At the center of much of the infirmary’s conflict was Syme himself, who often evinced a dark side to his genius. He was volatile and had an unnatural inclination to nurture lifelong grudges. When the obstetrician James Y. Simpson suggested in a pamphlet that surgeons use a procedure he had devised called acupressure to control surgical hemorrhaging, Syme stormed into the operating theater, pulled out his knife, and proceeded to shred the document before a crowd of spectators. “There, gentlemen, is what acupressure is worth.”
Even when his adversaries attempted reconciliation, Syme’s temper and pride were frequently obstacles. In one instance, his colleague James Miller—with whom Syme had been quarreling for years due to his close friendship with Simpson, the advocate of acupressure—decided it was time to bury the hatchet. Miller had lately fallen ill and realized he would soon die. He went to visit Syme at his home in 1864. When he entered, he found the petulant surgeon standing in front of a roaring fireplace, his hands clasped behind his back. Miller said he had come to bid Syme a final goodbye and offered his hand in rapprochement. Syme looked coolly at the frail man before him and, without extending his own hand in return, replied, “Huh, so you’ve come to apologise, have you? Well! I forgive ye.” Miller left without another word from his old rival.
Syme’s quarrels were both a hindrance and a boon to his career. He fell out with Liston, with whom he had been working closely ever since he began practicing surgery. The feud seemed to evolve from a series of small disagreements coupled with a growing professional rivalry between the cousins. Liston scorned the use of the tourniquet, for example, preferring to use his left arm to stanch the flow of blood, while the less physically imposing Syme vocally opposed such primitive methods. The animosity between the two men reached a tipping point in 1829, when Syme applied for a surgeoncy at the Edinburgh Royal Infirmary, where Liston was working. Syme was turned down for the position because the hospital managers anticipated a war between the two men breaking out on the wards and disturbing the convalescents.
Syme didn’t expend too much time or energy feeling sorry for himself. In that same year, he bought Minto House, a derelict mansion on Chambers Street that he planned to turn into his own private hospital. It was a brave move for a man who wasn’t exactly wealthy. Syme converted the property into a public hospital with twenty-four beds. While trying to collect funds to support his endeavor, he circulated a subscription book among the city’s wealthy people, who might have been able to support the project. When the book fell into Liston’s hands, he inscribed within it, “Don’t support quackery and humbug.”
Despite Liston’s churlishness, Minto House became a roaring success. Over the course of three years, Syme oversaw eight thousand cases and performed more than a thousand operations there. These included major amputations, excisions of elbows and knees, and mastectomies for “scirrhous breasts.” And so when the chair of clinical surgery at the University of Edinburgh became vacant in 1833, Syme considered himself an ideal candidate given his newfound experience running a private hospital. Liston also applied for the position, but the younger cousin finally won the day.
Six years later, Liston reached out to Syme. He had now moved to London to take up an equivalent post at UCL and in due time would perform his historic operation with ether, witnessed by Joseph Lister as a medical student. In his letter to his estranged cousin, Liston spoke of his desire to bring about a reconciliation and asked Syme in medical jargon to “tell me that you wish to have our grievances and sores not plastered but firmly cicatrised.” He ended his appeal with the words “I am not so bad as you believe me to be.” Syme accepted the olive branch and mended the relationship.
There was no doubt that Syme had found his niche in Edinburgh. The small surgical community there was rife with feuds, rumors, and jealousy. It seemed that every surgeon was pitted against every other, at one point or another. Indeed, at times, Edinburgh could be even more febrile than London, where a surgeon once fought a duel over a medical dispute.
* * *
LISTER TOOK UP temporary lodging on South Frederick Street in the newer part of Edinburgh shortly after his arrival. The weather in September, though quite mild, was invariably depressing. Swollen rain clouds hung heavily in the sky most days, casting shadows over the city and engendering a seemingly inescapable dankness. He only intended to stay a month before heading off to sunnier pastures on his tour of Europe. Once he settled in, he presented his letter of introduction to Syme, who welcomed him warmly into the city’s surgical community.
