Abstract
Background to the extract
Shortly after gaining his membership of the Royal College of Surgeons (MRCS), James took over a general practice (including his predecessor’s maid, Molly) in Walworth, south London. Eliza, who he was to wed that autumn, was still living with her family in the Fens. The only friend he had in London was Henry Hammond who had been house surgeon at the Middlesex Hospital in his early months working there. Hammond had been forced to resign as he wouldn’t agree to the senior doctors’ demand that he spy on staff and pupils to uncover who was writing critical reports for The Lancet. Hoping to put all that behind him, James relished the opportunities his new life offered.
‘Dr Bainbridge always gave me ointment that smelt of liquorice.’
‘It must be painful, Mr Lovewell,’ said James, examining the man’s swollen, inflamed feet.
‘Oh, it is, Doctor. Can’t walk far when they’re like this.’
‘I’m not surprised. I’ll give you that ointment, but I’m also going to give you some meadow saffron. You should use it whenever your gout flairs up.’
‘Thank you, Doctor,’ said Mr Lovewell, struggling to put his shoes back on. ‘So, Dr Bainbridge’s gone then? That’s a shame.’
James looked up and smiled. ‘I hope you’ll feel the same about me one day.’
‘Oh, sorry, Doctor. Don’t mean no offence.’
‘That’s all right. I’m glad you thought well of him. I hope to be as good as he was. Here,’ handing him the prescription, ‘take this to Mr Grover.’
As Mr Lovewell shuffled out, James sat back and folded his arms. It was still sparsely furnished, but he had his own consulting room. He heard voices in the hallway and then a light knock on his door.
‘Please, sir,’ said Molly, ‘you’ve got another patient. Mrs Birkin.’
‘Thank you, Molly. Is she a regular?’
‘Oh yes, sir. Dr Bainbridge was always seeing her.’
‘Fine. Show her in.’
‘Right, sir. And then will you take some lunch?’
‘Molly, you’re spoiling me,’ he said, laughing. ‘I thought I could smell something cooking.’
8 Keens Row, Walworth
5 February 1826
My dearest Eliza
I can’t believe it’s only five days since we parted. When I got here, Bainbridge was so welcoming. Seemed glad to have someone with whom to share his last meal in the house. I’ve bought the furniture he didn’t want, which was just as well, otherwise I’d have been left to sleep on the floor!
Molly couldn’t stop herself crying, thanking him for being such a kind master. She’s been so helpful, explaining to the patients there’s a new doctor. Only one person has chosen to go elsewhere. On top of that, she lays the fires and cooks. I insisted she have today off, and I’ll take dinner at the local inn.
Yesterday I went to the Westminster Medical Society. There were about thirty doctors there. I was astounded. The doctor giving the talk, name of Gregory, spoke complete nonsense about how jaundice was due to bile being regurgitated into the main vein going to the heart. Couldn’t understand why no-one challenged him, so eventually I said what I thought. To my relief, others supported me.
I can hear my first patients arriving, so must stop and get this in the afternoon mail.
October seems so far away.
All my love,
James
Synopsis of the novel
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 repercussion 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 health care has lain unrecognised for two centuries. Until now.
As word of his arrival got round, James suspected some patients were feigning their symptoms so they could check him out for themselves. He saw no harm in having to prove himself. Far from it, he wished doctors were subjected to more scrutiny.
When he finished his morning visits, there’d be a hot meal ready.
‘Oh, Molly. Just what I need,’ said James, as she placed a tureen of mulligatawny soup on the table. ‘It’s bitter out there. Mr Paulson told me he’d seen ice in the river at Greenwich.’
‘The boy in the butchers said Deptford creek had froze.’
She was about to leave the room when he asked her how she was finding things. ‘Are they very different from Dr Bainbridge?’
‘A bit, sir.’
He smiled. ‘What do you think the patients make of me?’
‘They like you, sir. I don’t know if I should say, but some of the ladies have said what a nice young man you are.’ She blushed, turning her head away.
‘Oh,’ said James, stuttering, ‘right. Anything else?’
‘Well, one thing. There’s quite a few new patients, people what have never come here before. They’ve ’eard there’s a new doctor.’
‘That’s good.’
It was dark by the time his last patient left. He sat for a while listening to the wagons and carriages going by in the street and the cries of peddlers. This time next year, he’d be going upstairs to join Eliza in the drawing room in front of a fire, telling her of his day and hearing what she’d been doing.
