Abstract
Background to the extract
It is 1825 and James has completed his training and recently become a Licentiate of the Society of Apothecaries (LSA). Despite having no personal connections and up against more experienced candidates, he was elected by the Weekly Board and Governors’ Council to the post of apothecary at the Middlesex Hospital. It was the sort of post he’d dreamt of since being a medical pupil at the Borough hospitals (St Thomas’ and Guy’s). With the help of his assistant, Sam Nunn, it had taken him only a few months to turn round the dysfunctional apothecary department he’d inherited. The senior doctors and Shedden, the hospital secretary, recognised what he’d accomplished. Apart from James, the only other resident doctor was the house surgeon, Tuson.
‘The Weekly Board have a request,’ said Shedden one morning. ‘They want you to have a key to the dead house.’
The dead house was just along the corridor from James’s office. With his door lying open most of the time, he was used to seeing porters bringing and fetching bodies. Enright, the surgery man, was another frequent visitor.
‘Why do they want me to have a key?’ asked James.
‘Thing is, Enright’s only allowed to go in there if he’s supervised by the house surgeon, but Tuson’s often busy elsewhere. If you had a key, you could supervise Enright.’
‘Can I just be clear,’ said James, trying not to show his annoyance at the thought of doing Tuson’s duties. ‘Enright’s not meant to be in there alone?’
‘Heavens, no. Strictly against hospital rules.’
‘I see.’ James paused. ‘I’d like to help, but it would cause delays in making up medicines for patients, which I’m sure the physicians and surgeons wouldn’t want.’
‘Oh, yes, of course,’ said Shedden, looking down at the floor. ‘Doctors’ needs must come first. I’ll tell the Board.’
James was still seething, sitting clenching his fists, when Sam appeared.
‘They have no respect for us, Sam. Think we’re their skivvies. It makes me so angry.’
From then on, James noticed every visit Enright made to the dead house, always unaccompanied. Returning, he usually carried a canvas bag. One afternoon, as Enright passed his office, James accosted him.
‘Ah, Enright. Where’s Mr Tuson?’
‘Mr Tuson?’ said Enright. ‘I don’t rightly know, sir.’
‘Oh, I thought he had to supervise your visits?’
‘Yes, sir, he usually does,’ said Enright, looking around to see if anyone was in earshot. ‘Thing is, Mr Tuson is that busy today, told me he didn’t have the time.’
‘Well then, you should wait until he’s free. Where did you get the key?’
‘Mr Tuson gave it me. Said I should return it to him straightway, so best I was going.’
Enright made to leave.
‘Why were you in there?’ asked James.
‘Oh, just the usual,’ he said, winking. ‘You know how it is, sir. Got to meet the surgeons’ needs, haven’t we?’
James had heard enough. ‘You better get that key back where it belongs.’
Enright scurried off clutching his bag under his arm. No doubt he’d report their conversation to Tuson.
With the arrival of spring, the sun now streamed in through his office window in the mornings, showing up all the dust that blew through from the mortars next door in the workshop. The usual calm was disturbed one morning by a woman’s voice in the corridor.
‘Why can’t I have her? I want to give her a Christian burial. Fanny was my only sister.’
Synopsis of the novel
The true story of the doctor who, 200 years ago, in taking on the medical establishment, helped change the profession and hospitals forever but died young, reviled and, to this day, unrecognised. In 1828, a trial at Westminster Hall gripped the nation. Never before had a doctor’s competence been challenged in public. Bransby Cooper, a leading surgeon at Guy’s Hospital and nephew of the greatest surgeon in England, was accused by James Lambert, a young apothecary-surgeon (general practitioner), of killing a patient. What drove Lambert to take on the medical establishment, risking everything he’d always wanted? His tumultuous journey takes him from his apprenticeship in the Fens with his uncle to the prestigious London hospitals and medical societies. It chronicles both his political awakening and his emotional development as his relationship with Eliza moves from initial bewilderment and hesitation to a deep love. Throughout, he struggles to reconcile his father’s cautious conservatism and his uncle’s reforming spirit, both contributing to his indefatigable sense of right and wrong. This leads to his traumatic dismissal from his post as apothecary at the Middlesex Hospital on false charges. Deepening his conviction of the need for scientific knowledge and the public scrutiny of doctors’ competence, he finds kindred spirits among those who have just established The Lancet – Thomas Wakley, James Wardrop, William Lawrence – under the guidance of William Cobbett. But he fails to realise just how ruthless the establishment will be to defend its interests. His report of a surgical operation at Guy’s Hospital leads to the first trial ever that challenged a doctor’s competence. And not just any doctor but a senior London surgeon, nephew of the country’s leading surgeon, Sir Astley Cooper. Thousands packed New Palace Yard outside Westminster Hall at midnight awaiting the verdict. For only the second time, national newspapers held their presses to ensure that the outcome was on the night stagecoaches (the previous occasion having been news of George III’s death). To learn the outcome of the trial and its repercussions for the profession, hospitals and for Lambert, you’ll need to read the book. Suffice to say, he was (and remains) the only doctor in 250 years to be expelled from the Medical Society of London. Despite being the first doctor to have an obituary published in a national medical journal, his contribution to the making of modern healthcare has lain unrecognised for two centuries. Until now.