Syme oversaw three wards at the Royal Infirmary. To Lister, the hospital was a marvel. With 228 beds, it was more than twice as large as London’s University College Hospital. It was massive by nineteenth-century standards. When first built in 1729, it offered beds for only four patients. In 1741, a new building was erected at High School Yards (later known as Infirmary Street). Over time, the hospital expanded—once in 1832 and again in 1853. Eventually, the Royal Infirmary would dominate the entire area situated between Drummond Street and High School Yards. The Royal Infirmary was about three-fifths the length of a football field, with twenty-foot wings extending at right angles on each end. In addition to the ground floor, there were three stories, accommodating two kitchens, the apothecary’s shop, a servants’ room, the dining room, and “twelve cells for mad people.” Woven through the middle of the building like a great artery was a spacious staircase that allowed the passage of “street chairs” so attendants could carry people with fractures, dislocations, and dangerous wounds onto the wards without difficulty. Most patients were confined to the first and second floors, while those requiring surgery recovered on the third floor, where they had greater access to fresh air. In the attic was a large operating theater in which two hundred surgical students wedged themselves each week to witness operations.
For Lister—whose opportunities to grow under Erichsen had been stymied by the dwindling number of surgical beds at University College Hospital, following the deaths of Liston and Potter—it was an extraordinary chance to gain the clinical experience he so craved. Shortly after his arrival, he wrote to his father, “If the day were twice as long I should have abundant occupation for it, and such an occupation as I believe will be valuable to me for life, if I like to practise surgery.” Lister’s trip to Edinburgh kept being extended.
Lister quickly became Syme’s right-hand man, taking on more and more responsibility at the Royal Infirmary and assisting him with complex surgeries. In a letter to his sister Mary, Lister wrote that the elder surgeon had woken him at five o’clock the previous morning to help with an emergency operation because “Mr. Syme [thought] it would amuse me.” Lister went on to tell his sister that his plans to remain in Scotland for only a month had changed:
My present opportunities are teaching me what I could not learn from any books, nor indeed from anybody else, while my experience, which our small hospital in Gower Street had left considerably limited, is daily receiving important additions. I am therefore quite satisfied that it will be well for me, if all goes well, to spend the winter here and even though my doing so should make my visit to the Continent exceedingly short.
A few days later, Syme invented a position for his protégé as “supernumerary clerk” because the role of house surgeon was already taken. The fact that Lister—a fully qualified surgeon in his own right and a Fellow of the Royal College of Surgeons of England—accepted a job that was more suited for a student speaks to Syme’s influence over him. Equally, Syme was plainly impressed enough with Lister to have created the post for him and to have appointed him over his other students.
Syme took a keen interest in Lister’s career and came to rely on him, both inside and outside the Royal Infirmary. He assigned Lister the important task of writing up reports of his clinical lectures for publication. The first appeared in the Monthly Journal of Medical Science and included some of Lister’s own microscopic observations of a bone tumor’s cellular structure. Two other papers were quick to fo
llow: one on an operation that Syme performed on a carbuncle, and another on the use of a hot-iron cautery as a counterirritant against pain and swelling. Both of these papers included original contributions from Lister himself.
Syme became a source of inspiration. In a letter back home, Lister gushed, “If the love of surgery is a proof of a person’s being adapted for it, then certainly I am fitted to be a surgeon: for thou canst hardly conceive what a high degree of enjoyment I am from day to day experiencing in this bloody and butchering department of the healing art.” So enthralled was Lister by Syme that he had to justify his admiration to his father, who had sent him a letter—half playful, half in earnest—warning his son to be wary of falling too far under one man’s sway: “Nullius jurare in verba magistri” (Swear allegiance to no master).
Although his father fretted about it, Lister defended the amount of time he spent assisting Syme: “I am pleased to be a means of aiding in the diffusion of his many original views in Surgery.… Had it not been for the publication of his lectures, much of his wisdom must have gone whenever he went himself.” What’s more, he told his father that although he agreed in theory with his warning to swear allegiance to no master, on reflection he considered Syme a very worthy “magister.”
