And so the two slowly began their ascent. Step by step, the city dropped away. As they reached the halfway point, Lister started to doubt whether he could reach the top. He shouted to his friend ahead of him, “I feel giddy; would it not be foolish in me to persevere to-day?” Perhaps Beddoe saw the fear in his friend’s eyes, or perhaps he himself was too exhausted to go any farther. He agreed that they should turn back.
As the two retraced their steps, Beddoe slipped, releasing a boulder. Lister heard a fragment come free and looked up just in time to see his friend and the rock hurtling toward him. He pressed his back against the face of the cliff just as Beddoe managed to regain his footing, but the huge rock struck Lister on the thigh. According to Lister’s friend, it “whirled down the talus below with leaps and bounds, and passed harmless through the middle of a group of children who were playing hopscotch.”
Beddoe quickly assessed that the situation was grave. Leaving his injured companion behind, he scrambled down the Cat’s Nick and returned shortly with a litter and four men, who carried the wounded Lister back to the hospital in a solemn procession. At the gates of the Royal Infirmary stood Mrs. Porter, wringing her hands and weeping. In her thick Scottish accent, she scolded Beddoe for putting her favorite surgeon in harm’s way: “Eh, Doketur Bedie! Doketur Bedie! A kent weel hoo it wad be. Ye Englishmen are aye saefulish, gaeing aboot fustlin upo’ Sawbath.”
Lister was laid up for several weeks, once again delaying departure from Edinburgh. Fortunately, he hadn’t broken any bones, though he had severely bruised his leg. Beddoe’s nerves were shaken by the thought of how close they had come to death. Years later, he reflected on how the course of history might have been changed had Lister died: “If I had killed my friend Lister that summer … how many would have been lost to the world and to millions of its denizens.”
6.
THE FROG’S LEGS
Everywhere questions arose; everything remained without explanation; all was doubt and difficulty. Only the great number of the dead was an undoubted reality.
—IGNAZ SEMMELWEIS
THE THUNDERING OF CANNON REVERBERATED around the battlefield. Bullets whizzed through the air, tearing apart flesh and mutilating anyone who stood in their path. Limbs were ripped off, and entrails spilled, staining the grass crimson with the blood of those who were often too shocked by their own injuries to cry out. Like many young men who had never seen the horrors of war firsthand, Richard James Mackenzie was woefully unprepared for what awaited him on the battlefield. Armed with little more than a bag of surgical instruments and some chloroform, he joined the Seventy-Second Highlanders in their fight against the Russians at the start of the Crimean War in 1854.
The thirty-three-year-old Mackenzie had taken a sabbatical from his job as Syme’s assistant to volunteer as a military surgeon. Both Mackenzie and Lister worked under Syme at the same time but in different capacities; the former was more senior, having been at the Royal Infirmary for many years. During Mackenzie’s time at the hospital, he had adopted many of the elder surgeon’s techniques, including the famous amputation at the ankle joint. It was because of their close working relationship that many members of the faculty at the University of Edinburgh believed Mackenzie would one day succeed Syme in his clinical professorship—the most coveted of all three surgical chairs due to its permanent allotment of hospital wards at the Royal Infirmary. But when Sir George Ballingall, the professor of military surgery, announced his own retirement, Mackenzie saw an opportunity to fast-track his career. The only thing standing in the way of securing the appointment was battlefield experience.
Soon after Mackenzie departed Edinburgh, he discovered that his meager medical supplies would be of limited value. What had most concerned Mackenzie wasn’t the bullets or cannonballs but the effects that the filthy battlefield conditions had on soldiers fighting in the conflict. In a letter back home, he wrote, “We had, as you know, a nasty time of it … not so much from the actual mortality, as from the vast amount of sickness.” Malaria, dysentery, smallpox, and typhoid fever swept through army encampments, draining the strength of forces before any battles had even commenced. Mackenzie bemoaned the fact that the men had been “brought out there to rot without firing a shot, or even getting a sight of the enemy.”
