Thomson made the cut in Martha’s belly. He reached in with his unwashed hands and pulled out the child, who cried; with the baby gone Martha’s uterus began to contract with a suddenness that took the men by surprise so that John Hunter had to help by holding in the mass of intestines which spilled out into the resulting space. Thomson stitched the wound shut and when the needle pierced Martha’s skin she cried out, and this was, Thomson said, the only sign of anguish that she gave. She died five hours later; the baby survived her by two days. Neither Thomson nor Hunter were present at her death although they attended to her again afterwards, for her autopsy, to which William Hunter also came. They could not find any immediate cause for her death, but in the notes that he appended to Thomson’s account of the operation John Hunter wrote that “an author would be more esteemed and relied upon, if, with candour and disinterestedness, he would relate the instances wherein he has failed, that the world might judge how far the chance or hazard of the operation rendered it advisable or not”—and progress is incremental, slow, and it is cruel, but it is made. In 1793 one of John Hunter’s pupils will assist at a Caesarean after which the woman will survive.
* * *
—
The night after the scan I lay with my belly pressed against Johannes’ back, listening to his slow breathing, each round ending with a snore, my long-worn irritation at the sound a form of habitual affection. Earlier in the evening, intending to put a pile of laundry away, I had come up to our bedroom and, suddenly overwhelmed, had lain down across the bed and pulled a blanket over me and fallen asleep. Johannes had woken me when he came up, helping me to pull off my clothes, shaking out the duvet where the weight of my body had flattened it; and now, although still heavy with tiredness, disorientated and chilly, sleep would not return. I shut my eyes and felt in imagination along the plane where the two of us did not quite join, our impenetrable skins closely separating, giving warmth but withholding access, each touch an affirmation both of proximity and disjunction, and I thought of the baby, that thing which lay between us, still more mine than his. The child was, for Johannes, still largely hypothetical: his life so far remained predominantly unchanged and what I felt as a set of prohibitions and a physical incapacity, a slow-fast-slow remaking of my own biology, was for him hardly more than anticipation, like waiting for Christmas to come—the gradual, enjoyable winding-up of affairs before the holidays. He would not feel the child’s weight until he held it in his arms, an object, loved but as apart as he and I were: a thing to be learned, understood from the outside as a puzzle or a book is understood, imperfectly, wholeheartedly. Things were not, for him, so ambiguous: the harbouring of a stranger inside oneself, this the closest to another person it is possible to be but that person still unnamed, unmet. I had tried, while walking sometimes through the city in the afternoons, to reach inwards and find some connection to my unborn child, but I was not one of those who felt able to talk to it, to feel intimacy, and for me the sense of being unwell, of being incapacitated, remained immediate while my child was a distant thing, floating in a space that was a kind of void to which I had no access. This is what John Hunter found, that chilly morning in the basement of his brother’s Covent Garden house as he bent over the flayed, dismembered body of a woman: that even inside the womb, intimacy is incomplete. Injecting with deft fingers the fine capillaries of the placenta, more gentle in his dealings with this already decomposing tissue than he would ever have been while it was still alive, he found two separate systems: the infant’s and the mother’s, coextensive but not conjoined, so that they were like the maps of two mazes interleaved, path laid on path but uncrossable, each leading back only into itself. My child and I shared breath, and we shared water, food, but we remained distinct: the line between us was a cell’s breadth across but still it held us back from falling into one another and we were not the same.
Lying by Johannes in the darkness, envying him the unquestioned habit of sleep, the way he could remove himself, I wished that I might pause, take stock; and this is a thought that comes to me again now: that I would like to pause pregnancy like a film, to walk away, do something else, returning later when I have had time to rest or think. I would like to be unpregnant for a stretch. I had always, before my first pregnancy, regarded my body as a kind of tool, a necessary mechanism, largely self-sustaining, which, unless malfunctioning, did what I instructed of it, and so to have my agency so abruptly curtailed, revealed as little more than conceit, felt like a betrayal. I no longer listened to my own command. Inside me, while I wished that I might be able to be elsewhere, that I might leave my body in the frowsty sheets and go downstairs to sit in the dark kitchen, unswollen and cool, cells split to cells, thoughtless and ascending, forming heart and lungs, eyes, ears—a hand grew nails—this child already going about its business, its still uncomprehending mind unreachable, apart.