When James arrived, there was already a large crowd in Portugal Street, pushing their way towards the small back entrance to the College of Surgeons. Although he was excited to be attending the annual Hunterian Oration for the first time, he hung back for a while to avoid being pushed and squashed.
The hall was packed. At the front he could see Charles Bell, Sir Astley, and Mr Abernethy. At four o’clock, the President, Sir William Blizard, bedecked in fine robes and a hat, entered accompanied by Sir Antony Carlisle, an elderly man who laboured across the stage, clearly relieved to reach the orator’s chair. The attendant removed the cloth covering the long table in the centre of the stage. What was revealed reminded James of the shellfish stalls in Harwich. Carlisle made his way to the lectern and, to everyone’s astonishment, announced he was going to talk about oysters.
James had sat through some tedious lectures, but this was by far the worst, only made bearable by the audience’s humorous remarks. When, after half an hour, Carlisle announced his assistant was going to inflate the rectum of a large oyster, the man sitting beside James could take no more. He turned to his companion.
‘Think of that when you’re dining at Lynn’s Oyster House tonight, Burford.’
‘Lynn won’t be seeing me again!’ guffawed his companion.
As it went on, even Council members at the front became restless, muttering to one another and looking to Sir William to do something. Carlisle seemed oblivious to the increasing amount of hissing until suddenly, after well over an hour, to everyone’s relief he abruptly stopped.
All around him, James heard members ridiculing Carlisle. Then, a few men started voicing their anger about the College, in particular that they were made to use the back door, the grand porticoed front entrance facing Lincoln’s Inn Fields being only for Council members.
‘No more back door!’ men shouted.
One member climbed over the barrier separating the ordinary members from the Council. As he confronted the President, everyone fell silent so as to hear him.
‘Sir William, can I leave by the front door?’
Blizzard ignored the cries of support, turned and walked away.
Amid all the boos and catcalls, someone shouted, ‘Saturday night, Freemason’s Tavern. Meeting on surgical reform.’
Back out on the street, James didn’t know what to make of it all. The only thing he was sure of was he’d be at that meeting.
‘Molly, I’ll be out on Saturday evening, so you can have the evening off.’
‘Thank you, sir. If it’s alright, might I go and see my mother and stay over with her?’
‘Of course. Where does she live?’
‘Thornton Heath. It’s only an hour on the coach. She’s been on her own these past six years since my father passed away.’
On Saturday evening, James got the cabman to drop him on The Strand. He wanted to walk the rest of way as he’d been indoors all day. Drury Lane was bustling with people dressed up, heading to theatres and music halls. As he turned into Great Queen Street, he could see a huge crowd. Even with all four of the tavern’s doors lying open, people were having to queue. By the time he got inside, it was packed, but he found somewhere to stand at the side, halfway back.
At half seven, the chairman rose, and the place went quiet. ‘Thank you for turning out on such an inhospitable evening. There must be more than a thousand members of the College here, and hundreds of our non-medical friends. To start things off, I call on Mr William Lawrence.’
Lawrence. Vitalism. This was the man Uncle William had been so excited about. A short, round-faced man in his forties, wearing a velvet jacket and waistcoat, rose and smiled to the crowd.
‘The way the College is managed and governed must be remedied.’
People applauded and shouted their support.
‘We members, and remember there are ten thousand of us in England, have no voice in electing the ruling powers, no control over how they spend the money, how they limit access to the museum …’
‘Which was a gift from the government,’ someone near James shouted.
‘Quite so,’ said Lawrence. ‘And we have to enter and leave our college, our college, through the back door.’
The crowd went wild.
‘Gentlemen. Bodies of men will bear general oppression for a long time. It’s not until their personal rights and interests are involved – it is not until the individual is attacked – that they think of resistance. Ours is a case that illustrates this.’
The applause and cheering went on even longer than before.
‘That’s not all. College examiners ensure their own interests are served. By requiring candidates to attend hospitals and schools of surgery in London, which just happen to be those where they themselves work and teach, they attract all the pupils’ fees. We need change.’
As Lawrence took his seat, someone shouted, ‘And they get all the money pupils pay the college to be examined!’
‘That’s not all,’ shouted another. ‘The exam is a joke.’
Lawrence mopped his brow while those around him were slapping him on his back. The chairman stood up and called for order.
‘Gentlemen. The resolution is, that the science of surgery has not been advanced nor have its practitioners benefited by the college.’
It met with unanimous support. Several more resolutions condemning the behaviour of the college council and the board of examiners were passed.
‘Enough of our grievances,’ said the chairman. ‘We need to take action. The proposal is we take our concerns to the college council and remonstrate.’
