‘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.

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The stories of Janet and Caesar

Drawings by Joyce Gunn Cairns, 2011  http://www.joycegunncairns.co.uk

 

Johnnie!”

I drop the gathered stalks at Mary’s cry and look round. John is staggering across the stubble towards the cart. Mary is sitting in the shade, she’s holding my Willie back by his arm, but she’s nursing a babe of her own and cannae chase after John.

The horses are moving slowly, the men are pitching up the stooks. I’m too far away to stop him, I watch as the wean runs and falls and picks himself up again, running towards his Da, running towards the great hooves of Davey, that wicked gelding who above all else hates wee bairns.

“William!” I scream. “Watch Davey – Johnnie’s there!”

William turns to me to see what I’m screeching about, he’s looking the wrong way – and it’s my brother, Gordon, who catches John and picks him up.

“You’re a wee de’il,” he says, and holds Johnnie above his head, shaking him. “Come away back to your auntie Mary.”

“Gie him here to me, Gordie,” my husband says, “I’ll teach him no’ tae get in the way. Hand him up here.”

But Gordon shakes his head and walks away with my bairn. I can see the rage is on William and he thrashes the reins against the seat so that the horses jerk their heads and drag the cart sideways.

“Whoa there. Leave it, man,” one of the men says, and Agnes, who is working next to me, gives me a look and raises her eyebrows.

I’m wet with sweat, and not just from the heat and work. My belly cramps and I bend over against the pain, fiddling withthe laces on my boot, hoping the wetness between my legs is sweat. Will I lose this bairn too?  “No, oh no, please. No’ again,” I  mutter inside my heid.

There’s no strength in me and my bones ache but I need to stand up tall again. Tall and strong, like my brother Gordie, and like the woman that William married. I wipe my arm across my face.

“Go and sit doon by your bairns,” Agnes says. “Ye’re wabbit. Lizzie and me’ll tak care o’ your work for a while. Go on now, Janet. Looks like ye’ll need all your wits aboot ye the nicht.”

She and Lizzie look at each other, and I hate it that they all know about William and me.

 ***

We take the boys to Penicuik for the October hiring fair. William asked to borrow the garron and the small two-wheeled cart to take us all; because although Johnnie is four he’s still a wee laddie with wee legs, and Mary’s daughter is more than a twelve-month and too heavy to carry all the day. My back feels cracked since the potato-picking but I dare not let on. Mr Alexander has let us have the garron because he says William is a good man with the horses, and will do nothing wrong if he has them to look after.

“He tell’t me, I can trust you when you’re with a horse, William Anderson. It’s when you’re without one that everyone needs to watch out!”

William puts his arm round me and laughs, pressing his beard against my face, and then lifts me onto the cart as though I’m a bairn myself. We are wearing our good Sunday clothes, and he has a smell of cotton dried in the wind.

Gordie has filled sacks with oat-straw for us to sit on and Willie fusses that it’s jaggy and he wants to sit by his Da, so that the cart rocks even more and we have to hang on tight. Then we are onto the bridge at Firth and William stops us in the middle.

“Oh, I cannae look!” Mary tucks her head down and pulls the front of her bonnet over her eyes, but William holds out his arm.

“Stand up, lads, softly now. Haud tight, and look doon.”  Willie and John clutch their Da’s arm and stand; Willie pretends he’s fright and makes his knees shake so that the cart wobbles and Mary screams.

There’s a damp green smell, and Betty snorts and stamps her foot, and the river rushes and hisses way down below, and the rock walls are dark with wet and slime.

“I want tae thraw a stane,” Willie says, but Gordie says, “Ye might kill a fish, that wouldnae be fair, would it? There’s troot doon there.”

“A fine troot for our tea, aye. Janet and me wouldnae mind a troot or two, would we, Jan?”

William winks at me and I’m remembering the fish that he’d sometimes catch in the night up the Esk and how we’d hide the bones in the midden. “I’d like a fish, right enough, I can feel the taste o’ it in my mouth,” I say, and I can feel the spit welling up at the thought.

William grins some more at me and then he makes the boys sit tight and clicks his tongue at Betty, who’s glad enough to get to solid ground.

Mary giggles. “Look at you, you’re blushing! What’s the story with you and William and the fishies, then?”

