by James McGee
But that didn’t mean that Sawney couldn’t indulge his own appetites. He had several hours to kill before he was due to pay the doctor a call. Sal was upstairs, and when he’d left her to nip down for a swift wet, the look in her eye had made it clear that, once his thirst had been slaked, it would be worth his while if he hurried back. As Hanratty left the table and returned to the counter, Sawney slid out from the booth and headed for the stairs. Be a shame to let the mood go to waste, he thought.
James Read frowned. “Eden Carslow and the Home Secretary? And what was Apothecary Locke’s response?”
“He had no answer to my question about Eden Carslow. As to the other, he said there was one other instance he knew of where the Home Secretary had denied release, and that was Matthews.”
“Matthews?” The Chief Magistrate’s head came up.
“James Tilly Matthews. Apparently he was locked away fifteen years ago after he’d accused Lord Hawkesbury of treason. Reckoned Frog Revolutionaries were controlling his mind. Now, he was bloody mad. The odd thing is, it took only a year for the Home Secretary to deny Hyde his freedom, whereas in Matthews’ case it took twelve years, by which time the man he’d accused of treason had become Home Secretary, so it’s hardly surprising he wasn’t about to approve his release.”
Read’s face remained neutral. “Matthews … yes, I believe I do recall the occasion. He’s still a patient, you say?”
Hawkwood nodded. “They’ve thrown the key away on that one. I’ll say one thing for our colonel, he’s no stranger to the high and mighty.”
“So it would seem,” Read murmured.
“But I still don’t know why,” Hawkwood said. “In fact, I’m no wiser than I was before I went. Their damned records were about as much use as a one-legged mule – I hope ours are better, by the way. I’d be interested to know on whose authority he was admitted. He had no family, from what I could see. No wife. There was a daughter, Locke told me that on my first visit, but she died.”
Read frowned. “What are you suggesting?”
“I don’t know. The Admittance Document says he entered the hospital in October 1809, by which time he’d been in a state of melancholy for four months. So the first signs would have occurred in June. Where was he then?” Hawkwood sucked in his cheeks. “Mind you, the only other choices, apart from melancholy, were ‘raving’ and ‘mischievous’. He wasn’t either of those. Maybe the records were vague on purpose.”
“Your point being …?”
“According to the hospital documents the only thing he was suffering from, until now, was melancholy. And yet twelve months after his admission, we have a note from Whitehall – the Home Secretary, no less – recommending they keep him locked up, which seems a bit bloody harsh. Now, it’s my guess that if you get a recommendation from Whitehall, it’s not really a recommendation, it’s an order.”
“Forgive me, Hawkwood, but I fail to see –”
“I’m saying Locke didn’t consider Hyde to be dangerous, certainly not murderous. None of them at the hospital did. But if, as we suspect, the colonel had been planning the killing and the escape for some time, then maybe he was murderous from the beginning and the fact was kept hidden, which would mean the only people who knew what he was really like were the ones who arranged his detention and who denied his release.”
“You’re suggesting he was admitted under a false diagnosis? But why? For what possible reason?”
“Maybe that’s what we should try to find out. I’d like to know what the connection is between Colonel Hyde and Eden Carslow, for a start. That certainly intrigues me.”
“You intend to question Carslow?” Read asked. There was a distinct note of caution in the magistrate’s voice.
“I promise I’ll be civil,” Hawkwood said, before he could stop himself.
“You will need to be. Carslow has powerful friends. He has influence.”
“That sounds familiar. Isn’t that what we said about Lord bloody Mandrake?”
“No, that was what we thought about William Lee. As far as we were aware, Lord Mandrake was just another of his highly placed friends.”
“Who turned out to be a traitorous bastard,” Hawkwood said.
Lee was an American adventurer who, with the support of Lord Mandrake, had been the leading agent in a French plot to assassinate the Prince Regent. Lee had died in the attempt; Mandrake had taken a boat from Liverpool and fled to safety across the Atlantic.
