by James McGee
Blood, Hawkwood could see, had started to drip from the incision.
A pig-like squeal rose from the head of the operating table.
“Heads!” The shouts came out of the blue, from the top tier away to Hawkwood’s right. “Heads!”
Jesus, now what? Hawkwood wondered. And then he realized the calls were coming from spectators who were unable to see the operation because the heads of the dressers were blocking their view.
Other students took up the chant. Obligingly, the dressers leaned away from the table, still maintaining their control of the patient’s legs. As the cries ceased and the onlookers settled down, Hawkwood could see that the patient also seemed to be becalmed, as if he’d surrendered to the inevitable. Carslow’s assistant, Gibson, was stroking the man’s sweat-streaked head and whispering in his ear.
The wound had started to bleed profusely. A thin dark-red stream was seeping down the cleft of the patient’s buttocks and dripping into the blood box beneath the table.
“Having located the groove, I cut through the wall of the bladder, using the groove in the sound as my guide.” The surgeon’s voice rose from the foot of the operating table. “I take my forceps, insert them through the perineum and on into the bladder, and remove the stone. Note that the insertion and extraction is gradual rather than sudden.”
With his left hand pressing down on the exposed end of the bladder sound, the surgeon insinuated the forceps into the incision. The look on his face was one of studied concentration.
The patient gave a piercing shriek.
Hawkwood took a surreptitious glance around. There was more than one student who was looking a bit unsteady; he presumed they were the ones attending their first operation.
Suddenly there was a grunt from the direction of the operating table and a collective gasp from the gallery. Hawkwood turned quickly.
At the foot of the table, Carslow was holding the forceps aloft, a look of satisfaction on his face. Caught in the metal jaws was a round, dark object the size of a hen’s egg. It was dripping blood.
With a flourish, the surgeon dropped the stone into the metal bowl and withdrew the bladder sound from the end of the penis. As if on cue, the onlookers burst into a round of applause.
Carslow held up his hand. The room fell silent.
The surgeon returned his attention to the patient, who was lying motionless, with the exception of his chest, which was moving up and down with the rapidity of a fiddler’s elbow as he fought to recover from his exhausting ordeal.
“Bravely borne, Mr Ashby, the ordeal is over. My assistant, Mr Gibson, will attend to you. Mr Liston and Mr Oliver, you may return to your places.”
The patient gave no sign that he had heard.
The surgeon waited while his two recruits made their way back to the gallery and the envious smiles of their friends, before addressing the audience: “Remember, it is the surgeon’s duty to tranquillize the temper, to beget cheerfulness, and to impart confidence of recovery.”
Behind Carslow’s back, Gibson had turned the patient on to his side and was staunching the blood seepage with pads of soft lint.
The surgeon raised an eyebrow towards one of the medical staff standing on the lowest tier of the gallery. “How long, Mr Dalziel?”
“One minute and forty-three seconds, Mr Carslow.”
A murmur went around the room. Hawkwood wondered if that meant it had taken longer or shorter than expected. To the patient stretched out on the table below, it had probably seemed like hours.
The surgeon accepted the time with a thoughtful nod. “Thank you.” He looked up at the students. “It is said that my illustrious predecessor, William Cheselden, could perform the operation you have just witnessed in under one minute. While swiftness is an admirable trait, never let the desire for speed dictate your actions. Let expediency be your guide. Cheselden was quick because he was a good surgeon and because he knew his anatomy. Anatomy is the cornerstone of surgery. Remember that, and you will not fail …” Carslow paused. “It is also incumbent upon me to point out that Cheselden did not pioneer the operation, he merely refined it. It was, in fact, a man of humble origins, one Jacques Beaulieu, who developed the lateral perineal approach. As you may have gathered from the name, he was a Frenchman. There are no frontiers in Science and Medicine, gentlemen. You would do well to remember that also.”
Cheselden. The name had been on some of the pamphlets in Colonel Hyde’s cell, Hawkwood recalled.
