Introduction to ‘Tell them our stories’, the Surgeons’ Hall Museum file

 

From 2010-2011 I was a ‘Bright Ideas’ Visiting Fellow at the European Genomics Forum (EGF), University of Edinburgh. My aim was to explore and write factual or fictional accounts of some of the people whose tissues and organs came to be publicly exhibited in the Surgeons’ Hall Museum, Edinburgh.

As a contrast to these stories of past ‘donors’ I felt it was important to find out more about the way in which we now treat donation and collection of organs and tissues, for both teaching, research and transplant purposes.  The stories of the people who responded are recorded in the EGF archive.

***

The great anatomy and pathology collections were initially intended as aids to teaching, but their purpose has changed with time (see the perceptive article, ‘Making sense in the pathology museum‘ by Dr Steve Sturdy, formerly EGF’s Assistant Director). The collections at the Surgeons’ Hall Museum (SHM) in Edinburgh date from the late 17th century and it is impossible not to wonder about the people – the ‘patients’ as Andrew Connell, the then Collections Manager, touchingly refers to them – whose organs and skeletons are in storage or on display.

These exhibits were ‘donated’ by human beings, each of whom had a life, perhaps in a town, on a farm, perhaps with a family and friends; or perhaps he or she was ridiculed and despised.

I had previously been shocked out of being a detached observer when I visited exhibitions and museums researching background material for my novel, The Embalmer’s Book of Recipes: at the Museum Vrolik in Amsterdam, the clatter of coffee cups being laid out for a conference, the loud talking and laughter of men repairing the heating ducts, the bright lights and chrome and glass of the display areas, suddenly clashed agonisingly with the contents of the jars – late-stage foetuses and neonates, each with some developmental or genetic abnormality. These specimens were once, briefly, sentient beings, brought into the world by their mothers, women of all ages and backgrounds, privileged or poor, who may or may not have had the sympathy and support of family or friends.

And so began my need to explore and write the stories of some of those people whose tissues and organs came to be publicly exhibited – in this case, in the Surgeons’ Hall Museum, Edinburgh.

Some of these ‘specimens’ were certainly obtained without the patient’s consent, and Andrew Connell’s musings (see “The Curator’s Reflections” ) helped me to understand why the patients might have been brought to such straits, in hope or fear or ignorance.

I was further helped in my hunt for information by Laura Brouard at the Lothian Health Services Archive in the University Library; by staff at the National Library of Scotland; and by Anne Carroll, archivist at Perth Library.

It was a special privilege to meet and spend hours talking with artist Joyce Gunn Cairns, who has drawn several of the exhibits at the Museum with great delicacy and empathy and allowed me to include her drawings and words. Poets Christine De Luca and Diana Hendry had also written about some of the exhibits – ‘Janet’ and ‘Andrew’ in particular – and to listen to them talk about their subjects was a great pleasure and gave new insights (and to hear Christine read in the Shetland dialect was an extra treat); they too have been happy for me to include their poems.

Part-way through my Fellowship, I organised a meeting that included a lawyer, a bioethicist, the curators, the poets, scientists, sociologists and writers and we had a very helpful and thoughtful discussion about my research and writing, and its ethical implications.

Finally, in February 2013, the EGF organised a well-attended ‘Tell them our stories‘ event for the public in the University’s Anatomy Theatre. The SHM’s Curator Andrew Connell and I both presented illustrated talks; poet Diana Hendry read her moving poem about ‘Andrew’, and actor Michael Flett gave an excellent and very funny reading of ‘Caesar’s story‘ (an extract from my ‘The stories of Janet and Caesar‘)


Steve Sturdy, 2006, Making sense in the Pathology Museum, in Anatomy Acts: how we come to know ourselves. Eds Dawn Kemp & Andrew Patrizio; Birlinn.

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The Curator’s musings

ANDREW CONNELL, Collections Manager at the Surgeons’ Hall Museum in 2011, talks about the Collection’s modern function.

 

“It’s like inviting people in and showing them round your house and what’s on your shelves – there are different hands exploring the collection in different ways. It brings out endless possibilities, like a kaleidoscope.”
“The first collection, which was very basic, not very good, was held in places like Infirmary Street and High School Yards. Robert Knox [1791 -1862] was made responsible for increasing the collection and for its move to new premises. He bought up Charles Bell’s collection and brought it up from London. Much of it was stored in Infirmary Street and in various corridors and cellars. Knox was also in charge of presentation and the collection was opened to the public from that time. So why would you come to see it?
“There’s a nice piece in the Tansey & Mekie ‘History of the Museum‘:
‘Visitors of the lower classes, mechanics, sailors and soldiers have uniformly been quiet, careful and most orderly…visitors of the lower classes seem to take more interest in the specimens than those of the higher, many of whom, especially ladies, merely walk through the rooms without looking at the objects particularly.’
Probably they were embarrassed to show too much interest!”
“The original context of the collection – the organs and tissues – was objective.
It was for teaching, for learning anatomy, all of which was observation-based.
For more than 150 years this was its raison d’être.
The teaching role was more a fade-out process from the 1970s/80s – that was
the start of its serious demise. With the advent of desk-top viewers for slides
you had the ability to represent material in different ways. There were other
diagnostic tools such as X-rays. And in terms of fairness in exams – you can
use the same slide for everyone rather than trying to get several identical
specimens. A photo of, for example, a pulmonary embolism is more realistic,
in its fresh natural coloured state, than a greying specimen in a jar.”
 ” ‘Benign neglect‘. That’s what I like to call it. We’re very happy to be a figure-
head for benign neglect. At first the collection was loved and cared for and
funded for teaching purposes. But the College is very reactionary, very slow to
follow trends, and the collection became semi-obsolete for such a long time.
But now, instead of using it to look purely at anatomy and pathology, we can
use it to look at the history of medicine, to tell a consistent tale about medicine, the medical personalities and pioneers, and also the context of the social history.”
“If we think about the patients who formed the collection – what was their life
like?
What misfortune led them here, with what stoicism?
We have to think about the things people put up with – and how they were affected.
We aim now to bring out the ‘patient-based’ context – the humanity, and
human stories.
This is where artists of all genres are important.”
***
“I started in the Chambers Street Natural History Museum, then I moved to
the University’s Department of Pathology collection. There was a certain
element of haphazardness – I liked working with my hands, and enjoyed fixing
things. Chambers Street was quite Dickensian, with the inventories still on
cards. At the University it was more hands-on, a very different collection – I
had workshop duties in anatomy and pathology, teaching duties such as
display sets for classes, and I repaired things.
Medical terminology? I made an effort, enough to get by on – but it was
‘shallow waters’. Don’t take my word for anything – you should demand a
second opinion!”
“When I was in Pathology, Dr Black once handed me a poly bag with a kidney
in it, still warm. He just said, ‘Can you deal with this?’ There was a bit of a
confrontation. ‘Am I supposed to?’
For me, the first issue was mortality – this was somebody’s organ, used until not long ago. Yes, the kidney was ‘dealt with’, but I then came away from that experience with some issues.
In the Museum, it isn’t red, it isn’t warm – and you start becoming aware of
your own feelings in relation to these aspects.”
“The society we live in, we’ve become desensitised to death, it’s all neatly
packaged in boxes. So you don’t know how somebody will react to a museum
specimen. When people come round, I’m very conscious of their response to
the collection. I try to think, what’s right, what’s wrong, about having that
specimen on show? But the responses are deeply personal, a gut reaction,
intuitive.
I might be overly protective, overly cautious, of how we present things to people.
For example, we had Siamese twins – they were on display in an educational
context, with X-rays that showed how their bones were joined. But then I used
to hear people coming in and saying, ‘Where’s the babies in jars?’ They were
missing the point, it was just voyeuristic, they were treating it like a Victorian
horror-show.”
***

“I want to get people to look without feeling distressed about mortality: to start

a reflective process that’s speculative – and they can then allow themselves to
go in different directions. I want people to use the collection as a locus for opening up, and contextualising in the way of social history.
There’s an inter-connectedness between people – the surgeons, patients,
pathologists, the family – and they’re all colliding and ricocheting in all directions.
The collection here provides the impetus for you to look differently, and to re-focus your thoughts and ideas.”
© Andrew Connell and Ann Lingard
January 2011

‘George’ and the cleft-palate baby

Specimen GC12334

Maxilla, anterior segment of the coronal section of the head, injected, showing ulceration of the face resulting from a carcinoma of the air-sinus of the left. … Microscopically, re-examination confirms the presence of a tumour growth which is diffusely cellular and which might be a spheroidal-cell carcinoma or sarcoma.

 (Specimen also listed as Bci6M38 – in the Charles Bell Collection, 1824)

“A section of the head of a patient who died in the Middlesex Hospital; when he first presented himself he had a large fungous Tumour which projected from the left side of his face, occupying the left side of the mouth, destroying the left side of his nose, and hiding the left eye. After some time, this Tumour burst, and ulcerated, and frequently bled, exhibiting all the features of Fungus Haematodes. The Tumour is seen to extend backwards and into the throat of the posterior nostrils.”

 

george3

There is no date to indicate when the patient died. The patient’s head is part of the Charles Bell collection, and Charles Bell moved from Edinburgh to London in 1804; his Collection of anatomical and pathological specimens was bought by the Royal College of Surgeons Edinburgh, the removal of the specimens being overseen by Robert Knox in 1825. (Of course there is always the possibility that patient had died before Bell arrived in London, and that Bell purchased the head subsequently for his Collection.)

The ‘section’ of the man’s head is in a large cylindrical glass jar filled with preservative. Not only do we see how the Tumour has disfigured his face, but we may also – because his skull has been removed from the back  – look inside his nasal and oral cavities, to observe how the Tumour has invaded the soft tissues. But if we are to remind ourselves that this was a person, not a pathological specimen, we should look instead at his face. The man has ginger stubble on his chin, and his hair is pale ginger too (although this may be an artefact of the preservative). His right eye is closed so that his expression – despite the terrible deformation of his features – appears peaceful.

