Inside the Barbary Coast

By David Jensen

John Pitman, Jr. didnt want to become a doctor. His father had been one and had faileda die-hard who had clung to cupping and purging as a means of ridding the bodys impurities. But as a stevedore on the docks of San Francisco no one could mend broken bones like John Pitmans lanky son Jack. Finally the young lad decides: If he is to become a doctor, he will be the best.

INSIDE THE BARBARY COAST is where Jack Pitman chooses to open his medical practice. It is an area of San Francisco filled with saloons, parlor houses and opium dens, bordering on Chinatown. Fresh out of medical school, Jack saves the life of a young Chinese prince who is an actor in Dr. Pierre Louthans medical show. Louthan did not go to medical school but easily passes off as a learned physician with his European manner, silver-tongued ability to converse on any subject relating to anatomy, and his courses of treatment that involve a growing array of patent medicines.

Jack falls in love with Louthans assistant, Marie, not realizing she is married to the quack doctor. Although Jacks nurse, the wise Madam Wong, cautions the young doctor, he is smitten nonetheless and fathers a child Louthan believes is his. Jack fights to discredit the huckster, hoping Marie will see Louthan as a charlatan and leave him.

She, however, has plans of her own and manages to snare Jack in her own secret web. As Jack becomes consumed in his new practice, he tries valiantly to save the life of Hawaiis King David Kalakaua who is dying at the Palace Hotel. His friend, Gentleman Jim Corbett, the famous boxer, plays a role, as does Adolph Sutro, San Franciscos flamboyant mayor who built the famous Sutro Baths near the Cliff House facing the sea.

Jack embraces electro-therapeutics because he believes it is the frontier of the New Medicine. When a prominent socialite is accidentally electrocuted in his office, he dismisses electrotherapy altogether and labels X-rays as another quack fad. But he is wrong and discovers his miscalculation just as tong wars break out in Chinatown and as President McKinley sends 10,000 young troops past the Golden Gate on their way across the Pacific to the Philippines.

The young doctor from the Barbary Coast hones his surgical skills while serving as a medic in the Spanish-American War. When he returns, Marie still loves him but cannot find justification to divorce her husband. The bubonic plague hits San Francisco, giving the unions ammunition in their fight to exclude more Chinese from immigrating to the United States.

Meanwhile, the always-scheming Dr. Louthan concocts a new patent medicine that increases sexual vigor. It is based on the findings of a European endocrinologist. Louthan experiments on himself, resulting in a fight with Marie that leaves their relationship damaged. But Pierre will not grant his wife a divorce, spurring Jack to join other physicians in San Francisco and around the country to discredit Louthan and other quack doctors like him. The plan works, and Louthan finds the underpinning to his nostrum business slipping away.

Jack and Marie have just attended Enrico Carusos performance of Don Jos and taken a room at the Palace Hotel when a devastating earthquake rocks San Francisco. It is April 18, 1906. Shaken out of bed, Jack puts Marie in a taxi to go home and heads to the Pacific Anatomical Museum where he finds Louthan has been trapped by a fallen beam. As a fire erupts and flames begin licking their way closer, Nate Nordstrand, an old friend of Jacks who now works for Louthan, swings a fire ax to amputate the quack doctors leg to free him from the beam and encroaching inferno. But Nate is not finished and swings again, this time squarely across Louthans neck. An eye for an eye, he shouts, Jack knowing the full meaning of his cry.

Jack returns home and finds th

• Language: English
• Publisher: Xlibris US
• Release date: Dec 12, 2001
• ISBN: 9781465315793

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INSIDE THE

BARBARY COAST

David Jensen

Copyright © 2001 by David Jensen.

All rights reserved. No part of this book may be reproduced or transmitted in any

form or by any means, electronic or mechanical, including photocopying, recording,

or by any information storage and retrieval system, without permission in writing

from the copyright owner.

This is a work of fiction. Names, characters, places and incidents either are the

product of the author‘s imagination or are used fictitiously, and any resemblance to

any actual persons, living or dead, events, or locales is entirely coincidental.

This book was printed in the United States of America.

To order additional copies of this book, contact:

Xlibris Corporation

1-888-7-XLIBRIS

www.Xlibris.com

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EPILOGUE

AUTHOR’S ACKNOWLEDGMENTS

SELECTED BIBLIOGRAPHY

INSIDE THE BARBARY COAST TIMELINE

To Maggie, Christopher and Patrick

My raison d‘etre

A physician is a man who pours drugs, of which he knows little, into bodies of which he knows less.

Voltaire

Medicine is a farce performed at the patient’s bedside by three players—the doctor, the patient and the disease.

Franjoise Rabelais

Man is only man on the surface. Remove his skin, dissect, and immediately you come to machinery.

WH. Auden

Country doctor to patient:

Did you sleep well? Do you eat well? Do you shit well?

Yes, replied the patient to all three.

Then why are you bothering me? admonished the doctor.

Quackery subsists almost entirely on credulity and ignorance, and it is your duty to expose it in every shape, and to save as many from its evils as you can.

D.W Cathell, M.D.

The Physician Himself (1882)

November 1890

On any other day of the week the small stage at the Opera Comique was the platform for honky-tonk piano players and canary-voiced singers whose warbling grew more tolerable to the audience as they consumed more liquor. But tonight, Sunday, there was less drinking inside the clapboard structure. It wasn’t because it was Sunday. No. The longshoremen, businessmen, and single ladies out for a good time had become accustomed to hearing Dr. Pierre Louthan on Sunday nights. It was the most amazing medical show in San Francisco. People would come from as far away as San Jose to hear the silver-tongued orator tell of medical discoveries he had made while traveling in China, Africa and the Middle East.