Their chance arrived on September 20, when the French and British forces came together to fight the Russians in a pitched battle just south of the river Alma in the Crimea. It was to be the first major engagement of the war. The Allies won the day, but not without sustaining enormous fatalities. Mackenzie’s side suffered approximately twenty-five hundred casualties, while the Russians incurred over twice that number. The Battle of the Alma was a bloodbath: in addition to extracting numerous bullets and dressing a multitude of wounds for his fallen comrades, Mackenzie had to perform twenty-seven operations that day alone (including two amputations at the hip joint), all in makeshift hospital tents.
Those who survived the combat and loss of limbs were not clear of danger just yet. Shortly after the guns fell silent, there was an outbreak of Asiatic cholera. It stalked Mackenzie’s battalion across water, over hills, and through valleys. It was relentless in its pursuit. Generated by the bacterium Vibrio cholerae, this disease is usually transmitted through water supplies contaminated by the feces of the infected. At the time of the Crimean War, the disease was making its way across Europe—and it’s possible that the cholera was carried to the front line in the guts of soldiers. After an incubation period of two to five days, a victim will suffer the sudden onset of severe diarrhea and vomiting, giving rise to massive fluid loss and dehydration. Death can follow within hours, as Mackenzie noted in a letter back home: “Many were struck down at morning parade, and died in three, four, or five hours.… I need scarcely say, that any treatment in such cases was utterly vain.” If left untreated, Asiatic cholera has a 40–60 percent mortality rate.
During the two-and-a-half-year conflict, more than eighteen thousand soldiers would die from the disease, which claimed more lives than any other that plagued the British army during the Crimean War. Among the first to succumb was Richard James Mackenzie. The promising surgeon from Edinburgh died of cholera five days after the Battle of the Alma, on September 25, 1854. Once again, death had cleared the way for another man’s advancement.
* * *
Many of Mackenzie’s colleagues followed him into war, but Lister’s religion forbade him from engaging in violent acts, even if his role as surgeon would focus on healing the wounded. As his house surgeoncy at the Royal Infirmary drew to a close toward the end of 1854, he found himself without a job and without a plan for the future. A few months earlier, he had expressed interest to his father in applying to become a junior surgeon at the Royal Free Hospital in London. Despite his fondness for Syme, Lister missed his family. This would be the first of many attempts to return home over the next twenty-three years.
The Royal Free Hospital was founded by the surgeon William Marsden in 1828 to provide free care (as the name suggested) to those who could not afford medical treatment. While hospitals around Britain catered to the poor, patients were expected to contribute to their room and board. Additionally, inpatient admission was only granted to those who could obtain a letter from the governor or subscribers of the hospital, which was no easy task. In contrast, Marsden believed that “the only passport [to gaining admission] should be poverty and disease.” His decision to erect the Royal Free was motivated by the plight of a dying girl whom he found on the steps of St. Andrew’s Church one evening. Marsden tried to have her admitted to a hospital but failed because she was penniless. A few weeks later, she died.
An appointment to the Royal Free Hospital would not just bring Lister closer to home. It would also promote his career. Hospital positions were difficult to come by, especially in the capital. It would not only elevate his prestige as a surgeon, initiating a lucrative private practice, but also might lead to a university position in the future. Both Syme and his old professor Wil
liam Sharpey, however, weren’t so sure that this position was right for Lister. They discouraged him from applying because they feared their protégé would become entangled in one of the latest political disputes raging at the hospital.
