The tenth of January, 2011: thank-you, I feel fine

Thanks to a combination of a visit to the dentist (I’m fine, thanks) and Richard Hollingham’s Blood And Guts: A History Of Surgery (BBC Books, 2008), my thoughts have been on the process of chopping people up to make them better.

Hollingham’s excellent book is, as he notes in his preface, very much a history rather than the history (I would’ve liked more on John Hunter, for instance – but not to worry, because one of my favourite Hunter stories cropped up in a fascinating article in my morning paper today).

I found the whole book pretty compelling (I’m pretty unsqueamish, and winced only at the accounts of Gaspare Tagliacozzi’s early experiments in plastic surgery (for those rendered noseless by syphilis) and of Walter Freeman’s disgusting (and notorious) ice-pick lobotomies).

The latter put me in mind of a poem by Dannie Abse. Actually, to be strictly accurate, it put me in mind of one key phrase from the poem (you’ll guess which) – I only later remembered its source. Abse was a doctor as well as a poet. His brother, Dr Wilfred Abse, worked as dresser (assistant) for the noted brain surgeon Lambert Rogers. The poem describes a real-life incident in the career of Wilfred Abse – from the days (1938) when locating a brain tumour involved more poking around in the grey matter than most brain-owners would like.

In The Theatre

Sister saying—‘Soon you’ll be back in the ward,’

sister thinking—‘Only two more on the list,’

the patient saying—‘Thank you, I feel fine’;

small voices, small lies, nothing untoward,

though, soon, he would blink again and again

because of the fingers of Lambert Rogers,

rash as a blind man’s, inside his soft brain.

 

If items of horror can make a man laugh

then laugh at this: one hour later, the growth

still undiscovered, ticking its own wild time;

more brain mashed because of the probe’s braille path;

 

Lambert Rogers desperate, fingering still;

his dresser thinking, ‘Christ! Two more on the list,

a cisternal puncture and a neural cyst.’

 

Then, suddenly, the cracked record in the brain,

a ventriloquist voice that cried, ‘You sod,

leave my soul alone, leave my soul alone,’—

the patient’s dummy lips moving to that refrain,

the patient’s eyes too wide. And, shocked,

Lambert Rogers drawing out the probe

with nurses, students, sister, petrified.

 

‘Leave my soul alone, leave my soul alone,’

that voice so arctic and that cry so odd

had nowhere else to go—till the antique

gramophone wound down and the words began

to blur and slow, ‘ … leave … my … soul … alone … ’

to cease at last when something other died.

And silence matched the silence under snow.

I’m a thoroughgoing materialist, but still, that doesn’t half give me the willies. I found it in the utterly essential Faber Book of Science, John Carey ed. (Faber, 1995).

I’ve had my own stab (so to speak) at surgical literature. The following is taken from my latest work-in-progress, as 18th century surgeon Henry Mendel pays a call on a butcher’s wife with a bad tummy-ache.

He thought of fat Pepys as thin Pol Coldwater lolled drunkenly on the stripped bed. But that was only a calculus from a bladder. This –

‘Ought I pray, Mr Mendel?’ offered Coldwater solicitously.

‘No.’

Mendel’s blades in their leather case were spread on a side table behind Mendel’s back. Also an empty cup and an empty glass. Mendel had pulled the curtains from the high window. On the bed Pol Colwater lay in a crossed rectangle of white light.

‘No?’

‘Do you love your wife, Mr Coldwater?’

Coldwater’s feet ceased to creak the boards.

‘I give her four boys, didn’t I?’ Defensiveness wound the butcher’s voice to a querulous pitch. ‘I said I’d pray for her, Mr Mendel, didn’t I?’

‘You did,’ Mendel nodded. He unsheathed from the leather case a scalpel and Coldwater fell silent and again the boards creaked beneath his feet. ‘Love may have a place here,’ Mendel murmured, bending over Pol’s body. ‘Prayer has not.’ He looked up, meeting the eye of Coldwater at the foot of the bed. ‘Hold her,’ he said.