Behind the stage curtain, listening to the clattering of plates that cued her it was time to get ready, a young, elegantly dressed woman of fair height checked herself in a floor-length mirror. Normally Marie liked what she saw, considering her beginnings. Parents she never knew had given her skin as lovely as alabaster and hair as dark and as full as the tail of a fine thoroughbred mare. Tonight, however, it was pulled high atop her head—in a French curl. It was all part of the act, to look French, to give the illusion she was as much European as her partner, even though she was not.

The woman felt a tug at her dress and looked down. Li! Don’t do that. She peered into the pleading, almond-shaped eyes of a young boy. He looked unusually tired.

Li Chi Chung was Louthan’s warm-up act. The kid was a born performer. Louthan knew it from the time he first spotted the boy four years ago in a line-up of orphaned children. They had just come off the boat from Hong Kong. For a hundred dollars he bought the boy, his sister, and twenty pounds of opium extract. It was a bargain. Especially the boy. He had learned rudimentary English at the orphanage and caught on quickly to the art of deception as taught by his new master. Touring with Louthan and his assistant all over the Western United States, mostly in small towns in California and Oregon, the thin little boy never missed a cue during the blindfold act.

Li. Is something the matter? Marie took off one of her gloves and placed her manicured hand on the boy’s forehead. Goodness sakes. You’re burning up! You must be sick. But before she knew it the Opera Comique’s orchestra began playing a fanfare, announcing the show was about to begin. Pierre! She went over and grabbed his overcoat.

He spun around. What is it?

Li. He’s sick. Look at his breathing, how labored it is.

Louthan glanced at the boy. He’s fine. Where’s his costume? We haven’t much time.

Marie could feel the heat of the gaslights on the other side of the curtain as she helped the boy into his red quilted jacket and hat. In a moment, he would sit blindfolded on a chair at center stage, straining to hear the cues Louthan would sprinkle during his patter so Li could describe, without seeing, any schnook the renowned showman might choose from the audience.

Minutes later, after welcoming the crowd and introducing his assistant Marie as the Marquise de Lyon and Li Chi Chung, a young Chinese prince with amazing mind-reading powers, Pierre Louthan stepped off the stage and maneuvered himself amidst the throng of people until he reached a monocled businessman he hoped the young boy would identify through his blindfold based on cues Louthan planted throughout his patter. Louthan cleared his throat and spoke toward the stage. „Prince Li, perhaps you did not hear me?" Of course, everyone heard Pierre Louthan.

His voice was unmistakable—accented, yet clear, with a natural timbre that Pierre’s father had recognized early on was special. Pierre’s father had been an actor. While Pierre did not follow exactly in his father’s footsteps and become an actor at least in name, he nonetheless learned at an early age how to project.. .and how to pretend. This evening he was doing just that. But to no avail as far as Li was concerned.

Li shood his head. Perspiration flew from his forehead but not from his ears. They seemed like wells into which water, not words, were pouring. Suddenly the boy slumped in his chair, as if someone had let the air out of his body. Was it part of the act? Those in the back of the Opera Comique thought it was. But those in front, including a large, well-dressed woman with auburn hair, could see Li was distressed.

A burly miner from somewhere in the middle of the audience yelled, „The boy‘s a fake! He‘s no prince!"

„Bring back the woman!" another voice piped.

Behind the curtain Marie gritted her teeth. She started to walk onto the stage but stopped midway when she heard Louthan attempt to answer the hecklers. „The lad is only eleven. Don‘t worry. You‘ll get your money‘s worth." He flashed a reassuring smile.

„That child needs a doctor!" exclaimed the red-haired woman, emphatically from her position not far from the gaslights.

„I am a doctor!" Louthan whispered back with a sneer.

If you’re a doctor, I’m Lady Godiva! the portly woman retorted, stomping up the side stairs and grabbing both the boy and Marie and leading them offstage.

Louthan frantically attempted to settle the crowd by grasping from memory bits of stories he wove together in an effort to convince them that Vital Spirits was indeed the medical discovery of the age.

Outside, the pace of the three did not slacken. My name is Marie. I demand to know where we are going

"Marie. Is that your real name?"

It is, said the assistant, her dark French curl becoming unbalanced as they hurried. But I am not a marquise.

Of course not.

The insistent woman, whose gown and corset were as tight as her thick body would allow, moved with surprising speed toward the waterfront where a driver and coach were waiting. Step in, she barked to the younger woman. Paddy? Help the boy. He may have diphtheria. A strong, gloved hand reached under the boy’s armpit and lifted him into the landau.

How do you know he may have diphtheria? Marie asked.

My husband is a doctor. My son is, too, as of yesterday. Hurry, Paddy. You know where to go, she said as she mopped the boy’s burning face with a handkerchief.

In line of sight of the Barbary Coast, but across the well-traveled waters of San Francisco Bay, John Andrew Pitman, M.D. stood facing the wind. He breathed in deeply, appreciating the salt air as he waited on the Oakland dock for the ferry. It was just after dusk and an unusually cold day. But young Doctor Pitman didn’t mind. His woolen overcoat provided protection, and inside, hidden from view, a new gold-plated stethoscope given him only an hour ago by Dr. Richard Beverly Cole seemed to warm him as a heated rock might comfort an Indian during winter.