As the students filed out of the lecture room, their faces animated by what they had seen, Carslow walked over to the pitcher, poured water into the enamel basin and began to wash his hands.
Hawkwood picked up his coat.
In the small waiting room behind the lecture theatre, Carslow finished drying his hands and passed the damp towel to his dresser. “Please inform Mr Savage that rounds will begin on the hour.”
The dresser, with Carslow’s soiled apron laid over his arm, nodded, handed the surgeon his coat and left the room, taking the towel with him. The surgeon watched him go, then turned with a frown.
“Now then, Officer … Hawkwood, was it? What is so important that you feel the need to disrupt my afternoon lectures?” Carslow slipped an arm into his coatsleeve.
There were dark stains running down the legs of the surgeon’s trousers, Hawkwood saw. Many of them looked crusted over, as though they’d been there for some time. Others looked fresh. He remembered the blood that had run from the last patient’s arse and assumed that it hadn’t been the day’s only operation. He suspected also that a lot of the stains weren’t just blood but had probably come from other body fluids. Some of them looked like dried pus.
“The sight of blood disturbs you, Officer Hawkwood?” The surgeon inclined his head.
“Only if it’s mine,” Hawkwood said.
Carslow considered Hawkwood’s response and allowed himself a taut smile. Close to, Hawkwood was struck by the ruddy hue in the surgeon’s cheeks; it was a complexion that would not have been out of place on a gentleman farmer. He wondered about the surgeon’s origins. In the lecture theatre, Carslow’s voice, while not strident, had reached every corner of the room, and his delivery had been clear and concise. But despite the well-modulated tones, there was a detectable burr that hinted at an upbringing some distance from the capital. The occasional rolling consonants suggested somewhere to the east, Suffolk or Norfolk, perhaps.
“Now, sir, I do believe we were on the point of discussing the reason for your visit?” Carslow made a display of shooting his cuffs and moved to a small wall mirror, where he proceeded to adjust his collar and stock.
“Colonel Titus Hyde …” Hawkwood began. “I’d like to know why his Admission Bond at Bedlam Hospital carries your signature.”
The hesitation was so slight that, if it hadn’t been for the tightening of the material across the shoulders of the surgeon’s coat, Hawkwood might well have missed it.
Carslow turned, his fingers playing with the knot of his cravat. “I wondered whether someone might come.”
Hawkwood waited.
“The answer is simple. I signed my name to the bond because I felt it was my duty to do so.”
The surgeon paused, considering his words.
“Titus Hyde and I were students together. We were from different backgrounds, but similar in age. We attended the same lectures. We had the same teachers. Our mentor was John Hunter. You’ve heard of Hunter, of course?”
Only from the book spines in the colonel’s rooms, Hawkwood thought. He shook his head.
Carslow looked surprised. “Really? He was a great surgeon. A pioneer. He taught us so much: anatomy, respiration, the circulation of the blood … Hunter changed the way students were taught. Our lessons weren’t just about medicine. They included chemistry, natural history, physiology, the function of living things; even philosophy. Hunter wanted to sweep away all the old superstitions. He wanted students to question, to think for themselves. He once said that hospitals were not
just places where surgeons gained experience before trying their luck on the wealthy, but centres for educating the surgeons of the future. Titus and I worked as his dressers during several of his operations. We were like explorers, charting the oceans, discovering new worlds …”
Apothecary Locke had said much the same thing, Hawkwood remembered. It could have been an echo.
Carslow smiled. “He would tell us not to make notes during our lessons because he was a student himself and his views were constantly changing. I recall someone – it may even have been Titus – challenging him on that, and Hunter said that by altering his views he hoped to grow wiser every year. I know there were some who judged his style too informal, and it was true that he had a tendency to meander, but Titus and I found his methods wonderfully liberating.
“He used to call the body ‘the machine’. He was the finest surgeon of his age, and yet he had a profound respect for the healing powers of nature. He was the one teacher who told us that surgery should only ever be considered as a last resort.” Carslow paused. “He was an inspiration; an exceptional man.”
