By John Rolfe Gardiner Knopf. 275 pp. $24

Reviewed by Audrey C. Foote

While deaths in war by gun or by germ are both final and may be equally painful, a loss from disease seems less heroic, more wasteful. And since infections, unlike wounds, are rarely deliberate, they are assumed to be more easily prevented -- or at least curable. This is the expectation of the two major characters in this novel, a conscientious middle-aged American doctor, Major William Lloyd, who in the summer of 1918 volunteers to run a hospital at Chaumont in France, and his unlikely assistant, a devout French peasant woman who knows more about respiratory diseases than the hospital's French nuns or the capable but adventure-seeking American nurses -- and in fact even more than the doctor himself.

Jeanne Prie, as she calls herself in honor of her patron saint, Jeanne d'Arc, had previously managed to get work in the Louis Pasteur laboratories, then trained as an observant lab maid for Jules Bordet, a pioneer in inoculation. No medical experience could have been more valuable during World War I. Source Records of the Great War (1923) reports that although more than 40,000 American soldiers died of pneumonia alone, this was "the first war in which the United States has been engaged that showed a lower death rate from disease than from battle." Obvious reasons for the improvement were cleaner water and better nursing and doctoring -- -and compulsory vaccinations. Pasteur had said at the opening in 1888 of the institute named for him, "The law of which we are the instruments strives even through carnage to cure the wounds due to the law of war. Treatment by our antiseptic methods may preserve the lives of thousands of soldiers."

With the anxious collusion of Dr. Lloyd, Jeanne clandestinely embarks on dangerous and often repulsive experiments (often involving the eyeballs of oxen, excrement and cherished colonies of head lice) in her effort to develop vaccines and cures for the fevers consuming their agonized patients -- English, French and German as well as American. In fact, her favorite patient is a young German soldier who has lost three limbs yet volunteers, as he puts it, to be her Stechnadelkissen (pincushion) for trial injections, though he himself is beyond hope of recovery.

The book's strongest scenes are in the hospital, where Jeanne is a dominant and most original figure. Somewhat pallid in her shadow, the doctor is a good, honorable man for whom one hopes the best while not expecting it. Otherwise, apart from the mostly doomed patients, the characters -- military or civilian -- bleakly range from the disagreeable to the despicable: a cowardly colonel, an insolent nurse, a melodramatically wicked adjutant, and mercenary or mistrustful French villagers. Meanwhile back in America, a three-generation family that these days might be labeled dysfunctional squabbles over the doctor's dutifully written but heavily censored letters.

The narrative shuttles between the French hospital with its staff and patients and the doctor's family estate on Long Island, where his wife and three children have moved in with his elderly mother for fear of influenza in the city. They are a charmless crew, but much of the characterization of these relatives seems unduly rancorous, as if not so much reflecting the doctor's own view of his family as rising from some resentful authorial voice. The old mother is distracted and indecisive. Emma, his wife, is critical, sour and unable to rein in her silly young daughter or two ghastly college-age sons, one pretentious and sly, the other a dropout and draft dodger who quarrels with the chauffeur and is briefly suspected of murder. Finally inducted, he is sent to France, where he nearly dies, is saved by Jeanne's vaccine, but gives all credit to the evil adjutant, fawning on him as a protector.

At the end of the book, Gardiner offers an intriguing postscript, noting that the boyhood letters of the doctor to his parents presented early on in the book are based on actual letters written by the author's grandfather, who was a doctor based in France during World War I, and later divorced his wife to marry a French nurse.

Unlike in such classic war novels as Erich Maria Remarque's All Quiet on the Western Front, Ford Madox Ford's Parade's End or Roger Martin du Gard's Les Thibault, no battle action or trench warfare is depicted in Gardiner's story. The danger here is not artillery but infection; the drama is the suffering of the dying. Its hero is not a soldier or an officer or even the doctor, but the French nurse. Tough, brave, shrewd, compassionate and devout, looking like a farm girl in her shabby, makeshift uniform and short-cropped hair, she is a rustic heroine very much in the style of George Bernard Shaw's Saint Joan. It is she who, by force of her personality, her selfless medical mission and the mythic resonance of her adopted name, finally saves patients and the good doctor too (though not with vaccine) and gives this novel its distinction.

Audrey C. Foote, who has lived in France, is a Washington teacher and critic.