James peered out along the corridor. The woman was speaking to a man who, though he had his back to James, was unmistakeably Tuson. ‘You’ll be able to have her, just not today.’
‘Why not? She’s been gone these four days.’
As Tuson turned, he spotted James, now joined by Sam, watching. He became increasingly cross, trying to shepherd the woman out of the hospital.
‘You really shouldn’t be here. I must ask you to leave.’
‘I’ll go, but I’ll be back tomorrow with my cousin, to collect the body. You see that she’s ready.’
As Tuson marched off, they stepped back into James’s office.
‘What was that all about?’ asked Sam. ‘Bodies are usually released within two days.’
‘Not sure, but something’s not right.’
‘Let’s keep a look out tomorrow,’ said Sam, grinning. ‘Don’t want to miss the promised visit.’
Late the next morning, they again heard voices in the corridor. The woman from the day before was accompanied by two middle-aged men. Tuson was there, with Enright.
‘I’m Lawrence, Fanny’s cousin,’ said one of the men. ‘Who might you be?’
‘Tuson,’ he said, brushing some fluff off his coat. ‘The house surgeon.’
‘So, what’s with the delay? Why can’t my cousin here have her sister’s body? I’ve had to come from Deptford to sort this out.’
‘There were some complications,’ said Tuson.
‘What d’you mean? You better not have been messing with her.’
‘Of course not,’ said Tuson. ‘If you’d just like to sign these papers, you can take the body and be on your way.’
Lawrence took the papers and read them.
‘What’s this? Why’s the undertaker,’ pointing to the man with him, ‘not allowed to open the coffin here?’
‘Just a formality.’
‘I’ll sign ‘em, but I ain’t happy.’
Once they’d gone, Tuson turned to James and Sam.
‘I don’t know,’ he laughed. ‘People can become quite exercised, can’t they? They forget that they’re not having to pay for all the care we provide.’
With that, he turned and went on his way. James and Sam just stared at each other.
The next day they were astonished to hear what were now familiar voices.
‘Right, who’s in charge here?’ Lawrence was shouting at a bemused porter.
‘I’ll go and find someone, sir,’ said the porter.
After a few minutes, Tuson appeared.
‘Good morning, Mr Lawrence. How can I help?’
‘Ah, you again. What the hell have you been up to? Can hardly recognise her.’ Tears started trickling down his cheeks. ‘Only knew it was our Fanny ‘cos of an old scald mark on her knee. Mutilated, that’s what. Her hair all gone, no teeth.’
Tuson was mopping his face with his handkerchief, looking around in search of a way of escaping.
‘That’s terrible. No idea how that can have happened. Trust me, I’ll get to the bottom of it.’
‘You better, or the whole world’s going to hear about this.’
With that, Lawrence left. Tuson scowled at James and Sam, who were standing stock still, flabbergasted.
‘These people!’ said Tuson, storming off.
As two weeks had passed and he’d heard nothing more of the Lawrence incident, James imagined the relatives had been paid to keep quiet. Then, there it was in the Morning Herald.
‘Sam, come here. Just as Lawrence threatened. He’s gone to the press. It’s all here. They call it “a shameful outrage and a disgrace”.’
‘You know what?’ said Sam, looking over James’s shoulder to read it for himself. ‘I bet this isn’t first time they’ve done this to a corpse.’
‘I’m sure you’re right. Coffins don’t usually get opened once they leave here. It was only because the Lawrences were suspicious.’
‘What’ll happen?’
‘Goodness knows. The governors and senior doctors will be furious.’
Over the next few days, James heard all manner of rumours as he made his way around the hospital. He noticed how Tuson was avoiding him, no doubt anxious about what James had seen.
On the day of the weekly Board meeting, Clayton called in beforehand.
‘I dare say it’s going to be unpleasant,’ said Clayton. ‘Fanny Lawrence’s relatives are coming. Dreadful business.’
By late afternoon, the whole hospital knew the outcome. Enright was escorted by Shedden to the dead house to collect his possessions, before being seen off the premises. Later, James heard that he’d been arrested and was in custody.
‘It can’t just have been Enright,’ said Sam.
‘No. Maybe the hair and teeth, but removing organs? Whoever did it, did it without permission.’
‘You mean a surgeon or anatomist?’
‘Who else?’
Despite the Board’s attempts to keep the details of their meeting secret, the facts emerged in spectacular fashion. That Saturday, the Evening Star published a full account.
