BiographyThis is an excellent book of superlative horror, about surgery before anaesthetics, when doctors depended on grave-robbers to supply cadavers for experimental dissection.
Druin Burch, a 34-year-old physician of admirable literary suavity, when working in the A&E rooms of hospitals in England became interested in what his job was like in even more arduous conditions two centuries ago. He is both rigorously objective medically and subjectively humane. He teaches human evolution, physiology and ecology at Oxford, writes for the Lancet, the British Medical Journal, the Times Literary Supplement and the Guardian, and appreciates birdsong and flowers in his garden in the Cotswolds. He seems to be the sort of doctor who would be welcome beside any deathbed. Such is his expert knowledge and charm that it might prove not to be a deathbed after all.
Now he has written about pioneer surgery in a biography of Sir Astley Paston Cooper (1768-1841), one of the profession's most ambitious, industrious and successful practitioners.
ASTLEY WAS BORN in Norfolk, son of a clergyman who, as the saying went, married well. His wife had "a significant fortune", Burch writes, "and her landowning father controlled a Church living . . . " Their home was a manor house and they rode to church in a carriage drawn by six black horses.
"Open, cheerful and brimming with physical courage, he was an attractive child," who enjoyed playing practical jokes. "He altered the clock hands on the church while his father was inside, confusing both the villagers waiting outside and the Reverend alone within." Astley "dressed as Satan, convincing the sexton's drunk wife to sell him her soul. She woke the next day, believing the memory to have been an intoxicated dream, to find to her horror that she was in possession of some very real money." He grew up tall and handsome, "with a taste and talent for boldness." Frivolous at first as an apprentice apothecary, he decided seriously to become a surgeon after witnessing the performance of a lithotomy, an operation to remove a stone, on that occasion from a man's bladder. Burch describes the surgical procedure in exquisitely appalling detail. The description may make women glad not to be male, and make men wish they were constructed differently. Lithotomy without anaesthetic made men scream; just reading about it made me whimper. Surgical access to the bladder was through the penis.
"For Astley Cooper," according to Burch, "the great passion of his life was anatomising." Throughout his long, illustrious career, he felt compelled to dissect bodies, dead or alive, every day. He required regular, secret back-door deliveries of the dead, far more than the quota permitted legally. When Henry VIII combined the companies of Barbers and Surgeons in 1540, he allowed them the bodies of four executed criminals a year. Charles II increased the allowance to six a year. After a 1752 act of parliament judges were authorised to decide what to do with the bodies of hanged murderers. But in Cooper's time the legal supply was never enough. He had to engage the services of body-snatchers, who ventured into graveyards at night to dig up newly buried corpses. Cooper developed such an extensive network of contacts with these ghoulish scavengers, nationwide, that he boasted to House of Commons investigators there was no man or woman in Britain whose dead body he could not obtain. He also practised on live dogs and cats caught in the streets and any other creatures he could get his scalpel into.
HE BELIEVED CORRECTLY that speculation and theory were not enough to prepare for surgery. There was nothing as useful as observation and experiment. After years of dissection, he was able to operate with accuracy and speed on men and women. His technical virtuosity and charisma were applauded by his acolytes at Guy's Hospital and St Thomas's, and often the patients survived.
Diligence, skill and amiability enabled Cooper to rise to the top of the medical hierarchy. Keats was one of his underlings at Guy's, while he recognised Apollo as god of medicine as well as poetry. Cooper treated many indigents free; however, as his public reputation grew he was able to demand the highest fees. As a young man he was politically radical, but with growing success he became a Tory. He moved from his house close to the hospitals in the city to a more fashionable address in the West End, gave up charitable work and catered preferentially to wealthy merchants and the aristocracy. Royalty patronised him. William IV awarded Cooper a baronetcy and the Grand Cross of the Order of Guelph. As sergeant-surgeon to the court, he had the opportunity to conduct George IV's autopsy and to embalm William IV, and was retained by Queen Victoria. Honours came to him from France, Sweden, Russia, Germany, Holland, Sicily, the United States and Mexico, in addition to his own country. He died a very rich man. At the time of his death, the Quarterly Review said he was the richest doctor who ever lived.
Writing with the insight of his own medical experience and research, Burch says "there is no longer so much of a role for the celebrity surgeon when operations are driven by protocol". Perhaps some surgeons would agree.
Patrick Skene Catling is an author
Digging Up The Dead: Uncovering the Life And Times of an Extraordinary Surgeon By Druin Burch Chatto & Windus, 276pp. £20