Prologue

‘Into the depths of our common nature’ John Brown qualified as a surgeon in Edinburgh in 1833. He had been apprenticed to one of the greatest of Scotland’s surgeons in the first half of the century, James Syme, whom he revered. Brown practised as a physician, gaining modest fame through his literary endeavours following the publication of the story ‘Rab and His Friends’.1 Appearing in 1858 as a pamphlet, the story was often re- printed and translated in the following half century. It long out- lasted its author, who died in 1882 having never equalled his first literary work in power or popularity. Ostensibly the story of Rab, a big, scarred mongrel belonging to James, an Edinburgh carter, it is rather a deeply felt description of the death of James’s wife Allie after a surgical operation. Brown later recorded how he had come to write the story while on holiday at Biggar, south of Edinburgh, in the mid-1850s. He sat down at twelve one mid-summer’s night, not rising to go to bed until dawn. He recalled how the story had come on him ‘at intervals, almost painfully, as if demanding to be told’.2 Pressed later to declare it fact or fiction, he told a friend and colleague that it was ‘in all essentials strictly a matter of fact’.3 Brown’s story tells how, as a medical student late in 1830 he meets James and Allie, a devoted and seemingly childless couple in their sixties. Allie consults Brown over a growth in her right breast. He examines her and finds it ‘hard as a stone, centre of horrid pain’ and he muses why she should have been ‘condemned by God to bear such a burden’. He calls in his senior, the taciturn Syme, who declares the growth to be malignant. Syme explains Allie’s predicament succinctly: ‘there could be no doubt it must kill her, and soon. It could be removed – it might never return – it would give her speedy relief – she should have it done.’ Allie looks at James and asks, ‘When?’ ‘Tomorrow’, Syme replies. Brown’s description of the operation occupies a few lines. He relates how the operating room of Syme’s private clinic, Minto House, is crowded with noisy students eager to secure good places to

7 Peter Stanley observe a ‘capital operation’. ‘Don’t think them heartless,’ he counsels. He explains that for students pity lessened as an emotion but gained power and purpose as a motive. Then, amid the clamour, Allie enters, her quiet dignity hushing the students. Behind her come James and Rab the dog. Allie climbs onto the table, still in her street clothes. She arranges her dress to expose her chest, rests on Brown and holds his hand as Syme begins cutting. She remains composed and silent all through a long operation. James sits with Rab’s head between his knees, staring at the floor, restraining his growling. At the end, Allie steps down from the table, turns to Syme and his still silent students and curtsies, begging their pardon if she has behaved ill. Brown and his fellow students weep like children. She is helped to a room where, at first, the wound appears to be healing cleanly – ‘at first intention’, as they said. Four days later, however, she lapses into delirium, imagining that she holds a long-dead baby to her bandaged chest, and she dies of post-operative infection. Victorian sentimentality and Presbyterian piety cannot mask the profound feeling of Brown’s description of Allie’s last hours, and of James’s grief. Reflecting upon what he had witnessed as Syme’s surgical pupil, Brown felt that his exposure to the operating room had allowed him to ‘see down into the depths of our common nature’. Like Allie, he had felt ‘the strong and gentle touch that we all need and never forget’. A sort of literary Landseer, Brown saw in the noble, pugnacious Rab ‘the three cardinal virtues of dog or man – courage, endurance and skill’.4 We infer that his mentor, Syme, and his patient, Allie, shared at least the first two qualities. The popularity of John Brown’s story – among a generation for which painful surgery was a recent memory – suggests how the dread of surgery had penetrated deeply into the psyche of its readers. The tale embodies many of the elements of this book. It illuminates the character and skill of surgeons; the place of students; the drama of the operating room; the limitations of contemporary medicine: above all, the plight of patients and their fortitude in undergoing an ordeal which is for us almost – but not quite – unimaginable. The story of Allie’s operation brings us into this world. This book, then, investigates the training and practice of British surgeons in the first half of the nineteenth century, between the death of John Hunter in 1793 and the acceptance of chemical anaesthesia about 1850: the final decades of painful surgery. It focuses on the relationships between surgeons, between surgeons and their pupils and between both and their patients. It is motivated by two central questions: how could surgeons like James Syme bring themselves to 8