, despite both his style of life and his heart condition, lived for another twenty years, although Mike was shot to death in front of The Fatted Calf not six months after I left Philadelphia. Sergeant Borst was indeed promoted, eventually to captain, and he was a mainstay of the Philadelphia police department until his retirement in 1915. As far as I know, he still lives in the city. Jonas Lachtmann returned to California, where he had gotten his start, just after the turn of the century. I was more than a bit anxious when I learned that we lived in such proximity, but Lachtmann was never the same man after 1889, and he preferred to ignore me than revisit the tragedy of his daughter’s death.

I kept Abigail’s portrait of me, not as a reminder of the man I wished to be, but rather of the sins of pride and arrogance that I wished never to repeat. I dedicated my life to atoning for my role in the death of George Farnshaw although, for quite a while, despite my wife’s assurances, I felt that I never would. Then, ten years ago, at Christmas dinner, I looked around at my family, and walked into the study to read a testimonial from the grateful citizens of Seattle that I had mounted on the wall. I considered the sum of my life, went to the attic, fetched the portrait, and threw it into the fire.

My life would have been very different, I know, had I accepted the Professor’s offer and accompanied him to Johns Hopkins. I would, as Dr. Osler predicted, have achieved wealth and fame; more importantly, I would have undoubtedly contributed, as he did, to the saving of thousands of lives. But among the many decisions of my life I might wish to rescind, that is one that I have never regretted. For in turning my back on the many, I believe that I saved myself.