“Indeed. Carslow, on the other hand, is probably this country’s finest surgeon. His contribution to medicine has been outstanding. You said earlier you might have to step on a few toes. Where Eden Carslow is concerned, you would be wise to tread carefully. I mean it, Hawkwood. While I place great store on your investigative instincts, there are others of a more – how shall I put it? – refined disposition who may interpret your direct approach as a recalcitrant attitude towards authority. I urge you to be circumspect.”
“Yes, sir. Understood. In that case, may I offer you the same advice in your dealings with the Home Secretary?”
Read blinked. “I beg your pardon?”
“Well, it struck me that, while I question Carslow about his connection with Colonel Hyde, you could use your authority to find out why Home Secretary Ryder felt the need to add his name to the list of people who would have preferred the colonel to remain in Bethlem.”
“You have the nerve of the devil, Hawkwood.”
“Yes, sir. Thank you, sir. May I take that as confirmation that you will speak to the Home Secretary? After all, you do meet regularly with him on matters of security. It would be a pity not to take advantage of that. Or am I being recalcitrant, sir?”
“You’re bordering on insolent, which rather proves my point,” Read said.
“But you’ll speak to him?”
Read sighed. “One does not speak to the Home Secretary, Hawkwood. One speaks with him. I rather suspect the same principle will apply in your forthcoming conversation with Carslow.”
“I’ll bear that in mind,” Hawkwood said.
“See that you do. Now, was there anything else? Public chastisement of the Prime Minister, perhaps?”
“Possibly,” Hawkwood said, striding towards the door. “The day’s not over yet.”
13
The lecture room was full to bursting; standing room only. The five horseshoe-shaped tiers rising from the floor of the theatre reminded Hawkwood of a steep-sided cockfighting pit. Even the atmosphere wasn’t dissimilar; the closely packed spectators, the vibrant hum of conversation, the heightened sense of anticipation as the crowd waited for the spectacle to begin.
Hawkwood had presented himself at Guy’s only to be met with a lofty refusal when he stated his wish to see the hospital’s Chief Surgeon. Mr Carslow was about to perform surgery. Police business would have to wait. Knowing he had no option but to bide his time, curiosity had led Hawkwood to take his place with the rest of the gallery.
It was warm in the room due to the mass of people. Removing his coat, he draped it over the wooden rail in front of him. From his seat in the top tier, he looked down across a sea of eager young men who didn’t appear to have seen more than fifteen or sixteen summers. But then some of the boys he’d commanded and fought alongside in the Peninsula hadn’t been that much older.
He glanced up. The theatre was illuminated by a large skylight, supplemented by chandeliers suspended above the centre of the room by a system of pulleys. Directly below the skylight, occupying centre stage, was the operating table. It was a robust piece of furniture with a hinged headboard at one end and an extension leaf at the other. On the sawdust-strewn floor beneath the extension leaf was a large oblong tray containing more sawdust. In the corner of the theatre was a large cupboard. The back wall held a rectangular blackboard. Below it stood two smaller tables and a small oak cabinet.
Several chairs had been set up on the floor, facing the foot of the operating table. The seating was for distinguished visitors, some of whom had alread
y taken their places. The lowest tier of the horseshoe was reserved for members of the hospital’s medical staff. The upper tiers accommodated the students.
A movement on the floor caught Hawkwood’s eye and prompted a buzz of chatter, but it was short lived when the crowd realized it was only the dressers bringing in linen and towels and a pitcher of hot water. Nevertheless, the air of expectation remained as it was now apparent that the operation and lecture were only minutes away. The two dressers appeared unconcerned at the reaction their appearance had caused and went about their business calmly and unhurriedly, placing the linen on the centre table, and the towels and pitcher on the oak cabinet next to an enamel basin. Another small square table was positioned near the main operating table. On top of it sat a deep-sided wooden box and a small tin bowl. One of the dressers began to transfer a selection of surgical instruments from box to tabletop. When they had finished laying out all the equipment, they moved to the side of the room and stood in silence, hands behind their backs, waiting.
