From China, the bubonic plague is brought to the West Indies by way of Marseilles and other European ports. Rats from the infected Pendown Castle escape in St. Hubert, and the first victim dies of plague. This small tropical city of a hundred thousand inhabitants is a British possession, the governor being Colonel Sir Robert Fairlamb. Next in social prominence is Sir Robert's critic, Hon. Cecil Eric George Twyford. Kellett the Red Leg, advocate of economy, has dismissed the official rat-catcher of St. Hubert, much to the disapproval of his political enemy, George William Vertigan. Dr. Inchcape Jones thinks that infectious diseases carried by rats cannot exist in St. Hubert. Dr. Stokes, an American physician, thinks otherwise, but even when there is a death from the plague, Dr. Jones considers it an isolated case and insists there will be no more. There are more immediately.
Blackwater, the port of St. Hubert, maintains a bar and restaurant known as the Ice House, where homesick rum swizzlers meet. George William Vertigan, a jolly and regular customer, dies of plague two days after a visit there. Panic envelops St. Hubert as the epidemic spreads, but there is no quarantine. Sir Robert Fairlamb tries to reassure the people that there is no danger, but Dr. Stokes of St. Swithin's secretly writes to Dr. Max Gottlieb, Director of McGurk Institute, in New York.
A complete change of scene and a new cast of characters are features in this chapter, half a dozen new people being introduced. There is much local color as background for the action, for West Indies scenery is exotic. Descriptions of the disease itself are detailed, horrifying, and no doubt accurate. Years later, Albert Camus, French Nobel Prize winner of 1957, was to build a whole novel, La Peste, around a similar scourge in Oran. Whether Camus had read Lewis is a matter for speculation. The most exciting and interesting part of Arrowsmith begins with this chapter, for all its sometimes revolting realism.