Joseph Jackson wasn’t alone in taking note of his son’s infatuation with the elder surgeon. Word had gotten back to London about Lister’s newfound friendship with the quarrelsome Scotsman. Writing to Lister, his friend and former student George Buchanan teased, “Why! You must be in a perpetual state of bliss of the most aggravated description.… We saw your name in the papers as an adopted child of Syme’s, reporting a case for him.” Buchanan went on to add a warning of his own: “Become Syme’s equal, if you will in Surgery, but pray don’t catch his only too apparent egotism!”
Despite other people’s concerns, Lister soared under Syme’s guidance. At the Royal Infirmary, he was exposed to a far greater variety of cases than he had ever encountered in London. Like any surgeon at that time, Lister experienced failure, and patients died. But there were also deeply satisfying moments, such as the time a young man came through the doors of the Royal Infirmary after being stabbed in the neck—an injury that under normal circumstances in this period would have been fatal.
The boy had been both lucky and unlucky. On the one hand, the knife had failed to sever the carotid artery, which, had it been cut, would have ended his life instantaneously. On the other hand, blood was collecting around his windpipe, slowly cutting off his air supply. One witness remarked, “Two lives … depended upon the slow, progressive leakage from the wounded artery,” because the assailant would undoubtedly be hanged if the young man died.
Syme and Lister wasted no time. The boy was hoisted up four flights of stairs to the attic of the Royal Infirmary, where the two surgeons began preparing for the operation. Word of what was happening quickly spread throughout the hospital, and the operating theater soon filled with surgeons and students, who jostled with one another to witness the unfolding drama. These witnesses to a potential death stood rapt in the auditorium as the patient gurgled and choked on his own blood. One spectator wrote that on every face “there was written the anxiety and dread which leavens all curiosity.”
Syme looked cool and collected compared with Lister, no doubt acutely aware of the awesome responsibility facing him as he braced himself for the gore. Syme picked up the knife and traced the long red line of an incision down the young man’s neck. At once, a deep pool of blood began to form around the opening. Undeterred, the senior surgeon continued to cut swiftly toward the injured artery. As Syme later wrote: “Even now I cannot, without a shudder, reflect on my position, when the slightest displacement of one hand must have instantaneously caused a fatal hemorrhage from the carotid artery, and a wrong direction of the needle by the other, to the smallest possible extent, would have given issue to an irrepressible stream from the jugular vein.”
The seconds ticked by. The audience leaned forward, but all they could see were “gouts of blood spouting and welling from the wound, and the surgeon’s and assistant’s quick fingers at work.” The patient’s face grew “ghastly in its whiteness.” Lister’s own face, he noted, was bathed in sweat, “as if he had been running a race.”
The two surgeons pressed on. Syme pushed his fingers into the open incision and with a blunt needle and a piece of silk began to tie off the injured artery. Suddenly blood erupted from the boy’s neck, drenching the wooden operating table and congealing at Lister’s feet. The spectators gasped, expecting death to follow quickly. But Syme continued to close the slippery artery as Lister held open the wound and sponged away the blood. After several tense minutes, both Syme and Lister backed away from the operating table so that the audience could inspect the incision. The bleeding had been halted.
A silence fell upon the theater for several seconds, before the spell was broken by the crowd erupting into riotous cheers and hurrahs for the two surgeons.
* * *
In January 1854, Lister became Syme’s house surgeon, a role he had more or less been fulfilling already. In this official position, he now had twelve dressers working under him—three times more than he did at University College Hospital. This number would soon grow to twenty-three. Syme made it clear that their working relationship would be collegial and that “house surgeon” was merely a title. Syme promised not to interfere in the treatment of ordinary cases and would allow Lister the exceptional privilege of selecting his own patients from those already on the wards—something no other house surgeon could expect at any other hospital. Because Lister was not yet licensed in Scotland, however, he would only be able to assist Syme in operations at the Royal Infirmary, not lead them.