The dispute had been all the gossip among the medical community in London. There were three surgeons at the Royal Free: William Marsden; John Gay, who had been working there for eighteen years; and Thomas Henry Wakley, whose father had founded The Lancet. That December, Gay had been forced to resign after he supplied information for a biography of himself that turned out to be critical of the hospital. The Committee of Governors at the Royal Free took the view that Gay had done too little to counter disparaging remarks that appeared in the book. At this point, two factions arose. Those who believed the committee was justified in pushing Gay out were pitted against those who believed a lay body shouldn’t interfere in a surgeon’s career. Wakley defended the committee’s actions vociferously in The Lancet, which was not surprising, because he would benefit directly from the fallout by being promoted to Gay’s position.
Sharpey wrote to Syme in Edinburgh, “The new Surgeon will be thrown much more in with young Wakley—and I fear they would not be long without a misunderstanding in which case there will be endless and distracting disputes before the public—or else Lister’s retirement. I cannot imagine Lister concurring with Wakley in his line of proceeding.” Syme had an additional concern. He worried that Lister might eclipse the quarrelsome young Wakley, which might anger Wakley’s father, who still held considerable sway over the medical community in London. Sharpey wrote to Syme, “I cannot conceive of Old Wakley allowing any new man to gain reputation at the expense of his son.” Both Sharpey and Syme relayed their concerns to Lister, who eventually allowed the deadline for an application to lapse on the advice of his two mentors.
That still left the question of what Lister would do after his house position as a surgeon ended. He considered following his original plan of traveling through Europe, and Joseph Jackson encouraged his son to do just that: “Thou art now at liberty to pursue without interruption the plan which thou hadst framed as the right one … to take a survey of some of the medical schools of the continent.” And yet, if the allure of an appointment at the Royal Free Hospital had been almost enough to take him away from Edinburgh, a tour of Europe was not. Instead, Lister proposed to Syme that he take over Mackenzie’s lectures on surgery and apply to become assistant surgeon at the Royal Infirmary.
Lister might have been overqualified to be Syme’s house surgeon, but he was undoubtedly underqualified at that stage to be his assistant because he still wasn’t licensed to practice surgery in Scotland. Lister’s suggestion even came as a surprise to Syme, who immediately threw cold water on the plan. But Lister would not be deterred so easily. He took a stand. In a letter to his father, he asked, “If a man is not to take advantage of the opportunities that present themselves to him, what is he to do, or what is he good for?” In his heart, he knew he was perfectly suited to this job, even if he was punching a little above his weight. “Though at first I have sometimes been almost ready to shrink from [opportunities],” he wrote, “yet I have braced myself up with that kind of reflection that if I do not do this now how shall I be fit to do my duty as a surgeon hereafter?” For all his bravado, he still exhibited his characteristic modesty, qualifying his aspirations to his Quaker father by writing that he could not hope or expect to have a “tithe of that success” that Syme had enjoyed in his own career.
Eventually, Syme warmed to the idea of Lister as his next assistant surgeon. Lister had impressed him with both his skill as an operator and his intellectual curiosity. On April 21, Lister was elected a Fellow of the Royal College of Surgeons of Scotland, which gave him license to practice surgery in Edinburgh. Shortly after that, he moved into a fashionable residence at 3 Rutland Street, across the road from Syme’s consulting rooms. His father, who continued to subsidize his living expenses, thought the rent was rather high, but he wrote to Lister that he approved of him moving into “premises that are in their character and their furnishings thoroughly respectable and suited to thy professional position.” Once Lister had settled into his new lodgings, the governors of the hospital confirmed his appointment to the Royal Infirmary. In September, he collected his first fee from a patient, whom he had treated under chloroform for a dislocated ankle. Joseph Lister’s career was on track.
* * *
AS WELL-APPOINTED as Lister’s home was, it could not compete with his mentor’s stately residence. Although Millbank House was only half an hour’s walk from the heart of the city, it felt like a country retreat to those who visited Syme and his family there. When one entered this grand enclave, the smoke, grime, and noise of Edinburgh instantly vanished. The ivy-covered mansion overlooked gently sloping hills and well-ordered terraces, providing psychological relief from the everyday horrors Syme experienced at the Royal Infirmary. The house already had several conservatories and vineries when he bought it in the 1840s. Over the years, as Syme’s wealth grew from his private practice, he added a fig house, a pineapple house, a banana house, two orchid houses, and a number of conservation walls for the growing of fruit, which could be covered in glass during the winter. It was something of a tropical paradise in an otherwise weather-beaten Scotland.
