by John Hicks
~
Whilst we are ensconced in the nether regions I would be remiss not to mention an operation of an even more horrific nature practised in Fiji and Tonga, as recorded in the first volume of that well known British medical journal The Lancet, (17th January 1834). In an article entitled Traumatic Tetanus, one R. Liston (presumably Robert Liston, the famous surgeon) uncritically transplanted this section from Mariner’s Voyage to the Tonga Islands.
Tetanus, it appears was a very common disease among the natives of Fiji:
…who from their warlike habits, are more frequently in the way of it; they adopt, however, a remedy which the Tonga people have borrowed from them, and consists of the operation of tocolosi, or passing a reed first wetted with saliva into the urethra, so as to occasion a considerable irritation and discharge of blood; and if the general spasm be very violent, they make a seton of this passage, by way of passing down a double thread looped over the end of the reed; and when it is felt in the perineum [echoes of Hollier’s itinerarium here] they cut down upon it, seize hold of the thread, and withdraw the reed, so that the two ends of the thread hang from the orifice of the urethra, and the doubled part from the artificial opening in the perineum; the thread is occasionally drawn backwards and forwards, which excites very great pain and abundant discharge of blood.
Liston claimed that thirty to forty per cent of cases of tetanus recovered as a result of tocolosi, but he was merely recycling Mariner’s hearsay evidence. As a cure for tetanus, tocolosi makes no sense. It is medical rubbish.
While it is entirely possible that the pain produced by this barbaric procedure would be enough to evince signs of life from a near corpse, it is to be hoped that early nineteenth century English physicians were not, as a consequence of this gem in The Lancet, inspired to inflict tocolosi on any of their patients. However, the early nineteenth century was an age of untrammelled experimentation and large egos and it is entirely possible that they did.
Robert Liston (1794 – 1847), surgeon and anatomist, was described (by medical author Roy Porter) as …a lion of a man with a sharp knife and a sharper temper. Speed was his forte, biting his blade between his teeth like a butcher so as to free his hands to save time. Lithotomy [stone removal], he declared, ‘should not occupy more than two or three minutes at most’.
It is possible to imagine this tall, powerful and celebrated man marching round to the editors of The Lancet, scalpel clenched between his teeth, demanding publication in their journal. How could they refuse?
Before anaesthetics, speed was of the essence. Liston’s students were in the habit of timing his operations with their stopwatches. Whereas his fellow surgeons, in these days before anaesthetics, might require six men to restrain and assist with the amputation of a leg, Liston was strong enough to use only one. Operating with great speed and skill, he compressed the femoral artery with his left hand while doing all the cutting and sawing with his right.
It is sobering to realise that, almost until Liston’s day, surgery had scarcely advanced over nearly two thousand years. Celsus, a Roman surgeon of the first century, described techniques of plastic surgery and, indeed, bladder surgery – including precise directions for crushing and removing stones. Celsus claimed that a surgeon should be …youthful or in early middle age, with a strong and steady hand, as expert with the left hand as the right, with vision sharp and clear, and spirit undaunted; so far void of pity that while he wishes only to cure his patient, yet is not moved by his cries to go too fast, or cut less than is necessary. Someone, in fact, very like Liston.
From the mid nineteenth century, surgery and medical knowledge expanded rapidly. Liston, himself, performed the first major operation in Europe with the benefit of anaesthesia in December, 1846 – a thigh amputation. At its successful completion he is supposed to have remarked, “Gentlemen, this Yankee dodge beats mesmerism hollow”. However, the need for hygiene to prevent post-operative infections was still unrecognised. The death rate following limb amputations varied between 25 and 60 per cent in the 1850s and, in military practice, was as high as 90 per cent; change in the army always came slowly. Dr John Hall, the Chief of Medical Staff of the British Expeditionary Army during the Crimean War, was an unpleasant character: a flogging disciplinarian who treated the troops like scum. He was vindictive and obstructive towards Florence Nightingale when she was lobbying for re-organisation of the inefficiently run and appallingly unsanitary military hospitals. In a letter of instructions to his officers at the start of the campaign he had warned them against the use of chloroform. The smart use of the knife is a powerful stimulant and it is much better to hear a man bawl lustily than to see him sink silently into the grave.
There is a gruesome satisfaction to be had from reading these accounts and counting our blessings in the (perhaps false) belief that we live in a more enlightened age; or even to contemplate that while refined nineteenth century society languished in the regency drawing rooms of Bath, something far more vigorous was going on in coir huts on the other side of the world. What would the genteel Jane Austen have made of tocolosi? And yet, medical knowledge would have remained static without these early and only partially controlled experiments on the human body.
Jane Austen had her own health problems. Medical historians have deduced that she died of Addison’s disease. She was only forty-two. The study of endocrinology dates from 1849 when Dr Thomas Addison first described the condition named after him and showed that it was caused by disease of the adrenal glands.
Since my surgical interventions on Max’s behalf, I have had a rather large taste of modern medicine and surgery myself, and it has given me the incentive to reflect on these things. With the wisdom of age I suggest that it would immeasurably improve patient care were surgeons to be on the receiving end of their treatments before they were allowed to inflict them on others. Of course, this is an impractical notion: Robert Liston would have become hopping mad and, with repeated incursions, completely stumped.