Suddenly the level of conversation dropped. Hawkwood felt the students on either side of him tense. Three men entered through a door in the corner of the theatre, their footsteps resonating on the wooden floor. Two of the men were dressed in dark tailcoats, and the younger one was holding the arm of a third man, who was wearing a white calf-length nightgown and slippers. The young man ushered the nightshirted individual to the table and invited him to sit, leaving his companion to take the floor.
So this was the great man, Hawkwood thought.
Carslow had presence, there was no denying it. Tall, well built, with a bearing that was almost military and a high forehead crowned by swept-back hair, his elegant stature and steady, unflinching gaze reminded Hawkwood of Arthur Wellesley.
A hush fell over the lecture room.
“Lithotomy, gentlemen. Cutting the stone. From the Greek: lithos – stone – and thomos – cut. The removal of one or more calculous formations that cannot exit through natural channels and must therefore be extracted by means of surgical incision.”
The speaker turned and indicated the man in the nightgown. “The patient is a forty-three-year-old male and a merchant by trade. His symptoms – abdominal pain and acute discomfort while urinating – indicate the presence of a stone in the bladder. This afternoon I will be operating to remove the offending object.”
The spectators turned their heads towards the patient seated on the table. His brow was bright with sweat. Dark stains were visible under his armpits. There was a noticeable tremor in his right leg. The man looked terrified.
“The operation to remove a stone or stones is one of the most important a surgeon can perform. It requires not only a detailed understanding of anatomy, but also a mind that never wavers and a hand that never shakes.” Carslow paused in his address and ran a stern eye over the faces of the onlookers.
Then the surgeon turned to the waiting dressers and removed his coat. “Let us begin.”
A dresser stepped forward to take the surgeon’s coat, exchanging it for an apron that had been hanging on a hook next to the door.
Carslow addressed the room once more. “There are only two safe routes to enter the bladder; the first is from directly above, through the lower abdomen. This is referred to as the high operation. The second is by way of the perineum, known as the lateral operation. It is the latter that I shall be performing today. However, before I begin the procedure, I shall require the services of two more assistants.”
Carslow placed a forefinger to his lips. His eyes swept the encircling tiers. Hawkwood, watching from above, had the impression this was a charade enacted before every operation. He could see students nudging each other and grinning as if it were a contest where the team captain got to pick his right-hand man.
The surgeon’s gaze settled on the second tier down, to the left of where Hawkwood was standing. He pointed. “You, sir, and the young gentleman to your right; if you’d be so kind as to join us. Your names, please? Mr Liston and Mr Oliver, is it? Very well, if you would attend my colleague Mr Gibson, he will instruct you.” Carslow ushered the two students in the direction of his companion, who was still standing by the table, his hand placed reassuringly on the patient’s shoulder.
“Now, gentlemen, if you’d kindly prepare the patient by placing him in the lithotomy position.”
The audience watched as the hinged headboard was raised to form a shallow angle and locked. A linen cloth was placed over the table. The patient was then laid on his back, hands by his sides, with the back of his head resting against the slanted board. His legs extended out beyond the end of the table, above the tray of sawdust.
The patient’s nightshirt was lifted and rolled back over his chest. Beneath the gown, the man was naked. His skin was as pale as paper. On Carslow’s instructions, a strap was secured around each of the patient’s ankles. On a further nod from the surgeon, the patient’s knees were drawn up and back towards his chest, and his legs were pulled apart until his genitalia and buttocks were fully exposed.
Carslow again addressed the onlookers. “The patient must be restrained and kept absolutely still. The slightest deviation, a slip of the blade for example, could mean inadvertent damage to the patient’s leg or rectum, or even the surgeon’s finger, and we would not want that, now, would we?”