The motion of clipper ships unloading at the dock and the sight of boats of all sizes crisscrossing offshore would have been enough to keep his attention. But his mind kept repeating the vivid memories of the last two days: the somber yet joyful commencement ceremony that yesterday had given him his medical diploma and the happy hugs bestowed by his mother, Esmerelda, and then by his father, himself a doctor in San Francisco.

Today, Dr. Cole, the former dean of the Toland Medical School, now part of the University of California, had summoned Jack back across the Bay to present his favorite student with a gift so special he didn’t want his other students to see.

This was presented to me by Dr. Toland himself, said the amiable professor through his trademark tobacco-stained mustache. „‘Listen to the patient‘s organs and breathing with this,‘ Hugh would say. ‚Listen to his words, too, and if you put the two together, you‘ll know what‘s wrong.‘"

Dr. Cole‘s placement of the stethoscope around his neck made Jack feel as if he was being knighted.

„Why me?" asked the graduate.

The old man smiled at the question. „When I was young, Hugh encouraged me to pay no mind to whether my patients were rich or poor. That was his philosophy." He put his hand on Jack‘s shoulder. „You didn‘t have to follow in your father’s footsteps. And i know you left the fold for a year to work on the docks. But on the docks you saw more of life than many men see in a lifetime. You will be a different sort of doctor, Jack. I know you will."

How will I find patients? the new M.D. queried.

"They’ll find you."

Pondering this memory, Jack gazed at the waters of the bay and noticed a steam-powered skiff chugging full speed toward him. As it got closer a young longshoreman he recognized yelled, Jack! Jack! Come quickly!

"Nate! What are you doing here?" shouted the young doctor.

Get in! barked another man, who spun a large handled wheel to position the boat closer. Jack jumped onto the bow and bounded into the cabin. Immediately the pulse of the steamer quickened as the skipper threw open the valve.

Your da-d-d-dad nee-needs help. Heee’s gah-gah-got a pa-patient he ca-can’t handle, said Nate, who since a child had been stigmatized by words that flowed faster than his fluttering lips could articulate. He’s a coo-lie. Real sick. Either croup or d-diphtheria. Dr. Pe-pitman ain’t sure which.

The grayish-brown water from the shallow bay splashed white around them as the skiff chugged at top speed toward San Francisco. Suddenly Jack felt cold.

Esmerelda Pitman paced nervously just inside the door of the family home, a medium-sized Victorian on Filbert Street. Finally, she called to her husband, John, they’re here!

Jack bolted past the door just as his mother pulled it open. On the sofa in the parlor, Jack. On the sofa? Why wasn’t the sick boy in bed? he thought during the seconds it took to reach the parlor.

Francis the chambermaid stood from where she had knelt to replenish the water in the croup kettle. If it was croup the boy had, the camphor fumes would help. If it was diphtheria, little if anything would save him.

The newly graduated medical doctor bent down to feel the boy’s head.

It’s not good, said the elder Pitman, whom Jack had barely noticed was standing next to his sister Victoria at the foot of the sofa.

I need a light, the son said.

Here, answered his mother, handing a lantern to him from a table near where she stood.

A fetid smell from the celestial’s breath was one the young doctor had encountered before. It had come from a patient brought to class by his pathology professor.

Jack held the light over the boy’s mouth as he pulled his jaw downward. There it was: a membrane growing over the tonsils and spreading across the throat that would soon choke the boy if unstopped.

Li Chi Chung. Where he is? cried a voice in broken English from the doorway. The boy’s eyes bulged upon hearing the fright in his sister’s voice. Oh, no, no, she said rushing into the room and flailing her arms atop her brother’s legs next to the young doctor.

She must have followed us here, said Esmerelda.

Get me a tube, any kind of tube, Jack Pitman commanded. As people fumbled and as he looked down at the pig-tailed hair of the Chinese girl crying beside him, he remembered the stethoscope. He poked his temple getting it into position and unbuttoned the boy‘s shirt, which was soaked. Before he had a chance to listen, his father had placed a pipette into his hand.

„Dad, hold the boy‘s feet. You..."

„My name is Marie."

„You lift his neck."

What Jack was about to do he had only read about—in the Chicago Medical Review. He had never practiced it at Toland.

With his left hand holding Li’s jaw downward, Jack took a breath and with his other hand drove the pipette through the membrane and into the windpipe. The boy’s swollen chest collapsed with relief, then expanded as it drew in more air. Dad, hold the pipe. Don’t let him choke.

Jack removed his overcoat, allowing Marie to better see the face and frame of the man who had dashed in so quickly. He was taller than his father but had his same build and cleft chin. The young man’s sand-colored hair appeared to be his mother’s. some red could be seen in his handlebar mustache and on his arms and chest as he rolled up his sleeves and undid his collar.

For the first time since entering the parlor, Jack looked into the eyes of the statuesque woman whose patient was suddenly in his care.

I’m Jack Pitman, he said, his right hand now supporting Li’s neck. Did you bring the boy?

Yes. He performs in our medical show.

Medical show? Jack questioned.

That’s right. A little entertainment—Barbary Coast style, a mind-reading act, and our pitch for Vital Spirits.

He parroted what he had read in advertisements about the nostrum: .A proprietary formula to reinvigorate the American male.

Or words to that effect, she said, frowning to herself in disappointment at his sudden haughtiness. Jack’s sister Victoria covered her mouth as the two sparred.

He’ll need to go to the hospital, Jack said. Is that possible, Father?

The City Hospital will take him in. I’ll go with you to admit him, the elder Dr. Pitman offered.

Marie, can you hold the boy’s head? Watch the tube. It will need to stay in place for awhile.