When Viv and I returned to New Zealand from a stint in small animal (dog and cat) practice in Yorkshire, I was thirty. It had been a valuable eighteen months’ experience for me, but our years in Taranaki and Ashburton had given us a taste for the more relaxed New Zealand lifestyle and, apart from the ordeal of re-separating from our families, we couldn’t wait to return.
Chapter Nine
Southland and New Beginnings
Immigration is the sincerest form of flattery. – Jack Paar
When Viv and I returned from England there were only two vacancies for vets in the whole South Island, the place we dearly wanted to be. One was at Hokitika on the West Coast, the other a locum position for six weeks in Otautau, Southland. It had to be Otautau because, as Viv said, “You know how I react to sandfly bites.” The West Coast, although an area of outstanding interest and beauty, is well known for the voracity of its sandflies.
We, like most New Zealanders, knew little about Southland. I had imbibed the “frozen wasteland” propaganda reinforced in the minds of other New Zealanders by the evening weather forecasts, and the negativity of Auckland-based travel agents. But Southland has a fascinating history and, when you start to grasp the history of a place you begin to belong to it and feel at home.
Two years before Jane Austen’s birth, Captain James Cook made his first landfall in the far south of New Zealand – among the fiords on its western edge. Fiordland. It was then – and still is – by far the wildest part of the country. The Resolution had spent four months probing deep into Antarctic waters in search of the great southern continent without success, and he decided to rest his crew …it must be natural for me to wish to injoy some short repose in a harbour where I can procure some refreshments for my people of which they begin to stand in need of…. So, on 26th March 1773, the great man brought his ship to anchor in the safe harbour of Dusky Sound – a place he had noted, but been unable to visit, on his earlier voyage (1768-1771) in the Endeavour. For five weeks he and his crew recovered and explored the
area. The stumps of trees he felled to fix latitude and longitude are still identifiable at Astronomer Point. Many of the other place names he bestowed on local landmarks live on, and have replaced those by which they would have been known to the few Maori families he came across – such as the place of his first recorded encounter with them: Indian Island.
Dusky Sound retains the impress of history. Just over two-hundred years after Cook’s visit, and after three days of rough tramping, I was thankful to lower the pack from my back, sit on the rocks outside the remote hut at Supper Cove and drink in the peace. It is a changeless place. Bellbirds chant their clear tones across its glassy waters, much as Cook’s crew would have heard them. Dark, dense forests still cloak its steep shores. The ghosts of Cook’s visit remain; a keen imagination can people the emptiness, and the mere matter of two hundred years dissolve away in the eerie stillness of its cool mists.
Close your eyes and listen... Light waves slap the hollow planks; rowlocks creak as men row ashore; timber spars groan under damp ropes; a pungent waft of tar drifts from men caulking their wounded ship, unsprung by the battering of the Great Southern Ocean. Hoarse voices, hardened by months under sail, slur, become whispers and the scene fades… I, too, will have freshly caught fish for supper.
~
Otautau is a small town within a few kilometres, as the crow flies, of Captain Cook’s lonely anchorage. However, in that short distance over the Fiordland mountains the landscape changes dramatically. If Cook had travelled east from Supper Cove, and crossed the rugged, bush-clad ranges, he would have reached a large and fertile plain of red tussock and tall forests.
Within a few decades of Captain Cook’s early visits, sealers and whalers were established on the south coast and intermarrying with local Maori. Before long they were tracking inland across the red-tussocked plains and following the inland hunting routes of the first inhabitants, the tangata whenua; and so, up the Aparima River from the seedling settlement of Riverton, they would have passed through Otautau – the place of the greenstone pendant with the curved tip – a thriving community even in 1850, when the area was explored by an official party from HMS Acheron.
The hunger for land in this new colony was explosive. By March 1857, John Turnbull-Thompson, the first Surveyor-General of New Zealand had completed his survey of the interior. During three short months he had, according to his great grandson and biographer, John Hall-Jones, travelled over, mostly on foot, 1,500 miles of difficult country and had surveyed by reconnaissance two and a half million acres. The total population of this vast area was 442, comprising 119 Maori and 253 Europeans and half-castes; but it was not long before it was claimed for agriculture. Over the next century the Southland plains were vigorously cleared and drained, creating a large area of what is now highly productive farmland.
~
In 1979 we drove from Invercargill late in the afternoon of a soft, spring day with some trepidation. What did Southland hold for us? To our relief the flat plains soon yielded to more rolling country. The Longwood hills now filled our horizon, their bush clad slopes light and dark: shadowed beneath fluffy cumuli, pierced by the shafts of a westering sun. Our road skirted around them and towards the distant dog-toothed Takitimus, a long, jagged range, representing the upturned canoe of Maori legend. The snows of winter still streaked their rocky fangs. Finally, we rounded a bend beside the sparkling Aparima and drove into Otautau, a typical New Zealand country town. The house we were to rent was on a hill and if we looked over the township and the fertile farmland beyond, far away to the west, we could see the roughened skyline where the last fling of the Southern Alps fractured into the wild mountains of Fiordland.