The surgeon fell silent. The colour in his cheeks deepened. He looked vaguely embarrassed. “Forgive me, Officer Hawkwood; it would appear that I’ve inherited my mentor’s gift for obliquity. You are here, after all, to ask me about Titus Hyde.”
Obliquity? Hawkwood thought.
The surgeon collected himself. “After our studies in London were complete, we went our separate ways. I spent time in Paris. Titus travelled to Italy. Their anatomy schools enjoy a particularly fine reputation. When I returned, I entered private practice. Titus embarked on his military career. His father was in the army; his grandfather too. He saw it as carrying on the family tradition. He was fortunate in having the patronage of John Hunter to assist in his deployment. Mr Hunter had recently been appointed Surgeon-General. It was through Hunter’s help and family connections that Titus was able to purchase his commission.”
Hawkwood had wondered about Hyde’s rank. Army surgeons commonly held the rank of captain. Few, if any, held the rank of colonel. There was an old saying about rank having its privileges. In the army it was often the other way round.
“What was his regiment?”
“The 6th Regiment of Foot.” Carslow’s face softened. “It’s a sad fact, Officer Hawkwood, that the battlefield provides great opportunities for the surgeon. It offers him the chance to investigate all manner of injury. I think it was Larrey who said that war carries surgery to the highest pitch of perfection. He’s Bonaparte’s chief surgeon, so I’m more than content to take his word for it. Ironically, the vast number of casualties returning from Spain has allowed civilian surgeons like myself the chance to hone our particular skills.”
Hawkwood thought back. From what he could remember of Hyde’s regiment, they’d been in the thick of it from the beginning. The 6th had probably seen as much action as the Rifles. As a regimental surgeon, Hyde would have had his work cut out, that much was certain.
“Titus and I continued to exchange letters, though our correspondence became more infrequent as time went by. A few months would pass, sometimes a year, and then a letter would arrive telling me of his travels in some distant land. I would write back about my life in London, and then another year or two would elapse. Then, just when I thought I would never hear from him again, a letter would turn up out of the blue. And so it went on.”
The surgeon hesitated. There were two chairs in the room. Carslow took one and indicated that Hawkwood should take the other. “It was in his letters from the Peninsula that I first began to notice the change. It had been a while since I’d received any correspondence from him, though he did send a brief note from Ireland – I remember he was not taken with the weather there. It rained so much, he thought he would rust. The next letter was from Spain. There’d been a battle, Rol … I forget the precise name. I –”
“Rolica,” Hawkwood said.
“Yes, that was it.” There was a questioning look in the surgeon’s eyes.
“I was there,” Hawkwood said, and wondered immediately why he’d felt the need to admit it.
The 95th had played a crucial role in the battle and the lead-up to it. Hawkwood had led raiding parties against the enemy’s rearguard, employing hit-and-run tactics that had infuriated the French general, Delaborde. The weather had been blisteringly hot, Hawkwood remembered. Hyde would have found it vastly different from rain-sodden Ireland.
Carslow stared at him. A shadow fell across the doorway. It was one of the dressers. “Time for rounds, Mr Carslow.”
Carslow turned. “Thank you, Mr Flynn, you may tell Mr Gibson to begin. I’ll join him presently.”
The dresser frowned, threw Hawkwood a curious glance, then left.
Carslow leaned forward. “So you were there?”
“I was a soldier,” said Hawkwood.
For a moment it looked as though the surgeon was waiting for Hawkwood to expand on his statement, but the dark shadow in Hawkwood’s eyes must have told Carslow that was not going to happen.
“Titus wrote that there were many wounded,” Carslow said.
Hawkwood nodded.
“His letter said that conditions in the aid posts were very bad.”
That was an understatement. Hawkwood glanced quickly at the surgeon’s blood-smeared trousers. Conditions in the forward dressing stations and battalion field hospitals hadn’t been bad, they’d been appalling.
