A pioneering cutter with a conscience

Digging up the Dead
March 2, 2007

Cutting up people for a living - for such is surgery - is a precious strange career, particularly in the pre-anaesthetic era, whose surgeons are often portrayed as cruel and ineffectual, dissecting corpses robbed from graves, vivisecting stray animals and hacking away crudely at conscious patients. Tennyson knew the sort: "Fresh from the surgery schools of France, (with) big voice, big chest, big merciless hands, Ihappier using the knife than in trying to save the limb... who would break... jests on the dead, and mangle the living dog that had loved him and fawn'd at his knee."

The sights, smells and horrors of blood and guts are still close.

As a student, I carried a man's warm, freshly removed sausage-like colon to the sluice room, cut the ligatures at each end, slit it lengthways, washed out the faeces and returned it to the theatre for the surgeon to inspect the tumour nearly blocking the bowel. As Sir Jonathan Miller says, one genteel foot of medicine may be "in the... world of consciousness and conduct", but the other stands solidly "in... the muck of the human body".

The part of the equation forgotten by those criticising early surgeons is that people needed to be cut up - and still do, desperate diseases requiring desperate remedies. The alternative was fast, pointless, preventable deaths - as with Astley Cooper's 13-year-old foster brother, exsanguinating through his popliteal artery for want of a piece of catgut - or lingering, painful, horrible deaths, as with a tumour-blocked bowel, the merciful end coming only after a viscus eventually bursts. Druin Burch understands these things, saying of the early surgeons that "their humanity was often what drove them", for "the pain was real, and (the surgeons) were the ones that the suffering turned to for help... They were the best that was available and they knew it. The knowledge drove them to become better".

Despite the silly sensationalism of this book's title - the publisher seemingly not knowing that a basic requirement of a biography's title is the subject's name - Digging up the Dead is a sympathetic and insightful account of the great Georgian surgeon Sir Astley Cooper. For Burch, biography "is a form of... autopsy, which means 'to see for oneself'"; and, lightly but effectively, he introduces astute observations of his own patients, colleagues and clinical experiences, while finding humanity in the hand that holds the amputation knife and scholarship in a surgeon for whom a day not spent in the dead house was a day wasted, a day not fully alive.

Cooper's eventful life contained much worth describing, and Burch describes it beautifully: the young radical who worked in the Hôtel-Dieu in the summer of 1792 while the Paris Terror escalated around him; the old conservative who earned his baronetcy by removing an infected sebaceous cyst from the forehead of George IV; the lecturer who enthralled Keats with his description of how bats fly faultlessly around rooms with their eyes removed; the comparative anatomist who dissected an elephant in the yard of his house in St Mary Axe, and whose servant Charles scoured Billingsgate for beasts "more fitted for the investigation of the Physiologist than for the gratification of the palate of the Epicure"; and the author of the definitive On the Anatomy of the Human Breast , published in 1840, a year before his death, with its appendices on the mammary glands of the ass, cow, goat, ewe, hare, guinea pig, cat, bitch, sow, porpoise and rhinoceros, the latter obtained from Richard Owen, who told Cooper that porpoise milk "felt like butter upon the tongue".

Cooper's great strength was the depth of his anatomical knowledge. Burch emphasises that for Cooper's successful operation on the carotid artery, "success was not the result of luck. It was the mark of many long hours... in the dead house". For Cooper, there was "no short road to knowledge; observations on the diseased living, examinations of the dead and experiments upon living animals are the only sources of true knowledge". As he told a parliamentary committee, "he must mangle the living (who) has not operated on the dead".

Burch is less enchanted with the older Cooper and his vanity, sycophancy and "silkiness of manner and finery of habits". Nevertheless, Burch tells approvingly of how the richest surgeon in England rode, one cold, wet Christmas Day, to see a poor and dying neighbour, "to do a kindness", so that Burch finds himself, "lingeringly fond of this vain, egotistical, nepotistic and rather wonderful old man".

Walt Whitman said - appositely - that a poet "drags the dead out of their coffins and stands them again on their feet". Cooper, the resurrection man, would have approved both the sentiment and this biography.

Chris McManus is professor of psychology and medical education at University College London.

Digging up the Dead: Uncovering the Life and Times of an Extraordinary Surgeon

Author - Druin Burch
Publisher - Chatto and Windus
Pages - 265
Price - £20.00
ISBN - 0 7011 7985 6

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