I just shrug my shoulder at her and hold my face to the damp wind, but when Gordie and I climb down to lessen the weight up the pull, William’s grin makes me blush again.

In the town there’s a yard set aside for the horses and carts. William unharnesses Betty and Gordon fetches water, and Mary and me try to keep the bairns away from hooves and wheels. Such a crowd! Last year I couldnae come, my legs were like water I was that weak. And now there’s our friends, and Lizzie calling to us across the street, and there’s Thomas and his brother, and Gordie shows me Mr Thomas from Whitehouselee riding down the middle on a brown mare as though he owns it.

There’s a sudden bang across the way and Johnnie and me jump and cry out, but it’s a man with a big drum, banging and calling for all he’s worth for everyone to come and see. “Ye’ll no’ see a grander show onyweer in the world!” He’s frae Glesga, or maybe Irish, I think, so he’s no doubt lying.

“Da, can we go and see?” Willie’s pulling at his Da’s sleeve, and William’s that big and braw that he has no trouble pushing to the front, and then I hear him call out for Johnnie, and the wee lad wriggles between the legs to get to him. There’s too many bodies for me, too many elbows, so I step back across the way.

“It’ll be one o’ they freak shows.” Agnes and her guidman Robbie are passing and they stop with me. And right enough, when the tall man with the black hat stops shouting for us to come and look and pulls back the curtains, there’s a great fat woman with hair all over her chin and arms like she’s a bear, and everyone shouts and calls out to her and she laughs and shouts back and does a wee jig. Next up is a man with his brother growing out of his front, but you cannae see the brother’s head, it’s buried in the man’s chest. All you can see is his back, and he kicks his wee arms and legs – but it must be a cheat and there’s groaning and yelling from the crowd, and someone throws something, I think it’s a turnip but Robbie says more likely horse-shit. I can see Johnnie up on his Da’s shoulders, and I wish William would bring the lads away.

Aggie digs me with her elbow and jerks her head. “See they folks? The one with the green coat? That one’s the doctor, Dr Robert Renton he is, lives in that grit big house that Sir James Clerk built for the old doctor.”

We stare at the three gentry who have stopped to watch the show. Folks are looking at their fine coats and hats instead of the freaks.

Robbie says, ” ‘Tis said he was a surgeon with the navy, and after he settled here he got himself some rich patients and made a pile o’ money and bought out the old doctor. Sent him packing.”

“Aye, but I’ve heard he’s no’ above helpin’ oot us common folk.”

“Depends what’s ailing ye,” Robbie mutters.

The man who had the drum is going through the crowd with a tin, and he’s using his drum-stick if folks are slow to pay up. We see Dr Renton and his friends stop him and talk, and then they go up to the man with the black hat who runs the show and talk to him, too. I’d like to see what they’re after doing, but Willie comes running towards me and he grabs my hand, something he usually thinks he’s too old to do.

“Mam, Mam! I didnae like that,” he whispers, “they scared me. But don’t tell Da.”

And I hold him against me, then we all go to look at the sweets and the toffee-apples and the pigs’-feet. There’s a woman selling a cure for thin blood and megrims and for the back-pains, and I think that I might slip away from William and buy a bottle, but Mary sees me hanging back and looking. She knows my bones still ache.

‘You can save your pennies and go and drink from that spring,” she tells me. “The one they call chally-something, below the Spittal-hill. Ma Jackson swears by it, she says it makes you strong after birthing an’ a’.”

“Aye. I might at that.” I sigh, and then I’m angry with mysel’ because I’m feeling low and should be having a good time at the fair. ‘Let’s get a bite to eat,” I say, “and we can sit on the wall at the back o’ the well.”

William and Robbie have been waiting for us and now they say they’re off to see who’s put theirsels up for hire, so Mary and me and the bairns buy some bridies and small beer, and we sit close up tight together to keep oursels warm because there’s a smirr of damp in the air.

***

The garron’s frisky, because she’s been with too much company of her own kind William says, and the track by the river is slippy with fallen leaves, but William gets us home safe. After the bairns are in their bed by the fire – Willie’s still holding the wooden horse his Da has bought him – he pulls out a half-mutchkin that he’s been keeping in his jacket, though I’d smelled already he’d had a drap or two when he was off with Robbie.