The boy groaned.

Mother, I know you have Wine of Coca in the cabinet...

To control my nervousness. Yes, dear, I do, she said, sauntering into the kitchen.

„Please give some to the boy. Then he added with some disgust, „Take some, too, if you must.

Australian-born Esmerelda Pitman went to the cupboard only too pleased to oblige her son. The Wine of Coca bottle was kept among her spices. She uncapped it, raised the liquid to her lips, and tipped enough into her mouth to swallow. The alcohol and cocaine in the syrup acted on her almost immediately. Calmer now, she poured some of the dark liquid into a glass and after returning the bottle took the medicine and a spoon back to the parlor and over to the boy.

„On second thought," Jack said, looking at the tube still protruding from the boy‘s throat, „that won‘t work. At least not yet.

„Come on, he said to the group. „Let‘s move him before he gets worse.

Jack thanked Nate who had come to get him on the skiff. He had always enjoyed working with Nate at the docks. He was smart and able-bodied. He just couldn‘t get his words out fast enough.

„Will we sss-ssee you tonight?" asked Nate.

„That depends on our patient. Bella Union, right?"

Nate nodded.

Jack walked out to the carriage. Paddy Corbett, a friend of the family and part-time undertaker, had helped Marie onto the leather-upholstered bench. Carefully Jack lifted the ailing boy with the pipette still in his mouth onto Marie’s lap. Then he hoisted himself into the back seat and extended a hand to help his dad. Li‘s sister climbed in the rear.

„Here‘s a blanket to keep the boy warm," said Esmerelda, lifting a woolen spread up to Marie.

„Thank you, Mrs. Pitman. Thank you for bringing us here."

„Good on ya, then," she said, slapping one of the horses on its back. Occasionally her Australian roots showed.

With a clop, clop, clop, the makeshift ambulance trotted a short distance east on Union past a half dozen Victorian homes, then south on Mason toward the business district. On a sunday evening the shops on either side were dark—barbershops whose shutters remained hooked, bakeries whose ovens stood cold, saddle shops and feed stores whose owners were at home with their families, or if they didn‘t have family, were boozing it up at one of the dance halls or saloons inside the Barbary Coast. Finally they crossed Market, the cable-car artery that once was the thoroughfare for merchants transporting food and supplies from the docks to Mission Dolores, the old mother church, built in 1776 by Father Junipero Serra.

Like Mission Dolores, which the Spanish fathers reconstructed in 1791, the City and County Hospital of San Francisco, as it officially was called, had been built as a temporary structure. But by 1890, twenty-two years later, it had become a permanent facility. Designed to serve the health needs of a city of 120,000, City Hospital had not kept up with San Francisco‘s explosive growth. Much bigger than Los Angeles to the south and Portland to the north, San Francisco was America‘s gateway to the Pacific, extolled by its leaders as the New York City of the West Coast. As such, with more than a quarter of a million people, it had grown to become the nation‘s eighth largest metropolis and had the distinction of being second in trade.

The inside of City Hospital was a microcosm of the surrounding population—roughed-up drunkards and prostitutes from the Barbary Coast, sailors who had arrived in port with nameless afflictions, builders suffering from industrial injuries, and society people like bankers and lawyers who for one reason or another were too infirm to be nursed at home.

Just inside the main entrance to the hospital, Sister Agnes was first to hear the sound of the arriving carriage. Neither old age nor the habit that framed her puffy face inhibited her sense of hearing. By hovering near the hospital‘s entrance, she could hear when the patients arrived and go out to great them, thereby avoiding the back-bending grunt work the younger sisters and volunteers faced inside.

„Whoa, boy," said Paddy gently to his appaloosa. The elder Doctor Pitman jumped out first, said a few words to Sister Agnes who was already outside by the carriage, and motioned to Jack to lift the Chinese boy by placing his arms underneath Li‘s shoulders. A stretcher arrived, upon which Li was placed.

On the gaslit porch of the hospital, a physician known to Dr. Pitman approached.

„Who would have done such a thing!?" asked the doctor, pointing to the pipe protruding from the boy‘s mouth.

„I did," said Jack, enjoying for a moment the physician‘s expression of alarm.

„And it‘s a good thing he did, because it saved the boy‘s life!" Dr. Pitman said proudly. He knew that his old colleague had never seen an intubated patient before, just as he had never seen one until his own son had performed the procedure right before his eyes.

I read about a Dr. Waxham who did it on cadavers a few years ago in Chicago, young Pitman explained.

Well, it’s a good thing it works on the living as well as the dead, said the other physician. Come on, let’s get the boy inside.

A club-shaped bacteria had recently been discovered as the cause of diphtheria, but there was no known cure. Li Chi Chung would have to rest and hope that his young body could fight off the savage disease by itself.

I will stay with the boy along with his sister, said Marie. She tried to put her hand on girl’s shoulder, but she moved away.

The next two to three days will tell. Jack looked up briefly from notes he was writing on a clipboard. He scribbled some more, then placed the clipboard on a hook at the end of Li’s cot. As he did, Li’s sister shifted her eyes appreciatively toward Jack.

Thank you, mouthed the girl, whose name Li Mei Ling meant sweet and pretty, almost in a whisper. She reached up and kissed him on the neck, after which he could feel the wetness of a tear on his flesh.

Jack smiled, then stepped aside to allow Sister Agnes to spread a light blanket on top of the boy. Li had fallen asleep, so relieved he was that he could finally breathe.

I’ll get some pillows to prop up against his head, the nun said.