We can ask many questions, all now unanswerable. He must have been born in the last years of the 18th century. What sort of a man was he and where did he live? What was his general physical and mental health like before the Tumour grew? How old was he when it first appeared? Did he ‘present’ himself at the hospital or did friends or relatives take him there? Where else could he have gone if the hospital had rejected him as an ‘incurable’? Was he relieved to be taken in by the hospital, or terrified lest his ultimate resting place would be in an anatomy museum? Did he assume he would die in hospital? How was he cared for? (There was no palliative care).

After the first shock of seeing a man’s head preserved in a jar – and shock at the idea of a man’s head being preserved in a jar – the overwhelming feeling is of sadness and sympathy; and sorrow that he was born long before medical care and surgery could have helped him.

 

From: Essays on the anatomy of expression in painting: Charles Bell, 1806; Longman, London.

Relaxation of languor, faintness, and sorrow.

The muscle which depresses the angles of the mouth is often accompanied in its action by that of the corrugator muscle which knits the eyebrows, and this again is combined frequently with the action of the central fibres of the frontal muscle.

The depressing of the angle of the mouth gives an air of despondence and languor to the countenance when accompanied with a general relaxation of the features, or, in other words, of the muscles. When the corrugator which knits the brows co-operates with it, there is mingled in the expression  something of mental energy of moroseness or pain.

 In sorrow, that general languor which we have now described pervades the whole countenance. The violence and tension of grief, the agitations, the restlessness, the lamentations, and the tumult, have, like all strong excitements, gradually exhausted the frame. Sadness and regret, with depression of spirits and fond recollections, have succeeded; and lassitude of the whole body, with dejection of face and heaviness of the eyes, are the most striking characteristics. The lips are relaxed and the lower jaw drops ; the upper eyelid falls down and half covers the pupil of the eye. The eye is frequently filled with tears, and the eyebrows take an inclination similar to that which the depression of the angles of the lips give to the mouth.

 ***

 

“WHY DO I CALL HIM GEORGE?” Joyce Gunn Cairns’ story

 

“I have a photograph of a family friend, George, as a young boy. He died in 1980, aged 61. George was born in 1918, with a hair lip and cleft palate, and the surgical procedure then was to provide him with a palate, and involved the removal of his top teeth and giving him a false plate. George came into my life when I was five or six years old, a year or two after my father died at the age of thirty-six. We lived at that time in the small mining village of Rosewell in Midlothian, and George was the village joiner. My mother and George became strong and lasting supports for each other, and my mother was grateful for his kindness towards us as children: always her first priority. She was glad of George’s steadiness of nature, and his offer to take us all out for a run in his car – still something of a novelty in the late 1950s. George continued to be a part of our life from then until he died, twenty-five years later.

Although I remember as a child noting something different about his appearance and speech, this awareness soon slipped away, and he became just George our friend, the man who brought us sweets and took us for picnics in his shiny car, fixing whatever needed fixed in the house. He never lived with us, but remained ‘part of the furniture’ when we moved to Bonnyrigg, only two miles distant. He lived in an old miner’s cottage in Rosewell, now gone and replaced: its interior remains in memory – coal fire, wee back kitchen, grandmother’s clock, outside coal sheds, horsehair chairs, all part of George’s solid, traditional and reliable ambience!

I can only remember one time throughout the years George was part of our life when I was reminded of his disability: I was in a shop with him and my mum, and when the woman behind the counter could not understand what he was saying and became irate, my mother gave this woman a lashing with her tongue. She, my mother, was very protective of George in this way.

When Andrew [Connell, Collections Manager] first showed me ‘George’ I felt a sense of shock on seeing his disfigurement. I was eager to draw him, but also felt apprehensive. However the more frequently I drew him, the less I seemed to notice his disfigurement; or if I did, it was never again with that same initial shock or recoil.

 

jgc's 'george',
Drawing of ‘George’ by Joyce Gunn Cairns

 

From the drawing you will see that there is nothing of the grotesque in my preconception of him. And so I called him ‘George’ in memory of my friend George.

There is something strangely moving about the way that love penetrates the surface appearance, just as it did for me with our dear friend.”

Joyce Gunn Cairns 2010

 ***

 

Specimen GC8184 cleft palate baby3

Portion of a child, showing congenital malformation of the Nose.

From a female aged 3 weeks, who died of asthenia.

There is a partial bilateral harelip and a bilateral cleft palate. A shallow vertical groove marks the frontal bone between the tuberosities. The nasal bridge is flat, and the nasal bones vertical or absent. The rest of the nose is small, the alae being merely indicated, the nasolabial furrows ill-developed, and there is congenital occlusion of the nares.  The central part of the upper lip, the prolabium, forms a narrow pyramidal projection whose base meets each half of the upper lip to form a notch.  Between the notches, which are symmetrical, the apex of the prolabium is pendulous. There is possibly a congenital absence of the premaxillary element of the maxillary bones.

Presented (by) Herzfeld, GMA

The baby girl has curly reddish-brown hair, and her eyes are cast down; her right arm has been severed just below the elbow, the left arm just above. Her torso has been severed in the region of her diaphragm. She is indeed a ‘portion’: preserved, sometime in the mid-20th century, in a fluid-filled jar, to show a cleft palate and a malformation of the nose and jaw.

She died three weeks after she was born, of ‘asthenia’ – generalised weakness of the muscles.

The shape and positioning of her head and body bears a striking resemblanceplaster baby head to another exhibit in the Museum, the plaster head of a baby, partly ‘dissected’ to show its brain.

Was this deliberate?

 

Or, you might – as you become used to her features, when you have got past that ‘initial shock and recoil’ described by Joyce Gunn Cairns  – see her as a work of art.

 

Frederik Ruysch (1638-1731), Dutch surgeon, anatomist and Konstenaar (artist), might have adorned her embalmed form with a necklace of blue-and-white beads, or small lace sleeves made by his daughter Rachel.

We can ask many questions: there is the ethical question of ‘parental consent’ about having one’s child used as a teaching specimen; the question whether creating such a specimen was justified for teaching/scientific purposes.

We can question why a half-torso is needed if the purpose is to show maldevelopment of the nasopharyngeal region.

We can also question why this preparation of a baby girl was donated by a female surgeon, the first female President of the RCSE, Gertrude Herzfeld.

Perhaps we could find some answers if we looked through the hospital’s and surgeon’s records, but that in itself would be unethical and in breach of patient privacy.

Let’s first of all consider Gertrude Herzfeld, (1890-1981): this is her Obituary from the British Medical Journal, volume 282, June 1981.

Miss Gertrude M A Herzfeld, who was formerly a consultant surgeon and a president of the Medical Women’s Federation, died on 12 May in her 91st year.

Gertrude Marianne Amalia Herzfeld was born at Hampstead, London, in 1890, and was educated at Edinburgh University, where she graduated in medicine in 1914. After house surgeon posts at the Royal Hospital for Sick Children and at Chalmers Hospital, Edinburgh, in 1917 she became a surgeon attached to the RAMC Cambridge Hospital, Aldershot, and from 1917 to 1919 was senior house surgeon at Bolton Infirmary.

After this she held many appointments as a consultant  surgeon, being from 1920 to 1955 at Bruntsfield Hospital for Women and Children, and from 1920 to 1945 at the Royal Edinburgh Hospital for Sick Children. She was also surgeon to the Edinburgh  Orthopaedic Clinic from 1925 to 1955 and a lecturer on the surgery of childhood at the university and a lecturer at the Edinburgh School of Chiropody.

Miss Herzfeld was chairman of the City of Edinburgh Division of the BMA from 1960 to 1962, a past president of the Medical Women’s Federation, president of the Soroptimist Club of Edinburgh in 1929, as well as more recent appointments such as vice-president of the Scottish Society of Women Artists since 1954, of the Edinburgh Cripple Aid Society since 1956, and of the Trefoil School for Physically Handicapped Children since 1964.

 CVK writes: A remarkable woman has just died, full of years and memories for many generations of students. At the time of her birth her father went to business in a carriage. Gertrude always longed to be a doctor and this desire crystallised into surgery after a prizewinning career at Edinburgh University, which gave her an excellent training but retained its established hierarchical traditions. In the early days of the first world war a newly qualified woman with a German name did not find life easy; being the first woman to take a seat as a fellow in the Royal College of Surgeons of Edinburgh opened no ready gates.

Gertrude was a large woman in heart, mind, and build, and she saw fewer obstacles than others of her sex, because she knew what she had to do. At first her surgical patients were women only, but she soon established herself as an infinitely patient paediatric surgeon. None of her housemen could forget her great figure bending over a tiny neonate, opening and semi-constructing a blind cystic duct, easing a pyloric stenosis, or, later, apposing two raw edges of a minute cleft palate.

Her wards attracted patients with conditions that we had never seen as students. Before the days of chromosome determination, sex was mysteriously undefined in more children than we expected, and from all over Scotland they came for cosmetic repair and the difficult assessment of what course they were to follow.

This was done by a great deal more than surgery: infinite thought, getting to know the child, the mother, the surroundings – a psycho-somatic exercise in which Gertrude Herzfeld’s warmth and wisdom combined with her skill.

Students over half a century, undergraduate and postgraduate, will always remember the extra help and loyalty that Gertrude gave them; she never let us down in front of others, but quietly made it clear where we had erred; it was not a failure, but part of learning. She also taught the skill of loyalty to the general practitioner who sent us his patients. She understood.

***

Andrew Connell, Manager of Collections.

“On our first, superficial examination, all we saw was that the baby had a cleft palate. But we looked again, at the specimen, and at her notes – and saw that the girl had died at three weeks old, of ‘asthenia’, and that there were further complications in the nose and jaw region.

Let’s look at the possibilities:

What other incompatibilities, with life, does this condition bring? From Gertrude Herzfeld’s position, there is maybe nothing she can directly do (and the child is so malformed that she dies after three weeks).