“‘Twas a good day, Jan, was it no’? And now ye’ll tak a wee dram with me,” he says, “for likely you’ll be needing some cheer.” I can see he wants me to do it, so I swallow a mouthful or two though I know where it’s from and it’ll burn my throat. But it will dull the pain, the terrible forcing pain. I know  he’ll be at me soon. When he pushes me into our room, and I cannae help myse’ screaming with the splitting of it, I can still think that tomorrow he’ll be pleased with me even if his heid is sore.

 ———————–

 Back in January Willie said he’d be going to the March hiring fair because he’d be 12 years old and he wants to be out working on the farms like his Da.

But William has already decided that the lad shall be prenticed to Weightman in Glencorse to learn the blacksmithing trade, because like his Da Willie has a way with horses. Weightman will take him on with free board and victuals – so we’ll have one less mouth to feed. Willie will find it hard at first but then he’ll be glad to be away. Mollie Weightman’s a decent woman.

I’m carrying again and this time I can scarce drag mysel’ about the place and young Willie keeps away from me, he hates to see his Mam like this. I hate to see mysel’! I cannae do my ane work let alone work in the fields. Not that there’s much work this time o’ year for the women, onie road.

Johnnie is a sickly lad, he helps when he can, but I wish he’d got more of his brother’s spirit. He came back from school with a book his teacher had lent him with pictures of animals and said he was going to catch taddies to watch them grow into puddocks. What use is that? He’s ten, he’ll need to be out helping on the farm this spring.

I can scarce walk and I can scarce sit. The bairn is kicking inside me and I know it’s not growing right, it’s not sitting right, I cannae get comfortable, my insides are not right and the pain in my back hurts that bad that …

William says it must be a heavy bairn and weighing me down because I’m getting shorter, he says. And now it’s March and he’s out with the new plough all the hours of daylight – and when he comes in I can see it angers him that I’m too tired and I can’t hide from him how I hurt. He gave me a skelp on the cheek when I couldnae lift the pan. I’m frightened that this time the bairn will be the death o’ me.

 ***

Johnnie left the puddocks’ jar in the sun and they got boiled and stank. He’s chucked them away and we cannae tell Da, he says. He’s skeered of his Da, and I dare not tell him I’m skeered too. We’re outside, listening because the cuckoos have come back, and I’m holding the doorframe because the pains are getting worse.

I cannae keep quiet, and Johnnie says he’ll fetch me some primroses because they’re bonny now and will make me happy, but I tell him to run and fetch Agnes instead because she’s closer and will be more use. I’m holding up my belly with both hands and I go to lie on the bed.

When Agnes comes I say to her, “Tell Robbie to go to Penicuik and ask for Dr Renton to come. But he must tell him I cannae pay …”

“Ye cannae ask him that! He’s far too grand.” Aggie’s eyes are round and she grabs my hand. “I’ll go for Ma Jackson.”

No! Not after what she did last time. I’ve thought it all out, Aggie -,” I stop to catch my breath, ” – I heard that the doctor has a special interest in women’s problems. Robbie can tell him …” But no, Robbie cannae tell him.

And Dr Renton comes. I cannae ask him why because I can scarce speak even to thank him. I hear him shout at William to look after his horse, and he gets Aggie to bring cloths and hot water. He shouts at the others, but he is quiet with me, and I think he has a sharp face but his voice is soft …

I think I died. They said later they’d looked out my death-clothes. Dr Renton looked half-dead hissel’ they said, they said he was on for hours. “There was that much blood,” Aggie whispered and she looked right shocked.

William said he’d offered him a dram but the doctor had given him a dram from his own wee flask which was more to his liking. William said he’d look after his horses anytime if he needed help, or Willie would when he was trained. But the doctor told him (Aggie said, because she was washing the cloths and could hear what was being said) that I was never to have another bairn and William should make sure I didn’t. “He tell’t William three times,” Aggie said. “He wasnae skeered at all.”

I came back to life, and oftentimes after I wished I hadn’t.

 * * *

 The years go by, the lads grow tall. William has a new Clydesdale mare to help with the ploughing. “She’s quieting Davey down, the old de’il.”

Johnnie’s started helping with the cows; Mr Alexander’s getting some of the new Ayrshires, he says, they make more milk than the black Galloways. He’s proud that he can show off what he’s learnt (he forgets my own Da was a farmer).