Millbank House was a lively place. Syme loved to host small dinner parties for friends, colleagues, and travelers who had come to visit the medical and scientific institutes of Edinburgh. He loathed large gatherings, preferring no more than twelve guests at a time. Lister often made the cut, and the household welcomed him.
Syme’s family was large by modern standards. There was Syme’s second wife, Jemima Burn, and their three children, plus his daughters Agnes and Lucy by his previous marriage. His first wife, Anne Willis, had died giving birth to their ninth child some years earlier. Seven of Syme’s children from his first marriage and two from his second had died of various diseases and accidents. These bereavements served as a reminder of how impotent medicine still was in the face of death.
In addition to regular dinner invitations, Lister was asked to join the family on an excursion to visit Syme’s brother-in-law at his country residence at Loch Long, on the west coast of Scotland. Lister accepted, but it wasn’t just to court the good opinion of the elder Syme. His gaze had fallen upon the boss’s oldest daughter, Agnes.
Agnes Syme was a tall, slender girl whose plainness was all the more apparent when she was placed in the measure against her beautiful younger sister Lucy. Agnes often pulled her long, dark hair back into a loose bun, which accentuated the delicacy of her features. In a letter back home, the besotted Lister gushed about his “precious Agnes.” He told Joseph Jackson that although Miss Syme’s outward appearance was “not at all showy,” she was blessed with an endearing personality: “There is in her countenance an ever varying expression that artlessly displays a peculiarly guileless, honest, unaffected, and modest spirit.” Most important, Lister noted, there was “no lack of sound and independent intelligence,” a quality she undoubtedly inherited from her father. Lister wrote about his newfound love with few inhibitions: “On rare occasions, though to me not now so rare as formerly, her eye expresses the deep feeling of a very warm heart.”
Lister’s mother and father were less than enthusiastic about the prospect of this union. Agnes was a firm adherent of the Episcopal Church of Scotland, as was her family, and showed no indication that she was willing to abandon her church to join the Quakers. From early on, both of Lister’s parents expressed concern. As Joseph Jackson wrote, “Thy dear mother tells me she has been persuading thee not to allow thy other [engagements] to absorb thee too entirely to our loss.” His father warned him to do nothing that might betray that he was interested in marrying Agnes. He added (perhaps to reassure himself) that he was certain that logic would win out: “Thy judgement would at once have dismissed it as incongruous.”
Despite his parents’ concerns, Lister fell deeper in
love. Soon, every junior at the Royal Infirmary knew that “the Chief” was pursuing the boss’s daughter. After a staff dinner on a night in mid-May, one of the young men sang his own parody of a popular music hall tune titled “Villikins and His Dinah,” in which Lister is mysteriously killed with a surgical knife after refusing to make an honest woman of Syme’s daughter:
As Syme was a stalking the Hospital around
He seed Joseph Lister lyin’ dead upon the ground
With a sharp-pointed bistoury a lyin by his side
And a billet doux a statin t’was by hemorrhage he died—
Syme tries to save the life of the fictionalized Lister by tying up the severed vessels “a dozen times o’er,” but to no avail. The song ends with a jolly warning:
Now all you young surgeons take warning by ’im
And never don’t by no means disobey Mister Sim;
And all young maydings what hears this sad history.
Think on Joseph, Miss Syme, & the sharp-pointed bistoury.
While the sentiment behind the parody was one of affection, the altered lyrics served as a reminder to Lister that he should tread carefully with regard to courting Agnes. Her father was not a man to be crossed.
The Butchering Art Page 11