Did Dr Herzfeld say explicitly that this specimen must go to the Royal College of Surgeons, did she emphasise this?

Was she even directly involved?

Maybe her name was just associated with the case. She may hardly even have seen it – the decision to preserve the baby was perhaps made somewhere else.

Herzfeld was a surgeon not a paediatric pathologist – she may not even have been to the post-mortem. She might have said, “I’d like someone to do a PM on this one, to find out what the internal organs are doing’: so the body goes off for autopsy.

In the Sick Kids hospital, the baby is taken to the PM room. And someone says, ‘This is quite unusual, let’s have it for the Museum.’

Then it comes here with the surgeon’s name on it.

Elsewhere the pathologist’s name might be on it, or on the histological slides in the records.

Since then (the baby could have died sometime in the period 1920-1950) there have been big changes in medical legislation and how records are kept. Records are now computerised, and there would be a field to complete for  each person involved, surgeon, pathologist, histologist – all would be recorded, partly for litigation purposes. It would be easy to follow the ‘trail’.

Now, I’m just trying to think about why she should be here.

Is this demonstration of a cleft palate useful for teaching purposes? We missed the fact that the nasal bones hadn’t developed properly. Maybe that is why the specimen is here – is it unusual to have these two faults together? There aren’t any nostrils – what are the other implications for the respiratory tract?

Perhaps her preservation is also for posterity – the meaning might be ambiguous now, but in the future might give important clues.

 So why the half-torso?

Why not the head, like ‘George’? To dissect that out takes time and skill.

What’s next easiest? To decapitate the body? But a detached head is probably more awkward, more offensive: it’s nastier.

What’s the next alternative? Dissect down to the shoulders – this too takes time and effort.

So why cut through at that plane, mid-torso, the arms as well?

The body could fit through a band-saw. This could have been the quickest method, chosen because it was the least unpleasant of the possibilities in order to present the specimen quickly.

Why not prepare the whole baby? It would be bulky and heavy. In an exam,  a whole body might lead students to look for the wrong thing, in the wrong direction: ‘It’s got a boil on its bum’.”

On occasion, Andrew has had to change the fixative surrounding bottled specimens, including those of teratologically-deformed foetuses and neonates.

“Your eyes interpret things which aren’t true. A baby should be soft, it should be warm, babies are very tactile. But as specimens they are completely different. For example the weight, the fact that the body’s completely rigid, there’s no softness, no bending, no impression of your fingers on the skin. It’s slimy, almost like a fish, the texture is completely wrong. And they’re cold, very cold, almost like a rubber doll washed up on a beach. Something innate makes you feel the utmost respect. For example, if you need to put a needle through the ear, say, so as to fix the baby in position in the jar – it makes you cringe, it’s completely against nature, something unnatural.

I had to re-pot a dissected head that showed microcephaly – it was half external face, half internal dissection.

That was difficult because you can relate to a face, there’s the mouth, lips, teeth and all the rest.”

***

 You can relate to a face: perhaps that’s why – once we have overcome our shock and intial revulsion – we can relate to ‘George’ and the cleft-palate baby.

Stories of dwarves

 

LISA’S STORY

Sometimes subjects cycled in and out of one’s life, entering without warning and remaining for a day or more, and then exiting again as though erased. This weekend dwarves and babies had pushed their way in, small but not the same, one group stalled by a malfunctioning gene, the other with genes that had yet to function.

Yesterday, coming off the motorway at a large roundabout, Lisa had seen banners draped along a fence on the far side of the road: ‘Car boot sale, Saturday and Sunday! Smokers welcome. Dogs welcome. Cross-dressers welcome.’ Delighted, she had circled the next roundabout and returned to drive slowly past. ‘Residents of Appleby welcome. Lap-dancers welcome.’ Chuckling, she had debated going in to see what was on offer for such an eclectic mix of customers, but the distant hills had a stronger pull, and she circled again and resumed her journey. As it contoured around the feet of Blencathra the road headed inexorably downwards into the bowl where the small town of Keswick nestled as though poured.

‘Chamonix of the North-West’. Who had said that, perhaps mockingly? She could not remember, but narrow streets were further narrowed by climbing-gear that festooned doorways and spilled out of shops, and there was an air of concentrated enthusiasm for the Great Outdoors amongst the ambling pedestrians. Serious walkers would surely be out on the hills at this time, late morning, Lisa thought: those remaining at ground level were the dreamers and the unfit, and people who lived here, going about their normal lives in this town that was not, after all, a theme-park; people who paused only occasionally to remind themselves that their horizons were unusually high, an undulating rim of rock and heather.  It would be good to dream, to drift like a somnambulist … But the main street was crammed with market stalls and she quickly became distracted by local fudge and mint-cake, which she bought for her research group, and a display of woven rough-wool rugs.

‘It’s Herdwick, love,’ the woman said. ‘That’s its natural colour.’

Lisa remembered the grey sheep that Madeleine had shown her, the sheep with the kindly faces, and she imagined how this rug, with the variegated colours of lichen-mottled stone, would look in her own house. She pushed her fingers into the weave, feeling the strong wiry fibres; the woman pulled out a wider selection and spread them over the scarves and hats at the front of the stall, and Lisa dithered over the different shades.

The owner of the adjacent stall, which glittered with cheap brass and baubles, occasionally interrupted his patter to slurp from a mug of tea. His long bony nose dipped into the steam and after each gulp, he wiped it with his sleeve. He caught Lisa’s eye and winked.

‘I’ve been telling Beattie here to knit me a nose-bag,’ he said. ‘It gets that cold. But she won’t do it, dunno why.’

‘I keep telling you, Derek, I haven’t got that much wool to spare. You’d need a flock of alpacas to cover that one!’

Lisa laughed with her while Derek continued, ‘I thought I’d get one of those balaclava things with just my eyes showing but what with the war on terror and and all that I was scared I’d be waterboarded.’ He passed a hand-mirror to a girl who was looking at some ear-rings. ‘Here y’are, lass, use this mirror. “Mirror, mirror on the wall”. This mirror never lies, we’re all beautiful people here.’

‘He likes it ‘cos it makes his nose look small,’ Beattie whispered loudly. ‘Now, love, have you any preference?’

‘As long as it’s only me nose. Look at these necklaces now, did you ever see such workwomanship? All the way from the mountains of Tibet, these – Blimey!  Any minute Snow White’ll be coming round the corner, too!’

Lisa looked round sharply at the change in his tone, half-knowing what she would see.

Two achondroplasics were browsing along the stalls. They could not have failed to hear Derek’s loud joke and the woman had stopped to examine a display of smoked trout with great concentration. The man, perhaps her husband, had glanced up and had caught sight of Lisa.

There was that awkward moment, the half-smile, the indecision that Lisa experienced on the very rare occasions when she met another achon. The mirror-image that she had forgotten about, that she felt had nothing to do with her daily life; the transient exasperation and the silent question, ‘Why should I greet you like a brother, sister?’.

‘Here come your friends.’ Derek was inexorable, but not unkind.

The small man’s crumpled, ridged face collapsed even more into a toothy smile. ‘No, hadn’t you heard? Snow White’s banged up in jail. We always suspected she was a paedophile, and she was lousy at housework, too. Hi there.’ He nodded at Lisa. ‘How’re you doing?’

‘Fine.’ Lisa smiled. Passing shoppers were looking at them covertly or even with the classic double-take.

‘Nice rugs. Come and look at these, Sheila, one of these would do very nicely for Johnnie’s flat. Johnnie’s our son. This is my wife, Sheila. I’m Terry, by the way.’ He held out his hand to Lisa. ‘Pleased to meet you.’

‘Hallo. I’m Lisa. They are attractive rugs, aren’t they? They’re made from the local Fell sheep.’

Beattie was looking at them in surprise. ‘Don’t you all know each other, then? I just assumed, well, that you were all together.’

‘Bit of a coincidence, isn’t it,’ Derek agreed. ‘Something of a rare breed, not often we see—’

‘We’re just like buses. You don’t see any for ages then three come along at once, eh?’

Derek roared with laughter. ‘That’s good. You wouldn’t like to come and help out here, would you – Terry, did you say? We’d make a good team, I reckon.’

‘We’re not that rare, you know. But I don’t know where we all hide ourselves, do you, Lisa?’

Lisa realised, unhappily, that Terry had evangelical tendencies: he would always be ready to ‘fight our corner’.

His wife had clearly heard it all before. ‘Terry, they’re busy and we need to go.’

‘If you reckon that one of us is born in every 20,000 live births, that should be about thirty new children a year with our sort of restricted growth. Our son is like us, of course. We knew he would be, and we were happy about that, weren’t we, Sheila?’

‘Thirty. That’s a lot,’ Beattie agreed, uncertainly.

‘But you don’t see them, do you? And it’s not just because we’re so small and escape your notice. It’s a mystery. But it just goes to show that you shouldn’t be surprised to see a few of us at one time in normal circumstances.’

‘I think I’ll take this one, I like the mixture of greys.’ Lisa raised her eyebrows at Beattie, who grimaced sympathetically.

Derek had been briefly distracted, helping two women choose a pair of candlesticks, but now he leant across the wooden bar that separated the stalls.

‘Colour. What about colour then? You three are white, but where are the black and brown ones? Don’t they have persons who are vertically challenged or whatever we’re supposed to say, too, or is it a culture thing? The wrong ’uns get left out on a hillside to die. Or get shut away.’

‘Derek! You can’t say things like that!’ Beattie was shocked, but Terry laughed.

‘In Brixton and Bradford? No, it’s a valid point.’

Lisa suddenly wanted to be far away, preferably soaring in tandem with one of the paragliders who were circling beneath Skiddaw’s peak. Counting out the correct money, she grabbed her parcel from front of the stall. ‘Sorry, I have to go.’

‘Join us for a coffee, Lisa. Sheila and I would be glad of your company, wouldn’t we, dear?’