A polite ripple of laughter ran around the room. The look of alarm on the patient’s face made it clear that at least one man present did not share the surgeon’s sense of humour. His body was visibly quaking.
Carslow moved towards the foot of the operating table. His hands hovered over the row of instruments.
“Mr Liston and Mr Oliver, a wrist each, if you please. Mr Allerdyce and Mr Flynn, if I may direct you to take the patient’s ankles and knees. A firm hold is required, gentlemen. Are you ready, Mr Ashby?”
It was the first time the patient’s name had been used. But from the stricken expression on his face, Hawkwood suspected that the poor man had probably forgotten what his own name was. There wasn’t even so much as a weak nod.
Carslow cocked an enquiring eye at the dressers, the two students and his colleague, Gibson. All five helpers nodded back imperceptibly. Hawkwood saw the muscles along their forearms stiffen as they took up the strain.
The surgeon’s hand dropped to the table. It rose into view holding a straw’s-breadth metal rod, curved at one end like a large un-barbed fishhook. The implement was held up for the audience to see. “The bladder sound. Note the groove in the outer curve of the staff.”
Holding the rod in his right hand, Carslow leaned forward, took hold of the patient’s flaccid manhood with his left hand, held it upright and, without pausing, placed the hooked end of the rod into the tip of the penis and pushed it down inside the shaft.
Christ Jesus! Hawkwood clenched his fists at the unexpectedness of it.
A bellow of pain erupted from the patient’s mouth and his body arched. The table became a mêlée of thrashing arms and legs.
“Hold him still, gentlemen! Hold him! Calm, Mr Ashby! Calm!”
It was clear from the speed with which the two dressers hauled down on the straps that they were accustomed to grappling with patients. The two students, however, despite their hold, had plainly been taken by surprise at the ferocity of the resistance. It was only with the help of the surgeon’s chief assistant, Gibson, who laid himself across the patient’s chest, that they were finally able to renew their grip.
It took several seconds before the man on the table was held fast. Through it all his head continued to whip from side to side like a newly landed fish.
Hawkwood found that his palms were slick with sweat. It had been an extraordinarily unnerving scene. There couldn’t have been a man watching who hadn’t imagined himself in the patient’s position as the probe went in.
Ignoring the patient’s yells, Carslow continued where he had left off. Gripping the metal staff once more, he began to feed the rod down the inside of the penis. His voice remained measured, th
ough louder than when he had started, to counteract the noise from the man struggling on the table. “We place the rod through the urethra and into the bladder, like so, and we listen …”
Hearing the surgeon’s words, Hawkwood was suddenly aware of how still the rest of the room had become. It was as if everyone was holding his breath. Even the patient’s cries subsided into a series of low mewling sounds, though the pain must have been excruciating. Then, to Hawkwood’s astonishment, the surgeon bent and placed his ear to the base of the patient’s cock.
“There!” Carslow announced. “The villain is located.”
Hawkwood realized the surgeon had been listening for the click as the curved end of the rod knocked against the stone.
Swiftly, keeping a hold on the end of the rod, which was sticking out of the patient’s penis like a stopper in a decanter, the surgeon reached for his scalpel.
Hawkwood’s stomach twisted.
“Hold him fast, gentlemen, if you please.”
The dressers bore down on the patient, exerting pressure. The leather straps were pulled tight.
“Now for the first incision. I place the blade against the perineum, so. And remember, slowly and deliberately …”
Placing the point of the blade against the skin behind the patient’s scrotum, he pressed in and drew it carefully down towards the patient’s rectum. The flesh parted like grape skin. Blood welled. A bleating wail rose from between the patient’s clenched teeth.
Hawkwood sucked in his breath.
The patient writhed as the surgeon continued. “I divide the prostate gland and with the point of my blade I press against the bladder wall, feeling for the groove in the bladder sound, while taking care to avoid damage to the surrounding tissue.”