* * *
—
If Jan van Rymsdyk’s talent was to see only the surface of things then John Hunter’s commensurate gift, perhaps, was to see how this surface might be extended: the folds in it, the crenellations that could be laid flat. Where for others the human body had seemed a single entity, one impassive mechanism, feared more than it was understood, to Hunter it was an urn and his task its excavation, gone about in winter when the weather held its rotting back: the disinterment of our long-hidden contents, the heavy organs, lungs, lymphatic system, the tree-like patterns veins make, the chambers of the heart. Seeing them, weighing them in his hands, feeling their give beneath the blade of his knife or watching pigmented wax bring ersatz life to a cadaver’s bloodless tissue, he hoped to gain something—not quite fame but something close to it, renown or vindication, and with it the satisfaction of his curiosity. Since the dark ages when plague came in waves to wash whole villages clean of their inhabitants, European medicine had been largely a matter of propitiation, being more akin to faith than science: a set of habitual, heritable practices based on the untested superstition that any intervention has a better chance of success than nothing at all. What conception of the healthy function of the human body existed was based on the humour system developed by the ancient Greeks, the acknowledgement of its insusceptibility to any kind of contemporary proof buried beneath the lingering belief that humanity was in decline and what had once been obvious was now mysterious, absorbable only by rote. Treatment was a combination of quackery, alchemy, and religion, its methods unchanged for generations, passed down from master to apprentice in a training system which required neither a knowledge of anatomy nor any practical skill beyond the performing of those techniques which were considered to constitute medicine and were demanded as much by the patient as they were prescribed by the physician: bloodletting, cupping, prayer, the occasional hacking off of parts. Where elsewhere the Enlightenment had begun to prise things open at the joints, medicine lagged behind, staid—susceptible to doctrine rather than proof, debate rather than experiment; and into this miasma John Hunter’s curiosity fell like a sharp illumination.
His interest in anatomy, both human and animal, began in childhood. He was born during the second week of February 1728 at Long Calderwood, his family’s farm which stood in the countryside south of Glasgow. The actual date of his birth is a matter of dispute: although he himself always celebrated it on the fourteenth it was recorded in the parish register as the thirteenth and in the family Bible as the seventh. He was the youngest of ten, and perhaps after so many the arrival of another child was routine, or, three of them having died already before he was born, perhaps his mother had learned that birth was no guarantee of life and so did not—yet—allow herself to give too much away, the lurch of affection that is betrayed by announcement, and this was why his birthday was forgotten; or perhaps it was only that he came swiftly into a world where there was work to be done, the ewes lambing out on the hillsides being more immediately important to a family with no other source of income and now another child to feed and clothe. As a b
oy he possessed neither an interest in nor an aptitude for schoolwork. He found reading a laborious task and one to be avoided, its rewards pale compared to those which could be got from an examination of the world outside the schoolroom, and often on his morning walk along the lane to the kirk for lessons he would allow himself to become diverted, curiosity leading him to spend long hours when he ought to have been at his books roaming about the countryside instead. His early life became a journey of investigation through leaf mould, through the mud along the sides of streams or underneath the hedges; and during these empty, meandering childhood days John began to learn by experiment the art of dissection, poking about in the remains of dead sheep he found on the hillsides or eviscerating earthworms, skinning mice and shrews. In adulthood this dislike of academic study became a principle of sorts—he distrusted that which might be learned from books, believing that it was always better to see for oneself with truth not proved until it had been performed.