For a moment the two women made eye contact. Eye to eye: the realisation was like a physical blow. Almost simultaneously Lisa understood that for Sheila and Terry this was unremarkable, routine. At home, in their kitchen, bathroom, sitting-room, at whatever time of day, they could see each other face to face and for them this was normality. Normal proportionate family life. And they had had a normal proportionate baby, who had now grown-up to be their size. Only outside their front door was the world a difficult and disproportionate place.

Lisa hesitated.

‘He means well,’ Sheila said softly. She could have been in her fifties; she wore a badly-fitting tweed coat and a knitted woollen hat from which grey curls escaped, but she stood within a shell of calm.

‘Yes.’ Struggling to hold the rolled-up rug, Lisa held out her hand. ‘But a friend is expecting me. Thank you.’ When Sheila took her hand to shake it, Lisa suddenly leant forward and not quite knowing why, managed to kiss her on the cheek. ‘Thanks. ’Bye, Terry. Enjoy your day.’

 

Lisa takes the slip-road that will lead her back to Liverpool. She is tired now and has been listening to music to stay alert.  The density of the traffic is increasing now, and she needs to concentrate fully on reaching home, but for the first time the ‘home’ image seems empty and resonant with echoes. She imagines Sheila and Terry, playing with a tiny, short-limbed baby who is sitting on a Herdwick rug.

(C) Ann Lingard
(This is an edited extract from The Embalmer’s Book of Recipes (2nd edition, Littoralis Press, 2014). More details about the novel can be found on my website where there are also three short, amusing and thought-provoking videos made by Dr Tom Shakespeare and Professor John Burn, about achondroplasia.)
***
Museum exhibit GC 13687achon1
Skeleton of Dwarf (female)
Achondroplasia.
Skeleton of an achondroplastic
dwarf showing the typical
deformity of the skull.
Diminution in length of the long
bones. Deformation of the
bone ends with a tuberculous
lesion associated with marked
kyphosis at the level of T12
Presented to Professor Struthers (1823-1899) by a former  pupil. It is seen that there is an acute curvature of the spine at the junction of the dorsal and lumbar regions.

***

ACHONDROPLASIA, by JOYCE GUNN CAIRNS
Achondroplasia2 joyce g cairns

 

***

 

IN MEMORY OF JAMES JACK

 

james jack, shm edinburgh
James Jack

“In 1922, Charles Cathcart, Conservator of the College Museum, recruited James Jack to help William Wardie, Technician, with the maintenance and remounting of specimens. He also acted as projectionist, displaying the glass photographic slides at lectures and talks.”1

“On the outbreak of war it was decided that the specimens in the Museum would best be saved from the risk of damage by storing them in the basement of the College. They remained there until 1943 when it was apparent that the risks of air raids were diminishing and it was desirable that the College activities should, at least in part, be resumed. During these years the only work conducted in the Museum was the repairing of damaged specimens by the one and only member of staff, James Jack. In addition Smith, the College Officer, and Jack undertook firewatching duties in the College buildings.” 2

“James Jack was a well-known, popular figure, who lived at No.7 Hill Square. In addition to working in the Museum, he helped the local newsagent on Saturdays by selling newspapers at the College gate.

It was said that ‘he brought to his task skill, hard work and always a delightful sense of humour’.” 1

hill square2
Hill Square

 

“James Jack was an unusually small person, described popularly as a ‘circus’ dwarf. In scientific terms he suffered from chondrodystrophia fetalis (achondroplasia), a disorder of the growth of bone that is inherited. The abnormality affects stature but neither physical activity nor mental function.” 1

James Jack’s arrival is also attributed to Professor David Middleton Greig (1834-1936).

“In 1922 Greig ‘procured’ for William Waldie [sic] an assistant from Dundee – an achondroplasic dwarf, James Jack.” 2

“During his years of surgical practice in Dundee David Greig had been an ardent collector of pathological specimens, especially those relating to diseases of bone and abnormalities of the skull. …

Many stories are told about Greig and his collection, some of which have been related by his nephew Dr B S Simpson who recalls visiting the attic of his uncle’s residence in Dundee and finding the place full of this material. Some of the stories suggest that the collection was acquired with an unusual enthusiasm.

The actual number of items thus added to the Museum [collection] is difficult to ascertain but it ran to several hundreds and included 300 skulls.”

The Greig skull collection, boxed in the basement, and on display

 

“Initially Mr Jack was employed in a temporary capacity on a wage of 30/-  per week, but he stayed with the Museum for over 40 years, eventually retiring in September 1964.” 1

“There was no question of Greig’s fascination for achondroplasics and there are in the College a large number of clinical photographs of the new assistant.”2

But,  “James Jack long outlived David Greig and at a much later date, still working in the College, he pronounced: He didn’t get me, and he’s deid.” 2

 

Notes:

1. From the text accompanying James Jack’s photograph in the Surgeons’ Hall Museum

2. From The Museum of the Royal College of Surgeons of Edinburgh by Violet Tansey & D.E.C.Mekie, 1978

 

 

 

‘The Man with Three Legs’: Diana Hendry

From the Department of Orthopaedic Surgery, University of St. Andrews

‘In the autumn of 1948 a message was received from a rural practioner stating that in the course of a vist he had discovered a man who, from the cursory glance that had been permitted, had a large sacral appendage with the appearance of a massive tail.’

 

The Mother

He was a monster, yes,

but he was my monster and I loved him.

His father would have done away with him

when he saw that limb, that leg

with its curled up foot hung from behind

like a huge tail.  Always between prayer

and drink, my man.  Said he’d been sent

as a punishment for our sins – your sins

he’d say, looking at me mad-eyed

for he’d rather the boy was not his at all.

The runt of the litter, he’d say, that freak.

 

His brothers and sisters were sworn

to secrecy with the threat of the belt or worse.

I’d take him out in the pram.  Until he was ten

I could hide him in that.  We’d walk in the woods.

I’d sing to him.  He’d sing back.

I hoped the thing would fall off or shrivel away.

I dreamt I’d wake one morning and find it

on the floor and him as normal as the others.

When he was too big for the pram

I bought him a kilt.  And when he grew out

of the kilt I made him a long flannel gown.

 

O the shame of him.  And the blessing.

My youngest who I loved the most

and kept most hidden.

 

A Local

As bairns we cried him Frankenstein –

Frankie fir short.  He was oor monster,

ken whit ah mean?  Fowk said how

he’d be oot at gloamin in the woods

happed in a lang sark, nae breeks

an wi this awfy tail hingin oot ahint him.

 

Maw telt me no tae be daft.  She said

he’s naebit a puir body who mendit watches.

We didnae believe her.  We thocht him a deil,

hauf mannie, hauf beastie.  Me an ma pals

wid daur each ither tae throw clabber and chuckies.

Gie us a look at yir tail! we’d shout

and laugh tae see him fleein hame.

 

From the Department of Orthopaedic Surgery,

University of St. Andrews

‘The operation consisted of little more than careful dissection through fibro-fatty tissue. Any difficulty lay in the pre-op preparation of the skin and then in fashioning suitable skin flaps.  We thought we’d gained his confidence during the unsavoury task of preparing his skin and suggested he celebrate his successful treatment with a shave and a haircat.  The suggestion was received in silence and disregarded. He showed neither pleasure nor gratitude. The post-operative photograph was secured at the second attempt only after angry words and our accusation of ungracious behaviour.’

 

The Patient

I knew I was a medical curiosity.

Those photographs!  Essential

for the treatment plan, they said.

Me, stood there bollock naked before

strangers!  Even with my back to them,

even in the polite medical silence,

I heard the ghost of my father

calling me freak.  I could tell

they were writing their paper

in their heads. I ask you,

who can photograph the mind or the heart?

 

They expected to be thanked

for making me ‘normal’.

Suggested ‘a change of personality’.

Gave me trousers.  All I felt

was loss, as if what had been

taken away was who I was –

father’s freak, mother’s blessing.

 

Afterwards, I stayed home, mending watches,

seeing no-one.  A stranger to myself.

 

From the Department of Orthopaedic Surgery,

University of St. Andrews.   Postscript

 

‘In spite of our hopes to the contrary, it became evident that this unfortunate man had lived too long with this tumour to change his ways.  He returned to his room and his watches and was not seen outside the house.  Whatever plans he had for the future, his new-found freedom proved short lived. He died unexpectedly at his home three months later from an acute infection of the urinary tract.’

 

Museum visitor

In its glass box, the leg

looks like a joint of meat.

I can picture it in the oven.

It would feed about ten.

 

The exhibit is entitled

Supplementary Appendage. Leg.

 

*****

Reproduced with Diana Hendry’s kind permission from The Hand that Sees, 2005, ed. Stewart Conn. Royal College of Surgeons Edinburgh/Scottish Poetry Library

http://www.dianahendry.co.uk

The poem has also been published in: Late Love & Other Whodunnits (Peterloo/Mariscat Press)

 

 

The tale of Andrew Kerr

Andrew leant on the cairn and and stared out at the view. From the top of Law Hill it is possible to see the River Tay where it broadens out by the McInnes Banks; the town of Dundee is just visible to the North-East, beyond the woods and fertile fields of the Carse;  and by looking to the West, the Gallow Hill near Leetown just hides Clashbenny, where Andrew was born. But he was not looking at any of the familiar landmarks: for once, he wasn’t watching or spying on anything, because he was concentrating on making a decision about what he should do.

After a long while, when he had convinced himself that there could only be one solution, he set off down the hill, past the old mansion with its charred and jagged roof timbers; round the carriage drive built by his father and grandfather long before he was born, and now carpeted by grass and other weeds; and along the overgrown avenue that led past his own home and towards the road. At the gardener’s cottage, which was almost hidden by the skirmishing Clematis montana and a ‘Marshall Neil’ – a heavy, old-fashioned rose that his uncle remembered being planted —  he paused, and snapped off a couple of late flowers and sniffed at their browning petals, but their scent was as pale and autumnal as their colour.