Jack looked at Marie, for the first time noticing the dark richness of her hair and eyes. I’ll be back in a few hours. He wondered if she’d still be there.

Outside the hospital the air had grown cold and damp. It wasn’t windy, but the air was swirling around as if it did not know where to go.

The Pitman doctors, father and son, stood in silence. Jack could sense the mixture of emotions his dad was feeling. Another patient’s life had nearly slipped through the elder Pitman’s fingers. Like numerous times before, it wasn’t because Dr. Pitman didn’t have the desire to heal; he simply lacked the knowledge and the skill—not unlike many doctors of his generation.

Jack had come in the nick of time. What if he hadn’t? On only his second day out of medical school, he had saved a boy’s life. While any other medical practitioner might have felt humiliated at being upstaged by a younger physician, Jack Pitman Sr. was undoubtedly proud of what his son had been able to accomplish. The elder Pitman’s next words confirmed Jack’s intuition was correct.

That was an amazing procedure you did back at the house, the elder Pitman said, breaking the silence as they stepped off the hospital porch onto the street. I certainly would not have thought to poke a tube into the boy’s windpipe.

The two faced each other in the night air, their features defined by the two gaslights that swung in the breezeway. Medicine is changing now more than ever before. That’s one reason why I finally decided to become a doctor.

The elder Pitman, a shorter, less athletic version of his son but with an identical cleft chin, buttoned up his overcoat. Your mother is probably worried. I had better go home to console her.

I’ll walk with you to Market Street, offered Jack. Then as the two began their stride the son invited his father to join his friends at the Bella Union for another graduation celebration. Care to join?

No, son. You’d have more fun without me. After three years of study and dissection, you deserve to tie one down with your friends. Just remember, you have your first patient in there. He nodded toward the hospital behind them.

For the next several minutes of their walk, neither Pitman said very much. Then the son recalled to his father the stethoscope his professor had given him and how Doc Cole said he wouldn’t have to find his patients, that they would find him.

Don’t be too sure, said the father, who recalled the difficulty he faced opening a practice in the years after the Gold Rush had peaked and before the Civil War had placed a demand on many doctors. My timing was all wrong. It always is, he said in a familiar cadence. Jack had wondered why his father didn’t head east during the War like so many doctors. They came back, most of them, having performed the work of amputating arms and legs and otherwise experiencing an intensity of medical requirements few physicians see in a lifetime of practice.

Your mother and I had fallen in love by then, he offered, with no prodding.

Jack knew why his mother preferred living on the West Coast of the United States. Any farther east is farther from Australia, she would say. And it was as simple as that. Esmerelda Pitman was among the relatives of Australia’s vagabond convicts called Sydney Ducks who came to California in the early Fifties like so many others looking for gold. To remind her of home, she and the other wives planted Australian eucalyptus trees along the bluffs of the Presidio looking toward the Golden Gate. Now I don’t feel so lonely here, she would say.

Dr. John Pitman and his son passed Franklin Square, which was quiet except for a few derelicts who were quietly imbibing from bottles in their knapsacks, then walked up Tenth to Market, the elder Pitman recalling his favorite patients through the years.

Jack Pitman actually liked his father a great deal. Without a medical degree, John Sr. had gradually built up his practice and had done quite well for himself—until August 25, 1875. That’s when he could have, should have, followed his intuition and prevented his most celebrated patient from dying. But he didn’t. Instead, when William Chapman Ralston, president of the Bank of California and citizen extraordinaire, closed the door to his collapsing bank that hot afternoon, Dr. Pitman should have seen that Ralston’s face was flushed and feverish and prevented him from taking his customary swim in the cold Pacific Ocean. But he didn’t.

Would you join me for a dip? the charismatic banker had asked.

No, I better not. Got something else to do, Jack’s father told him, never in the fifteen years since revealing what that something, if anything, was.

As depositors clamored outside the bank not far from where a competing bank had just opened, William Chapman Ralston, civic leader and member of the board of regents at the University of California, disrobed at Neptune Beach House, changed into his swim trunks, and plunged into the cool, natural elements that so often had given him relief from work’s pressures. Not long thereafter, local seamen found him floating dead in the waters off Alcatraz Island. The city was stunned. By the next day, all of the signature institutions for which Billy Ralston was known—the Bank of California, the mammoth Palace Hotel, and the California Theatre—were all draped in black. John Pitman could have prevented Billy Ralston’s death, but he had not been aggressive enough in diagnosing his condition.

Fifteen years later the landscape of the city had changed but not its memories. To this day, John Pitman Sr. still swallows hard every time he enters the Palace Hotel.

Jack, where will you set up shop? asked the doctor of his son, breaking the silence and bringing Jack back to the present.

I haven’t actually decided.

We could practice together.

I know, Dad. Jack recalled that had always been his father’s dream. I’ll let you know.

At Market, the two doctors, father and son, shook hands. Jack said good-bye and picked up his gait. He was heading for the Bella Union.

The familiar din of music and laughter inside broke into a chorus of more distinguishable sounds as Jack entered the fabled saloon. Double up! a businessman was saying to a table of poker players on his right.

Champagne, big boy? a call girl asked as Jack stepped further inside. They always tried to sell champagne first, since that was most expensive.

Maybe later, he replied. I see my friends now.

The call girl’s musk perfume dissipated as Jack unbuttoned his coat and inhaled the Havana smoke that permeated the air. Nate, the young longshoreman who had fetched him at the dock, was waving at Jack from a table in the middle of the room.