John’s adolescence was marked by loss. When he was thirteen his father died, swiftly followed by two of his sisters. Shortly after he turned seventeen his eldest brother, James, whose progress through his chosen medical career had taken him to London, became unable to work due to ill health and returned to the farm, lying for days on one of the beds that pulled out from the walls of the two-roomed cottage like drawers, coughing himself to death at last while John watched or was nearby; and I find it hard to imagine, now, when death is largely hedged about with treatment plans, when it does not often come senseless out of nowhere but can be postponed, or if not that then at least explained, what grief must have been like when that boundary was a curtain you could put your hand through. It is easy to think that when death could be so quickly turned to, a matter of misstep, and all families counted lost children in their numbers, that loss must have been a blunter thing—that, having so much practice, they must have been better at it, or inoculated, that it cannot have been for them such devastation, this laying waste—as the birth of a tenth child might be of less account in a busy week than the loss of a pair of lambs, so that the date of it was not looked for until later, when it was found to have been forgotten. It is easy to think that in an age without anaesthetics, when legs might be hacked off on kitchen tables, teeth pulled with pliers taking gobbets of jaw and gum away with them, that pain must have been somehow a less precise, less devastating thing, the alternative being unthinkable—that it was just the same but, persisting, could only be endured, too universal to allow concession; and so John Hunter watched the bodies of those he loved carried out of the tiny farmhouse one by one, making their last journey to the church, and afterwards he went about the business of his days, he went to school or to the fields, and then at last, summoned by William, the sole surviving brother he barely remembered, he went to London, and did not return.
* * *
—
Sometimes, walking down the street or looking outwards from the window of a bus, I saw a child run to take its mother’s hand or, stretching itself upwards, be swung into a father’s arms, their faces turned to one another, intimate, engrossed, and then I felt a swift pain like an upwards stab, my anticipation of this future I was in the process of laying down. Across those strangers’ faces I saw our own elided, mine and Johannes’, the child’s who was half-turned away; but although in the other two I saw imagination’s present of perfection it was my own that I bent towards, trying to trace in its lines the better version of myself I still waited to succumb to, someone steady, solid, rooted down—and this was the first intimation I had of the complicated interplay between our children and ourselves, the ways we twine about one another, using them as mirrors to our flaws, their reflective plasticity showing us how we must first learn that which we would like to teach: honesty, patience, the capacity to put another first. It seemed, at times, an act of profound selfishness, to have a child so that I might become a parent; but selfish, too, to have a child and stay the same, or not to have one—unless the only honest choice would have been to try to become this kinder version of myself without the need to bring another into it. Once my daughter was born, of course, so much was simplified: I could not now regret any aspect of her, or wish her unmade, or do anything but try to turn myself into the thing she needed, but still I wonder sometimes if I was right to foist life, and myself, upon her; if I am right to do it again because I want her to have an ally and cannot bear the thought of never holding another sleeping baby, the agony of their eyelids, their mouths, their skin. Perhaps it is an unjustifiable act—no reason for it quite good, quite generous enough. To feel myself tired of a life which stretched out like fine sand without much weather, to be dissatisfied, wanting to become the shape a child would force me into, must stand as sufficient explanation, an ill-formulated defence; and thinking this, sat on the bus’s upper deck, my forehead resting on the window’s sweating glass, I would hold my hands, momentarily, across my stomach, and feel it for what it was, for me: a kind of promise I must strive to keep, the commitment to make myself the best mother I could to make up for having made myself one at all.
* * *
—
I would like to say of John Hunter’s adolescent losses that they must have been formative, bringing about through their repetition the long inculcation of a desire to save, as I would like to see in my daughter’s birth a wheel rotating: the transmutation of the lives of others, lost, into a capacity for something else—kindness or happiness or an incrementally increasing volume of compassion; but I can’t make myself believe it. Such events are not crucibles but are only the natural order of things, what happens and then what happens after it—the same striations of grief and its easing that all of us suffer, to some degree. Looking back, we might try to make sense—to stand in a calm spot, latterly, and examine at leisure the details of a running tumble we barely kept pace with, the cumulative outcome of decisions made blindly or not at all, and try and find significance in it, some repetition of a universal pattern played out in ourselves. This would be comfort: to believe both that things could not have been other than they were and that how they were was right, one’s life a well-formed argument, each moment a logical progression from the last.