He briefly caught another scent, acrid and sharp,and he paused again then stepped softly into the walled garden, looking round for the fox. A blackbird exploded out of the weeds beneath an apple tree, its clattering alarm drawing Andrew’s attention to the remaining windfalls. Small birds chittered in the ivy that had grown up over the wall.

The garden was reverting to wilderness, a wilderness of imported exotic plants where only  those that could tolerate the long northern winters triumphed. It had once been a fine garden, with deep herbaceous beds, and paths lined by rose pergolas and pleached apples and pears. There had been lilies: the day-lilies had survived, but the tall speckled Lanceolatum rubrifolium, were long gone. Even their metal labels had vanished in the tangle.

The vegetable patch that he and Danny had cleared for their own use was thick with yellowing groundsel and chickweed. “Dig for Victory!” What a stupid idea that had been! All those Englishmen on the radio, telling them to do this, do that. What did they know about anything? His irritation flared briefly and he picked up a stone and hurled it at a broken sheet of glass, causing the  blackbird to shout indignantly again. He and Danny had had to dig for themselves and Cathie – there had been no-one here to stop them because the gardener had gone off to fight. Cathie had not been happy with what she called their thieving, but she had soon been pleased enough to have the extra food. Andrew  screwed up his face in sudden anguish and clutched at his beard. If only Cathie were still with them, then he would not have to do this terrible thing.

 

There was no light in the cottage, but he could hear music when he opened the door. Daniel was sitting in the big armchair, so still that Andrew was momentarily shocked into thinking that he had already died.

“Danny? Danny!  What’s wrong?”

His brother stirred, and opened his eyes, bemused. “Andy – where have you been? It’s almost dark. Light the lamp, Andy.” He slowly pushed himself up out of the chair.

“I picked you some roses.”

“Ah, the good Marshall Neil. And did you dig us some leeks, too?”

Andrew flicked a sideways glance at him, then made himself busy lighting the lamp. “There’s not much paraffin. You will need to get some more tomorrow.”

Daniel sighed. “Aye. And the radio battery is getting low, it needs to be taken for re-charging.”

Andy turned the knob on the radio, but the voices which had replaced the music were now barely audible. He waggled the contacts on the accumulator, but the radio merely whistled and crackled in response. “We could use the one I’ve been mending for Mrs McGillivray. You can take it back to her in the hand-cart tomorrow when you go down to the shop, and she will never know.”

Danny was leaning against the table, gripping its edge, still holding the two roses in his other hand.

“Danny?”

“Andy, I want you to listen to me. You must take a note to the farm. I will write a note and ask them to send for the doctor. I think it would be best if he could come here soon.”

Soon? You are not needing a doctor, you are only feeling tired because you are hungry. You will be better after we have had our tea. Here – ” Andrew opened the small cupboard that acted as their larder, “We still have two eggs. Mrs McGillivray will pay us with more eggs tomorrow. And we have potatoes. I will go back right now and pick up some apples to stew …” Not the doctor, not yet, he had only just decided what to do! He needed more time to get used to the idea. “I will go back and fetch some apples,” he said again. “I will dig some leeks too.” Panic welled up inside him, and his hands began to shake.

“No, Andy. You cannot go for apples in the dark, don’t be daft, lad. Tend to the range and put the kettle on to boil.”

Daniel went to their father’s oak bureau that had come with them from the other house, and took out some paper and a pen, but the ink, when he opened it, was dry and hard. “I shall have to write with a pencil and that will not look good,” he muttered.

“You know I cannot go to the farm!”

“It will be all right. It is dark and they will not see you – leave the note under a stone by the door. The dogs will be tied up for the night, so you need not fear.” Daniel spoke kindly, as he wrote. “It is all right, Andrew. The doctor will give me some medicine and I will be better soon.”

 ***

Edington drove up the rough track past the cemetery, fearing for the car’s undercarriage. The louring gloom of the trees that pressed in on each side added to his feeling that the journey was timeless, and might never end; fallen branches caused him to swerve and muddy water splashed up from untended pot-holes. When he reached the cottage he remained uneasy. Its door was closed, the place looked shut up and empty – but there was a sweet smell of wood-smoke that was drifting from the chimney. There would be no shortage of wood for the forester’s sons, he thought, even if they had little else.

He shut the car door with a heavy thud, and the front door of the cottage opened at once, suggesting the men had been waiting for him.

On his last visit, with Ian Smillie, the patient – if he could be called that, the “subject”, perhaps would be more accurate – had taken himself to his room, to lie down on his bed, and they had had to climb the narrow stairs to examine him. Daniel had remained downstairs in the living-room; he seemed to know what his younger  brother was proposing, but Edington wondered if he knew the reason for this late-in-life decision: that Andrew was frightened that Daniel – who was now clearly suffering from the gradual onslaught of pernicious anaemia – might die and leave him on his own. And Daniel Kerr had never been allowed to see “the Thing”, as Andrew called it. Not since Andrew was a wee lad.

But now both brothers stood at the open door, Andrew  staring out and apparently anxious to start his journey.

Daniel took his arm: “Andrew, let the doctor by, he’ll be needing a rest and a cup of tea after his journey.”

But Andrew did not even greet Edington, and rudely pushed past him. Edington noted that he smelt less unpleasant than previously, and his black hair and beard, still surprisingly free of grey for a man of fifty, had been washed and combed: perhaps his brother had had some influence there.

“That isn’t a two-seater. The other doctor said we were to drive there in his Allard.”

Edington was taken aback. “I’m very sorry, Mr Kerr. Mr Smillie has had to attend a meeting at the Infirmary today. But my car’s a Riley Kestrel, and I’m sure you’ll find it an exciting ride. I will do my best to make it so,” he added, jokingly. Of course someone as senior as Smillie would have had no intention of collecting Kerr himself, the man must have misunderstood.

Daniel Kerr had come outside too, and Edington observed that he seemed even paler and weaker than on the previous visit. Unlike his brother, he was grey-haired and slightly balding, and his body was thin and stooped. “I am sorry, doctor, he has never been in any sort of motor-car before, and even when he went in the wagon it was not on a main road. Hearing the other doctor talk about his cars made him really excited.” He was clearly very anxious. “It’s what has kept him to his resolve, you see.”

Edington nodded, and said quietly, “Don’t worry yourself, Mr Kerr. I’ll get him to the hospital.” He walked back to the car and opened a rear door. He smiled at Andrew. “See, there is a fine green leather bucket-seat, and it has a pneumatic cushion to ensure you can sit comfortably. And do you see the blind on the back window? You can pull it down with this cord if the sun is too bright.” Andrew remained where he was, not to be coerced, so Edington opened the front passenger door. “Or you would be welcome to sit in the front next to me, if you think you would prefer that. You will have a better view of the road, and you will be able to examine the gears and dials as we drive.”

Andrew looked directly at Edington for the first time, then quickly averted his eyes, before he nodded.

“Aye. I will sit at the front.”

He climbed in, and for a moment his long skirt, which appeared to be made of a length of woollen cloth, of a non-descript colour, caught on the sill, and he moaned and made little panting noises as he pulled it close around his legs.

“I will fetch your clothes, Andy,” Daniel called and he picked up the cloth bag that was resting by the door and brought it across to Edington. ” I have added a few things from his room. And a pair of my own trousers  …. They might not fit too well. But I thought he might need them. After.”

He twitched his neck and rested his head awkwardly against his right shoulder, then he bent down to touch his brother on the shoulder.

“You will be all right, then, Andy? The doctor will fetch you back here soon.”

Andrew looked up at him. “I wish Cathie could have come. I wish you could come,” he said, almost pleadingly.

Daniel patted him, and nodded, and when he stood up Edington was embarrassed to see that the man had tears in his eyes.

“Is there really no-one who could come and visit him?”

Daniel shook his head. “Our elder brother’s a forester over at Blairgowrie, and he would not be able to get away. And both our sisters have – passed on. How long will he be in there, doctor?”

“I cannot say, Mr Kerr. But perhaps a week or two.”

“It will be strange. I have never been on my own — in sixty years. And Andrew has always had us to look out for him.  Always …” He turned away, but then quickly turned back and beckoned for Edington to come close. “He is not at all used to other folk, you know that? He will be very troubled.”

“I understand, and I will make sure they understand that at the hospital.” Privately, though, Edington was deeply worried.

He shut the passenger door, and when he had walked round and climbed in behind the steering wheel, he saw that Daniel had already disappeared inside the cottage, and that Andrew was peering at the dials on the dashboard and fidgeting uncomfortably in his seat. Edington was a young man, still in his thirties, and the thought of the long drive to the hospital at Bridge of Earn in the company of this gruff, unmannerly recluse, made him a little apprehensive.

After half an hour, Andrew was so uncomfortable and fearful that he could not remain silent.

“Stop! I want to sit in the back.” He hadn’t meant to shout. “Please.”

The doctor immediately braked and pulled the car over. “Of course,” he said and got out, coming round to help Andrew with the door. “I have no doubt that it is all a little over-whelming,” he murmured.

Andrew, standing on the verge and in the open air, had a sudden urge to run, to run home to safety and familiarity, away from his enforced proximity to this stranger, and the smell of leather and tobacco smoke. But Dr Edington caught hold of his elbow and gently guided him towards the rear seat. “Now, you spread out and make yourself more comfortable,” he said, in a kindly manner. “And the bag that your brother made up for you is right there beside you. You can open the window by turning this handle, if that would help.”

Cold air streamed in noisily but Andrew felt less trapped. The doctor spoke to him sometimes and asked him questions, perhaps about his family – Andrew could see his eyes in the tiny mirror –  but it was difficult to hear and Andrew would not answer.  He stared out at the changing countryside, the gentle hills of the Carse, the fields of stubble, the small wizened apples left on the trees; he stared at the metalled road, the houses, the motor-cars and occasional lorries; the bridges and river crossings. The doctor pointed out a train, trailing staccato puffs of smoke as it climbed an incline, but that was no novelty for Andrew  – he had often watched the trains near Errol. He had never been so far from home and yet he was soon disappointed, with the motor-car, with the villages, the journey. He pulled his jacket tight around him, lifted his bundle of belongings onto his lap, and closed his eyes.