Lister quickly gained the respect and adoration of those who worked with him. The solemnity and decorum that had often characterized his behavior at UCL seemed to dissolve amid the young and sometimes rowdy group of residents in his charge. Lister even threw several lavish dinner parties for his subordinates and joined them in helping to tear down an advertisement that had been erected by a local quack doctor. The triumphant mob took the billboard and burned it in a mock ceremony on the hospital’s grounds.
The dressers and clerks dubbed Syme “the Master” and Lister “the Chief”—a term of endearment that stuck with him for the rest of his life. One member of the staff in particular took a shine to the handsome surgeon: the formidable Mrs. Janet Porter, matron of the hospital and head of the nursing staff at the Royal Infirmary.
At the time of Lister’s appointment, nursing was not a calling that required skill or training, nor did it command much respect. Educated, well-to-do women didn’t dare enter a profession that would expose them to the intimate workings of the male body or leave them alone and unsupervised with men. Florence Nightingale—the woman who would later revolutionize nursing—had not yet fully developed the protocols of cleanliness for which she would become celebrated. Furthermore, it would be another nine years before the founding of the International Red Cross, which would be instrumental in training nurses in the latter half of the nineteenth century.
As a result of the profession’s low recruitment standards, many of the nurses with whom Lister worked were a motley crew. Nightingale herself once visited the Royal Infirmary and found it to be a “lawless” place when it came to managing the nursing staff. She explained that it was the senior house surgeon’s duty to have the “drunken night nurses carried in on stretchers every night.” This unpleasant task would have fallen to Lister in his first year working under Syme. Indeed, there was a woman who used the hospital beds to sleep off her frequent hangovers and whom Lister had to reprimand on several occasions.
Lister’s admirer Mrs. Porter was at the opposite end of the spectrum from these alcoholic loafers. She ruled the surgeons with an iron fist and behaved as if the entire burden of responsibility for managing the hospital rested on her shoulders alone. When Lister arrived at the hospital, Mrs. Porter was already firmly establis
hed there, having cared for its patients for over a decade. Her sitting room was a veritable photographic portrait gallery of the medical men who had passed through her wards. Over the years, she would come to bridge the gap between the old vanguard of nursing and the new, and she was equally adored and feared by those who knew her. The poet W. E. Henley, who was treated by Lister later in his career, wrote about the “depth and malice of her sly gray eyes” and the “broad Scots tongue that flatters, scolds, defies.” Like all those who worked for Syme, she exuded an acute sense of duty. As Henley said, “Doctors love her, tease her, use her skill,” but “they say ‘The Chief’ himself is half afraid of her.”
There were many times when the new surgeon found himself in hot water with Mrs. Porter. In one instance, she caught Lister trying to break one of her ice poultices into small pieces with the ward poker. One account recalled: “[In] high dudgeon, she snatched poker and poultice from him and retreated in loud-voice remonstrance into her kitchen.”
In spite of all the bluster, Mrs. Porter truly took a motherly interest in Lister’s well-being. This was at no time more apparent than when he found himself crumpled in pain on the treacherous trail known as the Cat’s Nick, with his former UCL classmate John Beddoe, on a blustery Sunday afternoon in 1854. The Cat’s Nick cut a jagged path up the Salisbury Crags, which loom high above Edinburgh like an imposing fortress. Situated less than half a mile southeast of the city’s center, the 151-foot cliffs are the glaciated remains of a carboniferous sill that began to form in a shallow sea some 340 million years ago. Lister—who was terrified of heights—had reluctantly accepted his friend’s challenge to scale a precipitous face on Salisbury Crags so that they might view the magnificence of Edinburgh from an elevated position. Beddoe told Lister that all the great thinkers had done so: the novelist Sir Walter Scott, the poet Robert Burns. It had even been taken on by Charles Darwin, an enthusiastic walker who later credited his solitary rambles on Salisbury Crags for his acceptance of the geologist James Hutton’s notion of deep time, a concept that would later play a crucial role in his theory of evolution. For Beddoe, it was a “feat not to be left undone.”
The Butchering Art Page 10