 * * *

 I have never seen William in such a state.

“Davey! Davey has -” He cannae speak, he looks wild, and I cannae understand at first what he’s saying. “It was one of Alexander’s bairns – his grandson. I was walking them back to the yard with the harrow and the bairn came running out and Davey – he jist reared up and his feet were flying. He knocked the bairn down, Jan. His heid was cracked open.’

He comes near to the bed and I try to sit up.

“Sit here. Tell me,” I say. I want to hold him though he keeps away from me now.

But this time he sits, and he’s so much bigger than me that I have to look up at his face and there’s such a horror there at what he’s seen.

“Will the boy live?”

“They’ve called for Dr Renton on account of he knows how to mend sailors’ cracked heids. But Mr Alexander is going to have Davey shot.”

He starts to cry, and though he stinks of spirits and I know it is the whisky talkin’, I hold his arm and then he lies down. Soon he is on top of me. Later I am certain sure I have been cracked open, too.

 * * *

 It was John’s 12th birthday yesterday, January 27th. It seems this new bairn inside of me wishes for a January birthday too, the pains have begun again. After our Johnnie was born, William was gone away for several days, and I was that angry I took the bairn to the church myself and had them write “Hyslop” as his name.

William cannae bear to be near me now, he sleeps by the fire. I cannae move, I lie here on the bed. I stink, and I know that this time I will die. If they would shoot me like they did Davey…

William goes for Dr Renton, and when the doctor comes he sends William out and he jist stares and stares. He is quiet with me, and then he tells me it might be possible to save the child, but that he cannot do it himself, he will need to send to Edinburgh for help. For a Mr John Bell, he says.

“He’s the most skilful surgeon in Edinburgh,” he says, “He will be interested in your case and will do his very best to save you, Mrs Anderson, and your child. I will send for him at once and I can assure you and Anderson there will be no fee.”

I don’t believe him, and as he leaves I hear him speak angrily, it must be to William, because he says, “How could you do this to her after what I said last time? You’re a bloody fool, you deserve to be gelded. You should be locked away for what you’ve done.”

And so the surgeons, there are two, they are brothers, come down from Edinburgh in their fine clothes and they talk about me and do things, and the room is full of men. Men who are interested in birthings. The older one has a case of knives, they are going to cut my baby out. I wish they would shoot me first.

Mr Renton comes round to look at my face and he says, “It should not hurt too much, not nearly as much as giving birth, not nearly as bad as last time. But there is a grave risk to you …”

“Jist get the bairn oot. I want an end to it.”

I think it didnae take long but I think I died again.

Then there is a time when I hear a wee bairn, a live wee bairn, and a man says his name is “Caesar”. The men are holding my belly tight.  I think Mary is there too, it’s her that’s crying, and I try to say “Caesar Hyslop”, but my mouth is choked, so likely she cannae hear.

(See also Christine De Luca’s poem ‘Da Seevent Bairn’)

CHARLES BELL’S STORY

charles bell
Charles Bell

“Marion, the ambition of your young brother knows no bounds, we must send him back to Ayr for a dose of cold seawater!”

“Dearest, he has been working with you since he was fifteen so he has had an able mentor.”

My wife loves and humours her brother, as do I, for not only is he a dear companion but he works assiduously to improve our School’s collection. He has just informed us over dinner that he intends to become not only the greatest expert on diseases that affect the spine, but also on how to cure them.

Marion is familiar with the ease with which we medical men can so readily forget ourselves as to discuss matters concerning the body when in genteel company, but John has already made me aware that he wishes to discuss the parts of the collection that exemplify Mollities Osseum; and there is one specimen in particular whose history is not for feminine ears.

“It is one of the female skeletons you brought from Edinburgh,” he tells me before dinner, ” ‘A skeleton of great value’, is written in the catalogue in your own hand. I sense there is a story there.”

Instead, we discuss our forthcoming trip to France, and the plans for the new Medical School at the Middlesex Hospital, and the news from Edinburgh, and other matters of more frivolous nature.ospital

When John and I retire to my study after dinner, I take down the volume of the Medical Chirurgical Transactions for 1813, and find the page.

“You shall read this in a few minutes,” I tell him, “but first I will remind myself of the details before I tell you about the skeleton. You can entertain yourself by sitting quietly until I am done, and puzzling why a paper on the muscularity of the uterus – which Mr William Hunter himself would have been interested to read, were he still alive – could possibly be of any relevance to the story.”