The hospital was the final disappointment, this was not the grand stone building such as he had imagined, but seemed to be a collection of long low sheds. Dr Edington parked the Riley in front of one of them, and said, “We’re here, Mr Kerr — let me take you inside.”

As they walked up the wooden steps, Andrew said, “You will go back and look after my brother, you must promise.” It was an order, of sorts, and Edington knew it was important he should agree.

 ***

The day was not going well, Murdoch thought.

Matron had had to be very determined with Kerr, it had been a difficult job to clean him before his examination. He’d become noisy and quite aggressive, indeed he had shouted, that nobody was to come near him, and he would wash himself, but Matron had eventually persuaded him that his skin needed to be cleaned in a special way for the operation and that he must allow her to do it. Murdoch, who had only recently taken up his appointment as Registrar, thought that Matron had, in the end, been surprisingly gentle with the man and had managed to gain his confidence to a small extent. He was also rather impressed that Matron had taken the task of washing and disinfecting the man and his grotesque appendage upon herself.

Her comment, directed at Murdoch, had been a quiet reproof:

“From what Dr Edington has told me, it seems that Mr Kerr has lived like a recluse for all his life – and who, Mr Murdoch, having seen the disability that the poor man has had to bear, can blame him? I will be frank with you. I think the man is very frightened.”

Later, Murdoch had to speak sharply to Nurse Thomas because he overheard her gossiping and giggling with Nurse Stephens, “Did you see the size of it? He keeps it strapped to his right leg in the daytime. He can’t wear pyjamas, we didn’t know what to dress him in!”

The patient, wearing a dressing-gown, had been walked across to the radiology building yesterday to have several X-rays taken, and today when the radiographer had discussed the plates with Murdoch and Smillie he had pointed out a shadow in the mediastinal area that could possibly be a large tumour. This had been an unpleasant surprise for the surgeon and his Registrar, but since Kerr had made no complaints about chest pains and seemed to be suffering no ill effects, the chances were that it was benign. It would have to be ignored for the present, Smillie said, and the patient would not be informed.

It was the man’s third leg that was the focus of their attention. The X-rays of Kerr’s extra limb showed that the femur articulated via a bony ankylosis with a distorted tibia, but the patella and fibula were absent: the toes of the inverted stunted foot had the normal complement of bones plus an additional toe that lacked a nail. It was the proximal end of the leg that concerned them, where there was half of a rudimentary pelvis: but it seemed to be unattached.

“Let’s go and have another look at the man himself,” Smillie said. “Get MacLeod to come too and take some photos – we shall get them today however obstructive our patient tries to be!”

“Perhaps he will find it easier if we keep the female staff away and deal with him ourselves?”

But despite banishing the nurses, Murdoch’s hope was ill-founded and another furious battle of words ensued before Kerr would allow photographs to be taken of the lateral and posterior aspects of his third limb.

Smillie remained as affable and impeccably well-mannered as usual. “I apologise for the trouble to which we have put you, Mr Kerr, and I wonder whether – since you will soon begin a new life with, I hope, a great deal of freedom from its former contraints – you would also wish to have your beard shaved and your hair trimmed? To give you a new appearance as a form of celebration?”

Andrew Kerr ignored him completely, and merely picked up his gown and began to cover himself again.

As he and Smillie walked back to the surgeon’s office, Murdoch said, “Why did he never get anything done about it before? Fifty years, for goodness’ sake!”

“I asked Edington the same question, although of course he’s far too young to have had any personal involvement himself, and he put me in touch with old Liddell in Edinburgh, he was the local chap at Errol, you know, before Edington. Liddell was there at Kerr’s birth, and he told me the father was the forester for the Murie estate, when the Ogilvie Dalgleish family had it. Apparently the father died about 20 years ago, though he’d carried on working until he was seventy-odd. A tree fell on him or something like that, one of the hazards of the job I suppose.” Smillie laughed as he sat down behind his desk. “Of course they had to move from their tied house, but the estate looked after them, still looks after them according to Liddell, even though it’s been fragmented and bits and pieces have been sold off. Kerr’s brother – the one with pernicious anaemia, interesting case incidentally – worked there in some sort of capacity too before he had to give up. The Lady Dalgleish or whoever it is that owns it now probably felt she still had some sort of obligation. Rightly so, of course. Would you mind sticking your head out of the door and asking someone to bring us some tea, Murdoch?”

Murdoch went to find one of the secretaries, wondering as he did so if Mr Smillie had the same paternalistic attitude to the servants on his Sutherland estates.

When he returned to the office, Smillie was holding Kerr’s X-rays to the light again. “But you asked me why this limb -” he tapped the plate, ” –  remained in situ. It’s an absolutely fascinating story. Liddell told me that when he delivered the child he recommended that the appendage be removed at once — it was very small in relation to the rest of the child’s anatomy at that time. But the parents refused! And their reason? The birth of this ‘monster’ – that is the word the father used – was a punishment to them for some unspeakable sins of their forebears. Liddell wasn’t allowed to see the boy again until he reached adolescence — they hid the boy away, wheeled him around in a perambulator. He wore a kilt until the limb was too big, then a dressing-gown – so Liddell heard. Unbelievable, isn’t it? Come in!  Ah, the tea. Yes, just put the tray there will you?”

Murdoch remained silent as he tried to imagine Andrew Kerr’s early years. He shook his head in amazement. “Unbelievable!”

“I hope I’m not being unreasonably optimistic but I cannot see that this operation will afford us too many difficulties, Murdoch. There seems to be nothing needed in the way of separating a bony connection and I suspect the main problem will be in fashioning a suitable skin flap. I am assuming that the tests are accurate and there is no connection to the urethra. It should be considerably less taxing than operating on the knee-joint.”

Murdoch smiled politely, acknowledging that Smillie’s great oeuvre, Injuries of the Knee Joint, had just been published to great acclaim.

“If all goes well, our Mr Kerr should be back home with his brother in a few weeks. I gather from Edington that the elder brother is now fairly poorly, so perhaps they will have a reversal of fortunes – the revitalised younger Kerr caring for the elder.”

Can two men change the habits of their long life-times? Murdoch wondered. Edington had told him privately that he was extremely concerned about Andrew Kerr’s future state of mind. Murdoch wondered, too, if Andrew Kerr had always known his parents considered that he was a monster and a punishment: surely not, for what child or man could live with that knowledge about themselves?

“I also gathered from Liddell that two of the father’s brothers changed their names and emigrated to the USA. Fascinating, don’t you think? One does wonder about the gravity of the so-called ‘sins’. Well, we have an interesting day ahead of us tomorrow.” Smillie picked up his wide-brimmed black fedora and took his overcoat from the hanger. “Good night, Murdoch. See you in the morning, bright and early.”

***

 There was more food than Andrew was used to. When he first arrived he had been too nervous to eat, but as his wound began to heal and knew he was getting better and would go home, he had begun to eat well. He wondered if he could take some of the food home with him. One day he had been served liver; he hated the taste and texture of it – but Danny needed to eat liver to make himself well again.They had lent him a radio, too, the modern sort without a battery that plugged into a socket in the wall. At first he had had to lie in bed on his side to let the wound drain and heal, and he had listened to the radio all the time, ignoring the staff and their interference and questions. They touched him, too, lifting him, pushing his body around.

When he was allowed to swing his legs off the bed and stand, he was weak and unstable, as though he would at any moment fall forward on his face. Dr Murdoch had held his arm and explained that there was no counterweight behind him. Had it been so heavy? It had always been part of him, so he didn’t know. He frequently slipped his hand into the back of his pyjama trousers, his fingers probing the deep indentation and wrinkled skin on his right buttock. “The Thing” had really gone. Its absence upset and puzzled him.

He knew how to deal with the hospital now. You asked the nurses to get you things, and if you told them to go away, they usually did. He disliked the nurses, they were mostly young women who were always rude and giving him orders or disagreeing with him. The Matron was all right although she was very strict with him, the way mother had been.

He wanted to go home so much that sometimes his heart actually ached. He thought constantly about Murie, and he worried about Danny, he wished he knew what he was doing. He thought he might even show Danny the Thing, now it was not joined on to him; Dr Murdoch said they had put it in a big bottle.

” Will you give it to me now?” he had asked Mr Smillie,  a couple of days after the operation. “I will take it home with me.”

Mr Smillie laughed, “My dear fellow! No, of course you cannot take it with you.”

“Why are you laughing? It’s mine, it belongs to me. What are you going to do with it?” He was speaking too loudly, he knew, although he was weak with rage.

“We shall take care of it for you, do not worry, Mr Kerr.” Mr Smillie smiled coldly and gestured to the two young doctors who were accompanying him that they should all move on.

Andrew continued to ask for the Thing to be returned to him. Two weeks after the operation his skin was healed but now, when he asked, no-one even listened any more. He hated being here, with the noise and smells and so many people, never any peace, everyone talking and poking and pushing things at him. He had to escape, he needed to be outdoors. He climbed out of bed and felt around in the little cupboard for his bag. There were trousers in there, and the rest of his clothes. His fingers searched for and found the small hard object, and he pulled it out and stroked it: the flake of red sandstone that he had found in Clashbenny Quarry, with the embedded fossil fish. Danny had put it in the bag to remind him of his room at home.

He had to go home! But he had no idea how to get there, it must be a long way. His legs felt weak, but he would walk, if he knew in which direction. Then he had an idea. He left his room and walked down the corridor to the Ward Sister’s desk.

“I want to see Dr Edington,” he said.

“He doesn’t work here, Mr Kerr, and I’m afraid I don’t know when he”s next expected. But I’m sure he’ll be coming soon to see how you are getting on. And now, since you are here, I have a letter for you. But before I give it to you Mr MacLeod wants to take another photograph to show how well you have healed.”

“NO!” Andrew bellowed. ” No more photographs. You’ve no business to be looking at me any more. I want to go home, I want Dr Edington to take me home.”