As far as first impressions went, it seemed a promising start.
~
In the end, the six weeks turned into twenty-seven years of active service.
Daryl Marshall was the first vet to stay in the area for any length of time. But by the time we arrived, in 1979, he had retired from full time veterinary practice to develop a sheep and deer farm near to Otautau, and he only provided a veterinary service to a few clients of his own. His original employers were the farmers of the “Western Southland Veterinary Club” and it was they who were about to employ me. Vet Clubs were the standard model which established veterinary practices throughout rural New Zealand. They worked especially well by drawing vets into remote areas where they would otherwise have been unwilling to commit to the investment of setting up a practice. The clubs provided the staff, plant and facilities necessary to run a modern veterinary practice. The farmer committee I worked with were very supportive, but the system had its frustrations and eventually I found, as Daryl had, that I wanted to run my own business. Farmers are self-reliant businessmen themselves and, in the end they relented to a proposal Daryl and I put to them, and let us lease the premises.
Daryl put a manager on his farm and the two of us set up a partnership: Marshall and Hicks Veterinary Surgeons. I couldn’t have wished for a better partner. MHVS was a success from the start, no small part of which was due to Daryl’s unshakeable self-belief and strong work ethic. But if Daryl worked hard, he also played hard. The partnership, with its shared after hours duty roster, had freed him from the 24/7 obligations of being a solo vet and he was better able to indulge his passion for the outdoors. When he wasn’t on his farm he was hunting or fishing. Each of his forays resulted in the deaths of some poor, unfortunate creatures: deer, trout, flounder, crayfish, whitebait. Years later, as the practice grew and we employed more vets, he took a bit of teasing about this: wasn’t it ironic that he should spend his weekdays saving animals lives, but his free weekends doing the exact opposite? It was noticeable they took care not to push him too much, being keen to partake of the spoils. By this stage I had long ceased catapaulting cats so I, too, occasionally indulged in this gentle ribbing. In many ways Daryl and I were poles apart, but our partnership worked because we respected each other. He was certainly less risk-averse than me, but sometimes his gambling instincts led us astray.
JC, a new client, and a shrewd dairy farmer, must have recognised this. Daryl came back from a visit to a sick cow enthused by JC’s challenge: “John, he told me he was fed up with calling in vets who used s**tloads of expensive drugs, only to have the bloody things die on him a day or two later.”
“How do you know we’re going to do any better?” I asked, well aware that clients who swap vets once are quite prone to doing it again.
“Well he proposes a ‘double or quits’ policy. If we treat a cow and it recovers, we can charge him double fees. On the other hand, if the cow dies, he doesn’t pay anything.”
I detected a few loopholes in this rather loose arrangement: “And who is to police our success or failure rate?”
“He seems a genuine sort of joker. I reckon we should give it a go.”
So we did. JC lived out on a limb. It was a one hundred kilometre round trip to treat his sick cows, and he certainly knew which ones to pick for veterinary attention. We soon found out that JC was a pretty competent operator who could very well manage the routine easy calvings and milk fevers, so we were left with the thin cows cast in ditches with rotten calves inside them – patently beyond the scope of the most gifted clinician with a limitless armoury of drugs at his command. It soon became apparent that the occasions when we failed, and were not able to charge, far exceeded the times when we were able to charge double. We cut our losses by not pumping “diers” with expensive drugs – a lesson all enthusiastic young vets need to learn – and before the new month started we had terminated the arrangement. JC seemed unconcerned; he had proved his point. From samples we had taken from some of his sick cows we revealed reason enough to account for their poor condition. By the following spring JC had corrected the selenium and copper deficiencies we had discovered and, with his cows sleeker and fatter, their productivity lifted and their death rate lessened dramatically.
Dairy cows calving in springtime are on a metabolic knife-edge. If they
are thin they have no reserves, and it is frequently impossible to treat them and restore them to health. Even if they live they are unlikely to be productive animals: unlikely to milk well and unlikely to get pregnant again. JC’s “double or quits” strategy had eventually prodded us towards the correct approach – prevention is better than cure. He remained a loyal client for many years: definitely a genuine sort of joker.
~
Soon Daryl and I were joined by other vets, each with their own very different skills and personalities. Giles and Rosie Gill, husband and wife – both vets – were the first. They had graduated from Edinburgh University and worked around the world before deciding to settle in Otautau with their young family. Giles soon joined the partnership, but Rosie, with their young family, chose to work part-time. She was a consummate small animal surgeon.
Giles’ father was a highly skilled engineer who had imbued his son with a reverence for all things mechanical. On his first working day at MHVS, Giles made Daryl and me fully aware that the hoof knives we had been using to pare the horn from the feet of lame cows were woefully blunt. The next day, our knives came back from his workshop gleaming from a long overdue regrinding, restored in neat sheaths he had made out of hosepipe. It took a while to adjust to these re-invigorated tools. Not only did they now slice through horn like butter, but anything else that happened to be caught out by the user’s follow-through. Daryl and I both returned from our rounds sporting bandaged fingers.