Sam closed the office door while James leant forward, holding the paper close to the gas lamp, and read:
The undertaker declared he’d never seen such a mangled corpse before. Fanny’s sister described how the body had been laid open in the back, the whole extent of the front, and the front teeth removed. Throughout most of the testimony, John Lawrence had wept aloud.
Sam shook his head in disbelief. ‘That’ll be the man we saw.’
James continued, ‘Tuson defended the dissection, saying it was for the improvement of medical science.’
‘Did he say who did it?’ asked Sam, trying to turn the paper round so he could read it himself.
‘Hang on,’ said James, refusing to relinquish control. ‘Doesn’t look as though he was even asked! As for the teeth missing, Enright admitted to doing that for one of the surgeons.’
‘Which one?’ said Sam, standing up, excited by the thought that they were about to find out.
‘He refused to say.’ James looked up at Sam, who was now pacing about. ‘He must have been bribed to keep quiet.’
He went back to the paper: ‘The Board have reassured everyone that the only hospital staff involved were Enright and Tuson, and both have been dealt with appropriately.’
‘Tuson. Appropriately?’ said Sam. ‘How?’
James returned to the paper. ‘Reprimanded for allowing Enright to have the key to the dead house unsupervised.’
‘Is that all? That’s a joke.’
‘Sam, remember it was the surgeons, and Bell in particular, that appointed Tuson. They knew he’d do their bidding. They’ll stand by him. Until the governors take on the doctors, nothing’ll change. And they won’t be prepared to do that.’
‘I feel sorry for Enright,’ said Sam, shaking his head. ‘Never liked him much, but to lose your job and get put in prison can’t be right. All he did was earn a few shillings from a rich surgeon.’
‘I know, but there’s nothing we can do about it,’ said James, resigned to the situation. ‘Go on home.’
James extinguished the lights, locked up, and made his way slowly upstairs. How he longed to be able to talk to Henry.
‘You look decidedly down in the dumps,’ said Clayton, a leaning on his cane. He sat down in the seat James offered him.
‘I’m alright, thanks. Just been so busy. We seem to get more and more requests.’
‘As long as that’s all it is. You know you can talk to me any time.’
‘Yes, I know,’ James said, forcing a smile.
‘I tell you, Lambert, the physicians think you’re doing a grand job. MacMichael was singing your praises at the Board last week.’
‘Well, that’s thanks to those two,’ James said, waving his arm towards the workshop.
‘Let’s hope with the unpleasant business of Lawrence out of the way, the hospital can settle down. Just got to stop these libellous reports in The Lancet. Pleased to see the Board have set up a special committee to investigate.’
It sounded to James as though Clayton didn’t know Tuson was already spying on everyone. If he didn’t know, did any governors know what the surgeons and physicians were doing? James was biting a fingernail, trying to decide whether to tell him. He could see Clayton waiting patiently.
‘Well,’ Clayton said after a while, ‘I must be going. Try and get more rest. We don’t want you getting sick.’
Early on Sunday morning, James was woken up by Shedden.
‘Sorry to disturb you, Lambert. The Board’s special committee want to see you at nine.’
‘What?’ said James, still half asleep. ‘Why do they want to see me?’
‘No idea. I was just told to tell you.’
As he made his way to the board room, he assumed they must want to know what he’d seen or heard. The five governors, seated behind the long, dark mahogany table, looked as if they were as pleased to be there on a Sunday morning as he was.
‘Good morning, Lambert. Take a seat.’
A single chair had been placed facing them.
‘I’m Reverend Busfield. This isn’t an easy matter for us. We’ve heard good accounts of your work over the five months you’ve been here. That’s why we’re so disappointed to have received information that you’ve been supplying reports to The Lancet.’
James laughed. ‘I’m sorry. What did you say?’
Busfield repeated the charge. From the stern looks on all their faces, James suddenly realised they were serious. He went cold, struggling to focus, as waves of nausea rose up through his body.
‘Are you alright, Lambert? Would you like some water?’
James struggled to speak. ‘It’s just … you can’t mean it?’
Busfield cleared his throat. ‘We do.’ He paused, leaning forward. ‘Have you been doing this? Best to tell us now if you have.’
‘Of course I haven’t. How could you even begin to imagine it?’ James was shaking his head as he spoke. His eyes filled up. ‘All I’ve done is help the hospital. I’ve sorted out the mess left by the last apothecary. How could you possibly think it was me?’
‘We can’t go into that today. We’ll report to the Board that you deny the charge. You’ll have the opportunity to defend yourself.’
James couldn’t recall how he got back to his room. He sat there the rest of the day, trying to work out why they might think it was him. Even as a child, he’d never broken a rule. By late afternoon, his one desire was that the Board quickly got on with it so he could correct what must be a misunderstanding.