The Sister took his arm and he struggled hard and pushed her away. MacLeod grabbed him too, and all the while he was shouting, shouting that they should leave him alone and give him back ‘the Thing’ and let him go home. It was, finally, too much. His throat was tight, he began to sob.

“I want to go home.”

Great shuddering breaths and howling sounds burst from him.

Matron walked briskly to the desk to see what the racket was about, but she seemed to understand at once and she put an arm round Andrew”s shoulder.

“Now then, Mr Kerr. We’ll send you home very soon. Come along now, we’ll go back into your room and we’ll let Mr MacLeod take his photographs, then Sister will give you the letter that came for you. And perhaps we can get you a cup of tea.” Andrew could not stop shaking and tears poured down his face and into his beard, but he let Matron take him to be undressed and photographed.

“Would you like Sister to send someone to read the letter to you?” she asked afterwards. He stared at her, uncomprehendingly. “In case you find it difficult …”

He looked at Daniel’s round clear writing on the envelope, writing that he knew so well, for had he not copied it hundreds, thousands of times, when Cathie and Daniel taught him to read and write.

“I am not blind, nor am I stupid.” he said. “I will read it myself.”

Danny must have been to the shop to buy some new ink: “Dear Andy, I hope your op has gone well and that you are getting better. I saw Dr E. two days ago in the village and he said he would come and see you next week and bring you home if you were well. The house is strange without you, and I hope you will come home soon. Perhaps we can go down to Port Allen together. I went down there after you left and I saw a kingfisher. Do you remember how we all went with father to see the big windjammer that had come in for potatoes? It was a 200-tonner with two masts …”

I was only ten or twelve, Andrew thought, so Daniel would have been twenty or so, working for our uncle who was a pendicler over at Whiteriggs. Father had come back from Murie, and said he had seen the big ship from the road. Cathie was with us too, but surely she should have been working at the Dowager House in those days? He frowned, trying to remember why she was at Clashbenny; probably she had come over to hear him read, she liked to make him read from the Bible. They were all going to go down to the quay. Not me, I had to stay at home with mother.

Andrew stared unseeingly at the letter. He had gone out, though, up the Gallow Hill, and he had seen the masts in the distance, with its great white sails furled. So he had run away, down to the port. There were herons in the trees. And there were so many people, but he had not cared, he had seen his father with Daniel and Cathie, and he had run to them, and held onto Daniel. People had stared at him, but Cathie had taken his hand, too.

They saw their elder sister Jane, and she came over with her husband and their son James. It was her fault, really. She made a fuss of Andrew and said he and James should go and have a closer look at the ship. Cathie said to stay with her, but Andrew had thought he would go, he would be all right with family.

Then that girl had seen him. “Lookit him! There’s the wee bogeyman, the bairn wi’ a tail. Gie’s a lookit yer tail, laddie!” Everyone, all the villagers, all the crew, had looked at him.

Andrew remembered, even now, how he had run and run, leaving Danny and Cathie behind. He had hidden in the quarry until it was dark and they were out calling for him to come home.

Their father had been furious, but not with him. “How do they know?” was all he kept saying, “How did they find out?”, and their mother had said, “It would have been Jane, she never could keep her mouth shut, she was always making mischief even when she was a lass.”

They had never bothered much with Jane and her family after that.

” … and we watched her from up by the Greystane when they took her out on the tide. Do you remember what a fine sight she was? I thought I would like to join the navy and go to sea.”

But I wouldn’t let you, Andrew thought. And you’ve left out the bad bits, Danny.

He climbed into his bed. There was a rage and sadness deep within him. He had been cheated, all his life. But now he would lie here and wait for Doctor Edington. He will soon come and take me home, he thought, and Danny and I will go down to the port and watch for herons and kingfishers, and in the Spring we will collect duck-eggs. Perhaps we will even walk to the old quarry and look for fossils.

As he lay there with his eyes closed, another idea came to him. When he was back home, he would look in the bureau for Uncle Daniel’s letters to their father, that had been full of news about plants and trees and the farmland he had bought, somewhere ‘out West’. Perhaps he and Danny should take a trip to find their cousins in America; perhaps the cousins could even help them with the fare.

(C) Ann Lingard 2011


 

Notes

The names of the “man with three legs” and his family have been changed. However, the archival research by Anne Carroll (see below), and some details (including letters) generously provided by the great-grandson of one of the “uncles who went to America”, helped me to find out – then fictionalise – some aspects of the ‘Kerr’s’ family life.

Here are some facts:

‘Andrew Kerr’ was in hospital for nearly 4 weeks.

He died at home approximately three months after his discharge from hospital, on April 2nd 1949, aged 50. The cause of death is entered on the certificate as “teratoma of the lung; gastro-enteritis; cardiac failure”. His death was certified by Robert S Edington, and “Daniel Kerr, Brother”, was the registered Informant.

According to the Smillie & Murdoch paper (see below) “he died … from an acute infection of the urinary tract.”

‘Daniel Kerr’, ‘”forester, retired”, died four years after his brother in hospital, in November 1953, of broncho-pneumonia and cardiac failure, aged 64.

I S Smillie presented a paper about his (unnamed) patient and his unusual condition at the Joint Meeting of the Orthopaedic Association in July 1952; he and JS Murdoch published a written paper, with photographs, titled “The man with three legs” in the Journal of Bone and Joint Surgery in November 1952; the patient was not named.

The amputated extra leg, donated by Smillie,  is preserved as specimen GC13817 in the Collection of the Surgeons’ Hall Museum.

'andrew kerr' leg1

Other resources

Lawrence Melville 1935. Errol: its legends, lands and people. Thos Hunter & Son Ltd. Perth

The Parish of Errol: from the ‘New’ (1834-1845) and Third Statistical Accounts of Scotland (‘Errol’ account written in 1953)

Some information about Drs Edington, Liddell and Murdoch was gleaned from various British Medical Journals for the period; that about Ian Smillie (1907-1992) from Surgeons’ Lives: An anthology of biographies of College Fellows over 500 years, …..

All archival research (censuses, births and deaths registers etc for the Errol area) was carried out by Anne Carroll, Local Studies Assistant, A K Bell Library, York Place, Perth PH2 8EP; Anne also pointed me in the direction of many other useful sources.

 

Head-to-head: the plaster-casters

All we see are the heads and upper torsos of two men, in profile, facing each other across a table.

George Bailey is in his early 20s, with a slightly fleshy face, bags under his eyes, and red hair. He has traces of white plaster stuck to his hair and in front of his ear; his dark jacket is flecked with white. A white mask with strings protruding – clearly a mould of his own face – is on the table in front of him.

Gilbert Alexander’s age and the details of his features cannot be determined: his face is entirely covered in a coating of stiff Plaster of Paris; his mouth is slightly open showing his teeth, and there are two straws stuck in the plaster by his nose through which he is apparently breathing – just. His shoulders are covered by a white sheet.

 

GILBERT (gesticulating and pointing at his face): Mmm! Mmm-mm-mm

GEORGE: Just a few more minutes, it’s nearly set. (Touches the mask). Are you getting warm in there, Gilbert? A wee bit sweaty? No, don’t say a word – as if you could, heh heh! Don’t want the mask to slip, do we?

He yawns and stretches and looks at his watch.

Right, time’s up, we’ll have it off you now. Gently does it ..

Between them Gilbert and George pull the strings and prise the mask off Gilbert’s face which is red and glistening with oil. We see that Gilbert Alexander is in his 40s, fine-featured with a thin bony nose, prominent cheekbones and sandy hair; he wipes his face and eyebrows fastidiously with a cloth.

 GILBERT: (slightly shocked) I truly thought I was going to die in there, the heat when it’s curing is quite extraordinary. Indeed, for a few moments I had rather that I had been dead and you had been making my death-mask, then at least I wouldn’t have had to worry about where my next breath was coming from. (He discreetly spits into his handkerchief and wipes his mouth)

GEORGE: (Turning the plaster mould this way and that). You really should’ve gone for the botox option.  What colour are your eyes? Open wide, let’s have a keek.

GILBERT: They’re grey, and they are not blood-shot. (He takes the mould and feels the inside). Hmmm. I suggest we go for a wax cast instead of plaster, and try for a better flesh tone with those new pigments that arrived last week. I’m hopeful that they’ll be more miscible with wax than the previous set.

GEORGE: If you could see the colour of your face! Crimson Lake’s the only one we need. Still, better red than dead. And to think we do this to folk who are about to go under the knife! Talk about upping their stress levels. Aye, we’ll give those new colours a go and if they work I’d like to make another wax cast of that Mrs Fraser, the first one I did looks a bit peely-wally. I’ve had an order for another plaster positive of her pre-op mould, by the way. She’s one popular lady.

mrs fraser pre-op
Plaster-cast of Mrs Fraser with facial tumour  (with thanks to Andrew Connell for this photo)

GILBERT: She had a popular tumour, I would say. But you made a good effort with her, George, and her post-op cast is very fine. She’s got a lovely smile, she looks very serene.

GEORGE: Yeah. Despite the whacking great hole that Liston left in her cheek!  But she looks even better now it’s healed.

GILBERT: Mister Liston to you, lad. And how do you know she looks better now, anyway?

mrs fraser post-op1
Plaster-cast of Mrs Fraser post-operation, plus cast of tumour (photo: Ann Lingard)

GEORGE: I’ll update you on that in a minute. But that post-op cast – you’ll have noticed I had to sculpt her face a bit, right? Then I stuck the face onto the pre-op sides of her head, you can see the bonnet’s the same in both. But I had a pretty good look at her during the op and Perry let me see his pre-op drawing too. She was real quiet and dignified, that Mrs Fraser, not a peep out of her though she’d had some teeth pulled out and Liston was sawing away at her palate. I’m proud of the cast of the tumour, though – did you see the size of the thing?