It is fifteen years since I acquired the skeleton, but when I wrote this paper two years ago so many of preceding details came back to mind.

“ON THE MUSCULARITY OF THE UTERUS, BY CHARLES BELL, ESQ. FRS.Ed; AND TEACHER OF ANATOMY IN GREAT WINDMILL STREET.

“As midwifery makes no part of my occupations, I intend, in this paper, to confine my attention to the anatomical structure of the womb … I have dissected the gravid uterus in all conditions – in women who, in consequence of fever, have died undelivered; in women who had died from flooding; and in women who had died in consequence of distortion of the bones: I have had two opportunities of examining the uterus ruptured by its spontaneous activity; and one in which the uterus had been ruptured by violence; and I have examined the state of the uterus after death in consequence of the Caesarian section.”

I turn the pages to the next section of relevance, noting in passing mentions of Hunter and of Ruysch. I covet the position of Professor of Anatomy that Hunter held at the Royal Academy, for I am more of an artist than he; although he was the more accomplished midwife and accoucheur.

I skim quickly over the pages to find the relevant section.

Muscular Action of the Uterus considered in the Case of Caesarean Section.

While in partnership with my brother, Mr John Bell, an occasion occurred which made the performing of this operation an absolute duty. As the description of what occurred during the operation, and the appearances which were presented on dissection, may not be without interest to some here; and as they have a direct connection with my subject; I shall take the liberty of stating them.

In proceeding to examine this woman as she lay with her back towards me, I was surprised to find a large smooth tumour betwixt the thighs, which I could not readily recognize as the abdominal walls, thus strangely distended and pendulous. In this position of the pregnant uterus, with its fundus hanging down, we discover one consequence of great distortion in the pelvis, and an insuperable difficulty in the way of the operation of embryulcia, since the child’s head does not present to the opening of the pelvis and cannot be felt per vaginam.

My assigned station in this operation was to raise the tumour of the belly … Mr John Bell, with his characteristic neatness, made the incision. When the integuments and muscles were cut through, I moved my hands, which were spread upon the belly of the woman, so as to make the walls of the abdomen glide on the smooth surface of the uterus. …. I was convinced that the incision must be through the larger blood-vessels, and I already despaired of the woman’s recovery.

Mr Renton, Surgeon of Penicuik, (who had, in a manner deserving the highest praise, delivered the woman on former occasions with the crotchet, in very difficult circumstances) was prepared to break the membranes; to pass his naked arm into the uterus; to seize the child by the feet; and deliver it.

This was done rapidly and dextrously: the child was delivered safely and is now alive.

The instant the operation was performed, the mother was seized with violent vomiting; and now it required all my strength to compress the abdomen, and retain the parts against the operation of the diaphragm and abdominal muscles. For twenty minutes I continued pressing the belly, and compressing the uterus betwixt my hands. The wound of the integument was was dressed; stitches were introduced, and the intervals strengthened by adhesive straps; compresses were put on the abdomen, and the belly swathed.

But that happened which I foresaw would be the consequence of ceasing to compress the uterus: the woman became more faint, and at last insensible; she lived only to the gratification of her wish, to become, at all hazards, the mother of a living child.”

Ah yes, Renton, at Penicuik. That was it. I pass the article to John and show him the pages of relevance.

He reads slowly, but when he stops he puts down the journal.

“Is it really so, that her child still survives?”

“Aye. A boy, John. ‘Caesar’,  “pluck’d from his mother’s womb”  in the first month of the century. My brother John wrote to enquire of Renton some time back, who told him the boy is yet alive and does well, which does not surprise me because Renton, and now, it seems, one of his sons who followed him into the profession, keeps a keen eye on the boy’s progress.”

“A boy of great value.”

“Aye.”

“And his mother continues to be valuable too, poor woman. Although the family will never, I hope, know that?”

He raises an eyebrow questioningly, and there it is, the same expression that I see so often on my wife Marion’s face when she is in the mood to challenge me, and I laugh aloud. But he frowns, for his question was serious, as is he, and I respond by pointing to the journal.