“You said there was a change in him?” Hawkwood prompted.
The surgeon looked thoughtful. “Not then, but later, over the following year, as his letters became more frequent. He wrote of other battles. Vimeiro was another one I remember.”
Carslow’s expression grew solemn. “That was the first time his letters had shown real anger. They were very descriptive, too. He wrote of the men he worked with, the soldiers he tended, the type of wounds he had to treat; the lack of proper equipment, the dreadful food, and the filth. The list of diseases was endless: dysentery, typhus, pneumonia, cholera – you name it. More men were dying of infection than from their wounds. He described how the wounded were left on the field of battle, often for days, before they were retrieved. How local villagers would descend like wolves to steal personal belongings from the dead and dying. You could see in his words that he was becoming disillusioned by the knowledge that he could not save them all.”
Hawkwood listened to the litany without interruption. He’d seen it for himself. He didn’t need any embellishment. He’d known the treatment stations and the tents where patients lay two to a bed, where the overwhelmed staff had to light fir-log fires to try and conceal the stench of so many men packed together. He’d stood by the burial pits, too, and watched the orderlies torching the bodies to prevent contagion. The reality of war was never far from the minds of the men who had served and, more importantly, survived.
Carslow pursed his lips. “Titus felt that surgeons were too quick to intervene. He believed that meddling with wounds often resulted in a worse outcome than if the wounds were left to heal on their own. He’d learned that from Hunter. He worked among the French prisoners, sometimes with captured French surgeons. He said their methods were just as bad, that they preferred to amputate rather than let nature’s balm take its course. Though he and his French counterparts were in agreement that evacuation of the wounded from the battlefield should be much quicker. Were you at Corunna, Officer Hawkwood?”
Hawkwood nodded. We all were, he thought.
The winter retreat from Sahagun to the sea had taken nearly three weeks, over some of the most inhospitable terrain Hawkwood had ever encountered. There had been no mobile hospital facilities. The severely ill and injured had been left by the side of the road. Of the survivors who’d made it back to England on the transport ships, nearly a quarter had still required treatment.
Carslow’s mouth tightened. “When the troops arrived home, the government closed the hospitals in Gosport and Plymouth. There were not enough beds. They
had to use barracks, storehouses, hospital ships, anything they could find. Some of the casualties were even placed in hulks. There weren’t enough surgeons, either. Local medical students offered their services and military surgeons were sent down from London. According to Titus, the conditions were bestial. That was the word he used: bestial.”
Hyde had returned to the Peninsula the following April with the rest of the army to begin the advance into Spain. Conditions hadn’t improved; still not enough transport or food. The commissariat hadn’t been able to cope. Many of the soldiers, fresh from English barracks and newcomers to the climate, fell victim to the heat and the hard marches. The vast bulk of the army had been on half-rations, some troops on even less. Hyde’s work had begun the moment he’d disembarked from the transport ship. It must have seemed as though he’d never been away.
Listening to Carslow’s account, Hawkwood had no trouble picturing the scene. He was also aware from the Bethlem hospital documents that it must have been around this time that Hyde’s “distraction” had begun to manifest itself.
“Titus’s next letter to me was written shortly after his arrival in Portugal. It was sent on a packet from Lisbon. Mostly it concerned details of the voyage and the conditions on board ship. That was the last letter I received. It was not until I was approached to cover his bond that I learned what had happened to him.”
The way Carslow described it, the colonel’s continuous remonstrations over the inadequacies of the medical facilities and what he had perceived to be gross dereliction on the part of the general staff, had begun to irk both his fellow surgeons and his superiors. According to the latter, the colonel’s manner had started to become increasingly erratic. In the end, he had been relieved of duty, examined, and admitted to one of the base hospitals. From there he was taken back to the coast and transported home.
“A part of him must have remained lucid for him to have mentioned our friendship. I was asked if I would co-sign his bond. How could I refuse?”