Seated next to him were Warren McWilliams and Max Morgan. Broad-shouldered with curly hair, Max had just graduated with Jack. Warren, the more suave of the two, was in his first year of practice, having graduated from Toland, as they still called the Medical Department, last year.

Ol’ Man Cole give that to you? asked Warren in a voice loud enough to be heard above the crowd. Jack nodded, grabbing a chair. „Thought so, said Warren. „I remember seeing it around his neck.

Jack had nearly forgotten about the keepsake instrument. „I used it for the first time tonight," Jack exclaimed.

„T-t-told them all-l-l about it!" Nate said.

„You poked a tube down a poor boy‘s throat?" asked Max.

„It was that or let him die," said the young doctor.

Max shook his head. Although his marks had been high enough to graduate, the burly man with hands as big as dinner plates wasn‘t one to read the journals. „Too expensive," he always said. Even in the library, they didn‘t hold his interest.

„Whad‘ya have, Max?" asked Warren.

„Why, food and drink, of course," said Max simply.

A barmaid who had heard him purred, „You need more than that, Sweet Doll!"

He spun his head around to see the face that matched the voice. She was a veteran saloon girl—older than was usually Max‘s preference, face attractively painted, and with a look and a wink that propositioned before a man could say „Evenin‘, Ma‘am."

„What‘s good tonight?" asked Jack.

„You mean, on the menu?"

„Yeah."

„Welsh Rabbit," she said.

„I‘ll take that and a Sazarac."

„Welsh Rabbit, yelled the waitress in the direction of the kitchen. „Two stouts and a Black Velvet for the rest of you, she said before the others could ask for refills. Behind the long bar, a bow-tied man shook a mixture of rye whiskey, bitters, absinthe and ice that made San Francisco‘s most notorious cocktail.

„Sazarac for you, said the barmaid, snapping the drink down. „A stout for the kid, she said with a wink, „a stout for his friend, and one Black Velvet." Warren drew out two silver dollars from his pocket.

„Thanks, Warren," said Jack.

„Here‘s to medicine," toasted his friend.

„Here‘s to graduation!"

The bray of a donkey and restless shifting of its hooves could be heard behind a large drawn curtain at the back of the room. A gas spotlight focused on a man who stepped onto a stage polished by years of nightly performances. „Citizens of San Francisco!" belted Ned Foster, the Bella‘s proprietor, a pot-bellied oaf with a piercing tenor voice. „It gives me great pleasure to introduce to you tonight San Francisco‘s most celebrated entertainer—Big Bertha!"

Foster must not have expected the crowd to grow quiet, for after the orchestra had played its fanfare signaling the hugely overweight Bertha to appear, whoops and hollers from the audience only increased.

Bertha, who almost always made her entrance atop a donkey, had been a favorite of San Franciscans for years. Tonight she would not disappoint them.

As Bertha wailed, and as Jack ate, Max allowed the barmaid, named Lola, to sit on his knee. It was a position they both enjoyed since it rested her bosom squarely on Max’s left shoulder, an inch away from his substantial nose and widening eyes. Boys, meet Lola, Max said, not caring whether they heard him or not.

Nate sat staring with amazement as Lola bent her head to nibble at Max’s ear.

It’s Bertha’s last song, she whispered to Max. Why don’t you follow me upstairs for a spell?

Don’t mind if I do, he said, excusing himself to follow her lead up the stairs at the back. Warren put a hand on Nate’s knee to keep him from rising, too.

Jack noticed that many of the call girls and an equal number of patrons had disappeared, at least temporarily.

„Is he going to make it?" asked Warren of Jack‘s classmate.

„As a doctor? . . . Dunno, answered Jack. „He likes medicine well enough. He‘s great with people. Did well at dissection. Just doesn‘t have a good memory for all those anatomical terms.

„Who needs t-t-terminology when you when you c-c-can feel your way?" offered Nate with a smirk.

Jack grinned at his young drinking buddy from the docks, then turned and asked Warren, „So how‘s your practice going? Is Sutter Street a good location?"

„Not bad. It took a while to get started. Not much trust in a young upstart, I s‘pose. The ol‘ ladies, they mostly go to their established doctors."

„...Yeah. Some of whom aren‘t doctors."

„True. But who am I to say, ‚Excuse me, Madam, but the doctor who gave you that prescription is full of malarkey‘? And, ‚Oh, by the way, the medicine he prescribed to get you off the bottle will instead get you addicted to morphine!‘ Thanks, but no thanks. I‘ll have a following soon enough."

„I know you will, Warren, said Jack, realizing the liquor and Bertha‘s ballads were starting to dull his senses. „Have you paid back your bills?

„Oh, sure. The rent is no problem. And I‘ve paid for all my instruments and books. It‘s some of the furnishings that the bank still owns."

„So, no problem, right?"

„No. Except."

„Except what?"

„I had hung out my sign. Tools were in their proper place, and no one came—except Matilda Massencamp selling tickets to the fair, and purveyors of patent medicines trying to get me to buy every miracle concoction known to man."

Jack let his friend continue.

„My first patient, I mean first real patient, wanted an abortion. That’s what she came to see me about."

Did you do it?

No. I referred her to someone else. My next patient was a simple bone fracture.

You must be making money now?

Yes. Things are improving. The young doctor downed the last of his stout, then with his fingers pressed the dark hairs of his mustache back into place.

During the past quarter hour, many more patrons had filtered in, including a foul-smelling greaser—vaguely familiar to Jack—who took Max’s chair without asking and sat in it, the back of the chair against the greasers chest. Some of the barmaids and gentlemen who had gone upstairs had returned. But not Max.