Immediately, a man seated near the chairman indicated he wanted to speak. James could see this was causing great excitement round the hall. Cries went up.
‘Let’s hear from Wakley.’
‘Come on, Wakley.’
James craned his neck to get a better view. So that’s the man behind The Lancet. As Wakley stood up, James saw how tall and imposing he was. He couldn’t be more than ten years older than he was himself. His mass of blond locks reminded James of a knight from a children’s book.
‘Remonstrate? Remonstrate?’ Wakley asked, looking around the hall, daring anyone to defend the suggestion. ‘Gentlemen, I ask you, what can be gained from remonstrating with the college council? Even if they wanted to change, they can’t. Their constitution forbids it.’
There were wild cheers from around the hall.
‘We,’ he waved his arm across the audience, ‘we are its mortified members. Portugal Street is the filthy line of demarcation.’
The crowd cheered and stamped their feet.
‘The college is a disgrace to the surgical profession of England and is the laughing stock of foreign nations. Radical reform of the constitution requires nothing less than a petition to Parliament.’
James had only ever once heard a speech of such venom – William Cobbett in Lewes. For an hour, one man after another rose to speak in support of Wakley. When the chairman called things to a halt, everyone was agreed that a petition was needed.
As he made his way to the exit, carried along by the surge of the crowd, James heard his name being called. He looked around, and to his delight, saw Henry Hammond gesticulating. He fought his way back to him.
‘Henry,’ he said, grasping his arm. ‘So good to see you.’
‘You too, James. I hoped you’d be here.’
‘I can’t believe how angry everyone is.’
‘I’m surprised it’s taken this long. Are you up for a drink?’
‘I’d love to.’
‘Good. Before we do, there’s someone I want you to meet. Come on.’
Henry took his arm and guided him through the thinning crowd back towards the stage. A small group were gathered around Wakley. Henry attracted the attention of one of them, a tall spindly man with a mop of red hair, rather pink complexion, and wearing old-fashioned clothing.
‘Hammond. Good to see you.’ The man spoke with a strong Scottish accent.
‘And you. There’s someone I’d like you to meet. This is my friend Lambert. We worked together at the Middlesex until each of us fell foul of the powers-that-be.’
Henry turned to James. ‘This is Wardrop, one of the finest surgeons in London. You two have a lot of interests in common.’
‘Is that so?’ said Wardrop, shaking James’s hand. ‘It’s a bit late to find out if that’s true, though knowing Hammond, it probably is. Come and see me at the Hospital of Surgery one day.’
‘Of course,’ said James, who was finding it difficult to concentrate, as he could see, over Henry’s shoulder, Wakley peering at them. As James and Henry turned to leave, he heard Wakley’s voice behind him.
‘Wardrop, are you going to introduce your young friends?’
When Wakley heard James’s name, he smiled broadly. ‘At last. I’ve been wanting to meet the mysterious Lambert. I fear I’ve caused you untold trouble, for which I humbly apologise.’ He bowed his head slightly.
James was lost for words, desperately trying to think of something to say.
‘I enjoyed your speech tonight.’
‘Thank you.’ Wakley carried on staring at him. ‘Would you have time to visit me one morning?’
James felt awkward, not least because both Wakley and Wardrop towered over him, and he’d always lacked confidence talking to tall people.
‘Yes, of course.’
‘Splendid. Make it soon.’
Henry led James out of the hall. They picked their way along the crowded pavement, trying to keep together, before diving into a pub. Armed with two tankards, they found a table.
‘So,’ said Henry, taking off his gloves and unbuttoning his coat. ‘Did you ever write to the Middlesex governors?’
‘Oh, I did. Clayton told me a special court was held, attended by sixty of them. They refused to instigate an inquiry, saying my allegations of body-snatching were unjustifiable and should be ignored.’
Henry shook his head. ‘Like I said before, governors will never do anything to upset the doctors.’
‘Enough of that,’ said James. ‘What are you still doing in London? Thought you were off to Eton.’
‘Been some delays. Looks like I’ll be working for my father for another year.’
‘I’m glad,’ said James, ‘as you’re the only person in London I can talk to about what’s going on.’
‘There are others. That’s why I wanted you to meet Wardrop. And clearly Wakley is keen to talk with you.’
Later, in a cab heading home, James had an overwhelming conviction that in the previous few hours the course of his life had irrevocably been set, his destiny determined.
‘Yes!’ he suddenly exclaimed.
‘What’s that, mate?’ called the cabman. ‘You alright?’
‘Sorry … yes, everything’s fine. Never felt better.’