GILBERT: Aye, it must be half the size of her head! When I saw it I could scarcely believe it. It’s not a wonder that her cheek’s so stretched and shiny – you captured the veins sticking out to perfection, lad, like worms crawling over the surface. That was a good mould you made.

GEORGE: Not like your cast of Robert Penman – his face looks like a pig’s bladder, it’s that smooth. That’s not your best work, Gilbert.

GILBERT: No. But … (he pauses, shaking his head) … but .. well, that was the first time I’ve ever thought that I wouldn’t be able to do my job, George. The poor young fellow. That tumour! It was all raw and wet and bursting out of his mouth, I don’t know how he’d been able to eat all those months – and yet he seemed a strong well-made lad. It was just a great wet red mass, it made me want to retch just looking at it, let alone having to touch it. You can imagine what it was like, ladling the plaster over it and hope it wouldn’t slip off.  (He shudders and shakes his head again.) To tell you the truth, it’s more of a sculpture than a mask.

GEORGE: Yeah. Tricky, right? I guessed you’d had to have him tip his head way back, because his eyes are looking upwards.  Mrs Fraser was wet too, she was dribbling all the time because her mouth was so twisted. (He pulls his cheek and mouth down with his hand to show.) She had to hold a hankie against it all the time she was talking to Liston. She’d had the thing for years …

GILBERT: It’s not the same. Penman was raw. (The memory worries him, he keeps shaking his head). But it was not my best, you’re right. I’d have had another go at him if I’d been allowed. But Mr Syme was getting impatient …

He’s not at all bad at casting, by the way. He’s done quite a few anatomical specimens himself. But I reckon no-one can beat William Hunter’s gravid uterus series for beauty, they’re –

GEORGE: So do you want to hear about Mrs Fraser or not, eh?

GILBERT: Well, you’ve seen her again, that’s obvious. Go on then, what’s she like?

GEORGE: (sticks his head forward towards Gilbert:, and points at his own chin) Punch me in the mouth, then – go on! Break my teeth!

GILBERT: (rears back) What? What on earth has that to do with it?

GEORGE: Smash my teeth to bits and then I’ll be rich because I’ll get a gold palate. Custom-made. By my friend Mr Nasmyth.(George smirks and taps his nose)

 GILBERT: Pah. You have lost your mind.

GEORGE: Mr Nasmyth admires my work, dontcher know. I’ll be famous, you’ll see. He’d seen my casts of Mrs Fraser and he said he wanted to make a cast of the inside of her mouth so he could fit her with a palate – and that he’d like my ‘opinion on the feasibility’. That’s what he said.

GILBERT: Well, aren’t you the important one, then?

GEORGE: (smirks) But in the end he didn’t require my expertise. He came by a couple of days ago to show me the wax impressions that he’d made – not bad for a beginner – and said that Mrs Fraser had come down from Banchory to be fitted, and she was in the Infirmary and I should go and see her. She’d been asking after me!

GILBERT: She’d been asking after you?

GEORGE: Aye, Gilbert – me. She’d been asking after ‘Mr Baillie’, so he could visit her to see how much she was improved, Mr Nasmyth said. She remembered me because I’d done two casts of her, and you don’t get forgotten when you’re up close and personal like that. Anyway, older women always fancy me, Gilbert, but you’re too old to understand that.

GILBERT: Cheeky young bugger. So you obviously went to see her.

GEORGE: I did. Her own doctor was there, he’d come down from Banchory way to see how she was doing – Mr Adams, is he?

GILBERT: Adams of Lumphanan, that’s him. Aye,  he’s the Greek scholar. But of course you’re not educated enough to know that. He’s got a good reputation as a surgeon, too – the story goes that he once set a femur with a spirtle!

GEORGE: (dryly) Well now, there’s a thing. Anyway, as I was saying … Mrs Fraser’s face is really good now, you can even understand what she’s on about, because of this new palate. Dr Adams said she was the happiest woman he knew – from the point of view of her appearance, anyway. (whispers) I heard she was having to stay in the Infirmary a bit longer because she’d had a miscarriage – at her age! She’s old, man! She’s at least 40. Guess her old man found he fancied her again after her face-lift, eh?

GILBERT: (sits back, away from George) You’re disgusting, do you know that? There are times when I don’t know why I bother with you.

GEORGE: You don’t, mostly – bother, that is.

They are silent for a bit, each picking up their plaster casts and rubbing at bits, turning them this way and that. Eventually, Gilbert’s curiosity is too much for him.

liston
Bust of Liston

 GILBERT: So, did your Mr Nasmyth say anything about Professor Liston – do you think Professor Liston knows what Nasmyth’s done to his patient?

GEORGE: (holding his mask against his face; his voice is muffled) Bound to, they’re friends aren’t they? But if Liston doesn’t it’s his own fault, the great drama queen. Flouncing off to London in a huff just because Syme was given the Clinical Chair. What a pair of prima donnas!

GILBERT: (laughs) Edinburgh just isn’t large enough for those two big egos to co-exist. You’d never guess they’d been friends and colleagues when they were younger. I can remember when James Syme was Mr Liston’s assistant. Mr Syme’s the better surgeon, mind you, probably the best. Mr Liston – Professor Liston now, of course – he’s all flourish and flashing knives, just as likely to slash the leg of his assistant if he’s standing too close. Can you remember how long Mrs Fraser’s op took?

GEORGE: Blimey, it was a year or so ago, Gilbert, so I’m not too sure now  – but it wasn’t that long. Maybe an hour?

GILBERT: Mr Syme took 24 minutes with Robert Penman!  He called out for us to check our watches. And he hardly spilt any blood, even though there was a great mass of bone and teeth and tissue to come out – he weighed it afterwards, 4 ½ pounds! It was a wonder to watch. He says he operates as fast as possible so the patient hardly has time to feel the pain, but he was very careful of Penman, you know – he stopped several times to give him some respite. I thought he was quite respectful of the young man, even though the room was full of medics – Professor Ballingall was there, and Professor Russell, and Dr Abercrombie … They stuffed the hole with lint, stitched up his cheek and wrapped his face in bandages, and fed him whey and beef tea down a tube — and a few days later, would you believe it, they took off the dressing and Penman was saying he felt better than before the op!

 

GEORGE: (His expression is one of exaggerated boredom, and he picks up Gilbert’s mask as well, making the two masks ‘talk’ to each other) Oh dear me, you’re a real Syme groupie, aren’t you? Bet you’ve got the T-shirt.

GILBERT: Here, give that to me! (He grabs George’s mask and jabs his finger at the inside of the mould) See that lump there, on your forehead? That is indicative of a highly-developed sense of arrogance and self-importance. If you don’t watch out, Mr Baillie, you will find yourself as one of the exhibits at the Phrenological Society. (He stops, a thought has struck him) Phrenology. Have you come across Dr Sibbald, by the way? He’s a phrenologist, and if it hadn’t been for him, Penman would surely have died.

GEORGE: Man, it really hit a nerve with you when I mentioned Penman, didn’t I? You can’t stop talking about him.

GILBERT: The point I was going to make, George, if you would stop being so clever and would listen for a minute, is that I wouldn’t be surprised if some of the aggravation between our two Professors doesn’t stem from Penman’s case. Penman’s tumour had been growing for years and he came to Edinburgh and saw Mr Liston, but Mr Liston refused to operate. Can you believe that? And then more than three years after that, when the tumour was apparently three times bigger, Dr Sibbald sees him again, and tells Professor Ballingall about him, and then he tells our Mr Syme – who decides to operate. With great success, as we know. Penman went back to Coldstream and resumed his occupation, as a bootmaker I believe.

penman photo post

Photograph of Robert Penman 27 years after the operation (photo in the Museum Collection)

GEORGE: Ah, so you think Syme’s success rankled with Liston, and so Liston wanted to prove that he’s better? He waited a long time…

GILBERT: Aye, to get one that looked the same, six, seven years maybe. Though Mrs Fraser’s tumour wasn’t bony like Penman’s. Did you see Penman’s? It cleaned up really well after macerating – the bone’s like lace …

 They’re both silent again.

 GEORGE: (looks around, then speaks very softly, confidentially, beckoning Gilbert to come closer) Did you ever hear the stories about Liston when he was a student – that he was one of the resurrectionists? The one about him and his mate dressing up as sailors and taking a boat up the Forth to collect a body from a village graveyard? It seems they stuffed it in a sack and hid it behind a hedge when they went into an inn, then an old drunk went out for a pee and found it and brought the sack in over his shoulder … (he laughs) and they had such a fright that they had to scarper without it, in the dark!

GILBERT: (sits back and looks over his shoulder nervously) Whisht, man! You keep quiet about that, now. That sort of thing makes Mr Syme very agitated, he’s completely against it.  But there’s another side to Professor Liston that people forget, that he could be very charitable. You know he’s even gone to the tenements to operate on poor folks who’ve been discharged as incurables.

GEORGE: Aye well. He’s ‘good in parts’, as the clergyman said. All good practice, it keeps his hand in  – and the spin-off is plenty of specs for the anatomy collections, I’ll bet you. I’m glad that Sibbald or whatever you call him saved your Robert Penman, though, or the poor guy’s head and its tumour might have ended up like that head in the Bell Collection. You know the one?

GILBERT:(his face crumples in disgust). Aye, I know it. You would think Bell or whoever it was in London would have had a cast made instead. (Slyly, he touches George’s arm). It is like a mask, though, isn’t it, the way it’s been prepared? And he’s got red hair!

GEORGE: (lifts Gilbert’s hand off his arm, expressionlessly, then picks up his own plaster mask and turns it towards him, face to face.) I think I’ll paint the teeth gold.

© Ann Lingard January 2011

Further information:

Mrs Fraser

See also drawings in: James Liston, 1836, Some observations on the tumours of the mouth and jaw.

Robert Penman

See also drawings and information in: MH Kaufman and MT Royds, The Penman case, a re-evaluation, J.R.Coll.Surg.Edinb., 45, 2000, 51-5;

Plaster-casts Collection at the Surgeons’ Hall Museum