Coldwater, moving to the opposite side of the bed, leaned and laid pink hands on Pol’s bare white shoulders.

Fingers must always do as fingers are told. It has been done before, Mendel reminded himself. The gentleman Claudius Amyan performed the operation at Saint George and it was said the child lived.

As for the disease: Heister and Mestevier have spoken of it in the dead. As also the Frenchman Fernel in the days of Henry the jouster. The caecal worm turns bad and must be removed like a grub from an apple. The belly of Mendel’s scalpel-blade touched Pol’s skin. Pol giggled, and, slobberingly, kissed the air.

Again Mendel said: ‘Hold her.’

A heartbeat’s pause. A breath. The surgeon must breathe. Incision.

Pol Coldwater bled before she screamed: a wet red line following the scalpel edge.

‘We must be swift,’ Mendel muttered, prising open the three-inch wound. ‘Many die from the wounds but as many die from fright.’

Pol, now screaming, kicked against the torn sheets that bound her by her ankles to her bedposts.

‘No, Pol,’ Coldwater said sternly. He bore down hard on her shoulders.

‘A nightmare, Mrs Coldwater, from which you will soon wake,’ Mendel said. He licked his lips and tasted sweat. Pol screamed on without words. In the screaming Mendel heard an interrogative note. Why. What.

‘Stifle her, sir,’ he shouted.

Coldwater’s weight shook the bed. With one knee on the bed’s timber frame and a hand gripping each wrist he had dropped his body on to Pol’s, pressing his chest across her face, forcing her into stillness. Still her feet kicked but Mendel’s knots held.

‘Bold work, sir,’ Mendel smiled bleakly. ‘But see that the woman can breathe.’

The screams now were muffled by Coldwater’s chest and Mendel paid them no mind. He peeled aside skin and fat and holding apart the lips of the wound with his left forefinger he eased the blade through the tripelike peritoneum. Inhere lies the worm. But where? Mendel’s third finger pushed beneath the omentum majus, slid across the ribbed skin of Pol Coldwater’s lower bowel, groped for the caecum. In his mind Mendel recalled his researches, his winter rootling in the vitals of dog and monkey: from gut to caecum, and from caecum – yes. Here the muscular ribbons of the teniae coli converged: here was the worm, here the disease. With two fingers Mendel loosed the appendix from its bed of warm, oily tissue. He brought it to the wound.

‘Dear God,’ panting Coldwater wheezed. Beneath him his wife sobbed. The appendix held between Mendel’s knuckles was black with blood.

‘The worm,’ Mendel announced.

At the first blow the scalpel snagged. We must take great care, great care. Mendel tugged, chopped again. Thin blood welled around his finger-ends. The worm came away.

‘Praise God,’ gasped Coldwater.

Mendel, throwing the black appendix to the floor, said: ‘The work is not God’s and, besides, the work is not yet done.’ He set his scalpel down carefully on Pol’s belly and with his left hand reached for a threaded needle. Through the fingers that held the seeping stump of the gut he could feel the beat of Pol’s heart. ‘Hold her still, now, sir, still as still,’ he said.

Mendel’s snaking wrist drew figures in the damp air as the needle was drawn through the gutskin in a a purse-string stitch, closing off the severance. Then the fibrous belly muscle, resistant to the poking needle point. Then the white skin.

Mendel straightened carefully, touching one hand to his lower back. The fabric of his shirt was wet. He turned and pushed the soiled needle into the leather of his scalpel case. With care he opened his cramped right hand and flexed the fingers.

Coldwater’s voice was hesitant and low.

‘Over?

‘Over.’ Mendel wiped fingers on breeches.

This has been an unreasonably long Clutterbuck. It’s probably taken you a while to read this far. Perhaps you should consider that Robert Liston (1794-1847) could amputate a leg in twenty-five seconds, and ask yourself whether your time could be more profitably spent.

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