Unconcerned, Warren asked of Jack, Do you miss the docks?

A little. Not much. Warren knew that Jack had wanted early on to become a doctor but had had trouble figuring out what doctoring meant. Was it allopathy, or regular medicine, as most practitioners called it? Naturopathy, which relied on mostly herbal remedies? Or homeopathy, which contended minute doses of drugs were the answer?

Mankind progresses thousands of years, Jack would say. We have electricity. We have steam engines. We even have gasoline-powered automobiles; at least the Germans do. But medicine? My father still believes in cupping and purging!

At the table, Nate said that even if Jack didn’t miss the docks, they missed him. The u-u-union guys were real obl-bl-bliged at how many times you set their bo-bones straight, he said, recalling when Jack would witness accidents on the docks and offer to help.

Suddenly the reminiscing was interrupted.

"Accchr screeched the greaser nearby, clutching his stomach. I...need a doctor!

Blood began to drool from his mouth as he fell onto the floor.

He’s hemorrhaging, said Jack. He yelled to Warren, What do I do?

You don’t know? said a heavily accented voice from the crowd, nodding to the stethoscope that hung around Jack’s neck. You’re a doctor.

It was the famed medical showman, Pierre Louthan. Removing his neck scarf, he wrapped his fingers with it and cleaned out the stranger’s mouth, wadding the scarf into a ball and placing it in his coat pocket. Here, drink this, he said, uncapping a nostrum bottle from his other pocket.

The greaser took a gulp, shook his head and paused, the way an actor might on the stage. It’s working! You relieved my ulcer. He got up. How can I thank you enough?

Just buy more of my Vital Spirits, lad, said the top-hatted showman, loud enough for others to hear. It restores health, cures ulcers and rejuvenates what makes a man a man.

The hell it does! said Max, reappearing, the fakery of the showman’s remarks angering him. He swung his fist, missing the man whom he had seen hide the scarf, and hit the greaser. The brown-skinned laborer punched back—a low left, then a high right at Jack. Both connected. Max had taken the left in the side; Jack felt his head snap as the man’s right hit his eye.

All right, that’s enough, the hall’s giant bouncer said, causing chairs to shuffle as he separated the men.

It’s OK. We’ll leave, said Warren, a sophisticate who preferred negotiation to fighting.

Jack could feel that his brow was moist as they entered the night air.

Who was the ass with the medicine bottle? asked Max.

"That was Doctor Pierre Louthan," said Warren.

Same quack whose Chinese mindreader nearly expired on me this afternoon? said Jack angrily.

One and the same.

Arrogant bastard! He turned and started walking back to the Bella Union’s entrance only to be stopped by the doorman.

Come on, Jack, said Warren, who had chased after his friend. He probably left through another door anyway.

The four men walked past the El Dorado, another noisy saloon, then separated. It was past midnight. Warren went to his modest but well-appointed apartment atop Nob Hill. Max went to his boarding house south of Market. And Nate, with stories to tell, made a beeline to The Whale, a dive near the docks that stayed open all night for sailors and fishermen.

Jack meanwhile headed south for the hospital, hoping that all the hacks had not retired for the night. Luckily, they had not. Spotting one, he waved it over and climbed in.

Jack caught Sister Agnes’ glance when he arrived at the hospital, but instead of greeting him she said, Just have a seat and a doctor will be with you.

The young doctor smiled, realizing how with his swollen eye she had mistaken him for a patient, and without asking walked back to the ward where the Chinese boy lay.

Li Chi Chung and his sister, curled up on the cot next to Li’s feet, both were sleeping. Li’s mouth and throat hissed with each exhale. Although the tube had been removed, the swollen membrane in the boy’s mouth had not completely receded.

I wash it every hour with saline, said an aproned Chinese woman appearing from the darkness. Jack figured the round-faced grandmother with the kindly smile was a volunteer.

Just watch him carefully to make sure the airway remains open, Jack said.

I will, said the old woman with only a moderate accent. You been in a fight?

Yes.

Please, let me clean it for you. It wasn’t a request as much as a statement. For the next hour, after she had cleaned the wound and applied a compress, the woman named Madam Wong conversed with Jack.

You like Chinese tea? she asked, pointing to a stove in the darkness where water was kept on a low boil.

„Yes, I‘d appreciate that," he whispered, trying not to disturb the children.

The squatty woman stood, ambled a careful course between the cots of sleeping patients, her wood-soled shoes clicking softly, and returned with two empty cups into which she had dropped a pinch of leaves from a tin in her apron and poured boiling water. she peered into his cup to watch the leaves settle, then smiled, handing it to him. „You will have good fortune."

Her gentle demeanor was as reassuring as her words, Jack thought.

„.. .but not without trials."

„Trials?"

Madam Wong switched the subject. „Do you know the origin of tea?"

He shook his head. The old woman took a seat beside him and in her calm, measured voice explained the ancient legend of how the tea plant originated in China from a criminal‘s eyelids that had been chopped off as punishment. Where the eyelids fell, a plant grew, producing the flavorful leaves whose broth keeps the weary from sleeping.

„I don‘t need to stay awake. I need sleep," he said.

„The tea is not strong. You will have no problem sleeping."

The young doctor with the bruised eye looked at the boy and explained how he had become his first patient.

„We make good team, she said. „You with your tube and me with my herbs.

„You gave him herbs?"

she nodded. „He is Chinese. He respond to my medicine, too."

„What herbs?"

„You would not believe me if I told you."

He paused, suddenly aware that the body of knowledge he had acquired at Toland was only the beginning of his medical journey. „No, try me."