In the afternoons, home from Italy and waiting out the shortening late-autumn days, I sit upstairs while Johannes and our daughter play outside, running through the drifts of fallen leaves that skirt the garden or lifting up stones to see what lives beneath them, and I watch them through the window and feel how precarious things are. All this will soon be lost. The solstice will be passed, and Christmas, and the new baby will be born, buds will come on the trees again and our daughter’s tiny figure which seems at every moment so complete will be superseded by another version of itself. I would like to believe that what we have made of our lives is good or at least that it is inevitable, and so I try to find in all that has happened a pattern or a thread, some shape beyond the turn of past to future. I search for meaning everywhere. It is as if I believe that I might, drawing back a swathe of cloth left in an attic, find comprehension waiting for me, and with it a final understanding of the way things are, and why, and that in doing so I might feel the fragility of things less; but there is nothing there. Meaning is not found, discovered in a cold basement with an artist lurking, or as an image unexpectedly projected on a screen, but is assigned, the task of its superimposition upon what exists no more than an inelegant scramble to keep up; and underneath it nothing but events come willy-nilly into being and our need to fill the days, decisions leading to decisions, a mapless ramble, haunting and unthought-through.
* * *
—
The journey from Long Calderwood to Covent Garden, made in the late September of 1748, took John Hunter two weeks, at the end of which he presented himself at his brother’s house, a rough young man, travel-worn, grubby, given to casual obscenity and with a stubborn refusal to temper his manners that he would maintain throughout his life, the first sign of that uncompro
mising streak which would manifest later as an absolute commitment to progress in the face of a largely intractable establishment. He would work as his brother’s assistant for twelve years, quickly becoming the more skilled of the two in matters of dissection so that soon he was performing almost all of the anatomical work of the school, both the routine preparation of cadavers for demonstration and the more specialised work necessary to the preservation of body parts for permanent display. At last his health began to give out, the result of overwork or of those long hours spent amongst the rot and filth of the dissection room—it would be another century before Lister introduced the idea of hand-washing to surgery and John’s fingernails would have been crusted under with remnants of the tissues, living and dead, that he had been working on; or perhaps he wanted only an excuse to extricate himself from William’s benevolent indenture. Lacking, despite his experience, any of those formal qualifications which would allow him to set up as a surgeon in private practice, but wanting access to the same proliferation of live subjects as he had already observed dead, he joined the army, a course of action which would have the added benefit of circumventing the need for qualification, since an army surgeon, demobbed, had an automatic right to practice on the general population; and in March 1761 he set sail on board a hospital ship to take part in the assault by the British on Belle-Île, an island off the coast of Brittany.
Battlefield medicine was a desperate affair. In an initial failed attempt upon the island, John found himself stepping across the bodies of the wounded where they had been thrown upon the decks, waiting for their limbs to be sawn through, for lead shot or wooden splinters to be excised from the flesh of chests or flanks, the slashed skin flayed half off the heads of men to be stitched shut as best as could be managed. Deaths must have occurred from a multitude of causes: the wounds themselves and attendant blood loss but also from shock resultant upon the brutality of treatment or from infections introduced while the wounds were being enlarged, standard practice to allow foreign bodies to be removed more easily. In such conditions, men’s flesh cut away without sanitation or disinfection on board a ship or in the churned mud beside a battlefield, any procedure was liable to be rendered worse than useless, and infection was so ubiquitous that suppuration was considered by surgeons of the time to be a necessary part of healing. John Hunter, watching his colleagues going about their business with the surety of those who doubt neither their purpose nor their methodology, while around them men screamed, and bled, and died, began to wonder what the point was of practices which seemed to him to save no one. Later, after April and reinforcements brought a second and successful assault upon the island, John would come across five French soldiers, wounded by gunfire, who had taken refuge in an empty farmhouse. Their wounds—despite no medical attention—had healed as well, if not better, than those who had experienced all the supposed benefits of the ministration of a surgeon. John began to modify his practice accordingly, treating only those injuries where treatment seemed an absolute necessity. He advocated too that surgery should be delayed if possible until the patient was no longer lying on the battlefield but was somewhere relatively comfortable, and until their condition had to some degree stabilised, particularly in the case of amputations—and although despite these adaptations of standard practice many men still died it was not quite so many, which John Hunter, despite the opposition and at times derision of his colleagues, considered proof.
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