„It‘s called Ma Huang. It is made from the horsetail plant. It reduces inflammation. Then add deer antler—in powdered form, of course. The deer antler is for strength."

I see, he mused, reluctant to argue thousands of years of medical tradition in China.

For a long while there was silence, except for the muffled steps of the ever-watchful nun who checked on them from time to time and the variations of breathing that came from faceless patients sleeping on cots in different parts of the ward. Many had been quieted for the night with narcotics.

Madam Wong disappeared, then returned with a blanket. You sleep now, she said, placing the blanket on an empty cot.

But I have to get home.

True doctor waits to make sure patient OK, she said. Besides. It’s almost morning. Sleep while you can, child.

He maneuvered onto the cot head down, closed his eyes, took a deep breath and let his muscles go limp. She was old enough to be his mother, he thought. Child? The reference lingered in his mind.

2

Sunlight filtered into the ward giving definition to patients who had only been outlines the night before. Jack rose to see two nuns struggling to help a large man sit so he could take his medicine.

Here, let me help you, he said, reaching behind the man to push him forward from his middle back. As the man’s head came up, Jack saw two shallow incisions on the back of his neck near the hairline.

You’ve been venesected. One of the sisters grabbed a pillow to give the man support.

He looked up. That’s right. Usually four or five cups. In this case it was six. That’s when I blacked out.

Six cups of blood, Jack thought. It was a good thing the man was overweight, or he might have died outright.

The man, about 50, said he had been feeling feverish. He wasn’t getting along with his wife and had gone in for another treatment.

I usually feel better afterwards. . . . But not this time.

Jack wanted to explain that the practice of lancing the skin to extract blood was a carryover from when the early physicians drew blood to draw out evil spirits. Herodotus would even cup the temples to evacuate offending matter from the head. Twenty-two centuries later, George Washington might have survived his sore throat had doctors not bled him to death.

Sir...

Charles Wright. You can call me Charles.

Venesection may still be widely practiced. Jack took a breath. But in your case, it is not recommended. At least by me, anyway.

Charles scratched his nearly bald head.

Jack took the stethoscope from around his neck. What is your affliction?

The man leaned reluctantly toward his questioner. Impotence, he whispered, trying to conceal his answer from the nuns.

Nurse, Jack called out to the man’s surprise. Where is Madam Wong?

He heard her now familiar clickety-clack behind him. Here I am, sang her kindly voice.

Jack whispered the man’s condition in her ear, then asked, Do you have ginseng?

Of course. Always have ginseng. She went off to ground the root of the plant widely known in the Orient for its strength-inducing properties.

Jack asked Sister Agnes to fetch some beef broth and a bowl of fruit to restore the patient’s blood.

Come see me and let me know how you’re doing, Jack said to the man.

How will I find you?

The young doctor thought for a moment. Good question! I’m new at this. I mean, I just graduated from Toland. . . . Haven’t even figured out where my office is gonna be. But I’ll tell you what. You see Madam Wong in a few days. I’ll let her know my whereabouts. In the meantime, she is bringing you a special tea. Drink it until it’s finished. Then drink some more. If it doesn’t taste good, you’ll know it’s working.

But I don’t need more fluids, he said, grabbing his belly and fluttering it so Jack could see.

Charles, soup and tea won’t make you fat any more than cupping will reduce your weight. What you need is exercise.

The man scowled at the thought.

Do you take the cable car to work?

He nodded reluctantly.

Then I suggest you get off a few blocks early and walk the rest of the way. You’ll be amazed at how much better you feel.

"Hrrumph!"emitted Charles.

Just as the young physician was noticing another doctor consoling a crying woman in the far corner of the ward, a familiar-sounding voice called out from the hallway.

Prince Li. Gather yourself. We’ve leaving.

it was Marie. Dressed in an ankle-length, maroon-colored dress with a ruffled blouse and ostrich-plumed hat to match, her entrance caused all heads to turn.

Jack stood erect beside the boy’s cot.

Li, come on, said Marie. We have an appointment at City Hall.

Just a minute, Jack warned, but she ignored him.

I am better now, said the patient, looking up at Jack. Thank you for saving my life.

Marie, the boy has diphtheria.

She reached down to feel his head. He doesn’t have a temperature.

He’s still recuperating.

Then he can recuperate with me! she said, grabbing the boy’s silk jacket and cap.

The sister glared at Marie, then pleaded with tearing eyes at Jack. She tugged at Madam Wong’s apron. Ngo goh goh chang mei ho fan.

Mei Ling say she is afraid for her brother, the elderly woman explained.

Marie interrupted. All due respect, Mr. Pitman...

It’s Doctor Pitman to you.

All due respect, Mr. Pitman. This boy has his own doctor, and he will be in his charge. So if you’ll please excuse us, we’ll be on our way.

She said the words with surprising composure, which angered Jack, because at that moment he wanted to argue.

Helping the boy to his feet, Marie pulled his rumpled clothes straight and directed him to put on his coat. Jack leaned down. He motioned for the boy to open his mouth so he could check his throat. The disease was receding. Jack’s hand was still on Li’s head when she pulled him away.

Mr. Pitman, she said turning, looking squarely into his bruised eye. You are not a doctor. You haven’t even opened an office. You are a street fighter. That means you have street sense, nothing more.

The comment stung, referring to his days before medical school when fists were the language of the dockworkers. How could she have known? Did she ask about him around town?

He wanted to spin her around and shout into her face that the boy was not fit to travel, but she had begun to leave and had Li