“The description of the postmortem examination of her uterus is written there too. The husband, and her brother’s family, knew we would examine her further before she was given up for burial. They knew it because it was, let us say – understood – that we did not require a fee. Consider, John – we were summoned from Edinburgh at a half-day’s notice, my brother was acknowledged as the best surgeon in Edinburgh, even, I have to admit to myself, throughout Scotland. Her’s was a unique case.”

“But it was not her womb that was of greatest interest to you. We both know that.”

“Renton sent a note to Edinburgh with her history, he had become interested in obstetrics – ask not why a former navy man should choose this subject for his expertise –  and he’d attempted to deliver her on previous occasions. But he wrote that delivery, in any form, through the pelvis was no longer an option and that my brother was the only surgeon who had any hope of delivering the child. As for the woman’s history, you only need to look at her skeleton to see she had puerperal softening of the bones. When I dissected her afterwards the knife slipped into the bones as though into butter. Think of it, John – for years, she must have had incessant pain in the bones, phosphate of lime in the urine.”

“She must once have been a tall woman judging by the length of the femur. But then her spine is increasingly compressed upon itself, her pelvis collapsing, her sacrum curled inwards. Her husband made her pregnant seven times and she spent the last couple of years of her life lying in bed.” I realise that my voice is too loud and speak more quietly. “Have you seen the narrowness of the pelvis? I can tell you that a ball of an inch diameter cannot pass through it.”

Another young man might have made a lewd remark, but my brother-in-law has a different type of imagination; he is quite still, staring out at the tops of the trees in Soho Square. There is a clatter of wheels and horses’ hooves on the cobbles below. He sighs and frowns and taps the book on his lap.

“There comes a moment, Charles, does there not? We are endeavouring with our utmost energy and desire to preserve the patient’s life, to grant them more time upon this earth … it is our greatest commitment and surely the reason why we enter the medical profession?”

He starts to his feet and paces round the room, clutching the bound volume to his chest. His young man’s anxiety, and his accent, come out in his agitation.

“Oh, I know we have talked about this before, but I still cannae understand how – in that very moment – we switch from being intent on healing a life, to being men who .. who look at a corpse with acquisitiveness and, yes, even excitement at the prospect of acquisition. How can we reconcile these two opposites within ourselves?”

He leans his head against the window and looks down into the square.

“We must, John, or we cannot make progress in our understanding of the way the body works. And if we cannot understand, how can we hope to prevent or cure? These are such old arguments, John. And in the end, we must each find our own means of keeping one foot on each of the bifurcating paths.”

He turns away from the window but cannot look me in the eye.

“And so you took the path that led to her grave? Did you pay for her mort-cloth and her stone too?”

CAESAR’S STORY

 “Ssssh! Tom, watch those sticks!”

I’m on tippy-toe, bending my knees. Isobel said to keep down and my heid is tucked intae ma chin like a urchin.

Izzie’s giggling and she clams a hand ower her mouth.

“What if they see us?” Tom whispers and I can tell he’s skeered, so I jist say, “Izzie and me’ll run and leave you for their dogs an’ they’ll rip ye to pieces while we get awa’.”

There’s brambles and stingers and there’s sudden noise like “tchtchtchtch’   that makes me jump but it’s ony a squirrel.

Then we see it, the Big Tree. Auntie Mary says its name’s a Silver Fir and it’s famous everywhere – I asked if everyone in the world knew about it but she said mebbe not –  ‘cos it’s so big.

We spy around for the ghillie and the dogs but there’s naebody there and we creep up and stand underneath the tree, and there’s wee brown needles that make the ground soft.

“Caesar, you hold my hand and Tom you hold Caesar’s,” Izzie says and she pulls me so that we go round the bottom of the tree. “Tom, see if you can reach round to me.”

We press oursels against the tree and Izzy has her arm out trying to reach Tom and he’s reaching for her too. Or so I think ‘cos I can’t see because he’s the other side and my face is against the bark and it’s all rough an’ sticky.

“Come on Tom, stretch!” Izzy’s saying, and then Tom shouts out that he can feel her fingers, but she says he cannae, it’s likely a slug.

“Let me go on the end where Tom is,” I tell her. “I’ll reach ye.”

And she lets go of my hand that quick that I yell out, and then I cannae reach her at all ‘cos she’s run round to Tom’s side.

Tom says he can hear a dog and so we run, and Tom falls over and I grab him, and we climb over the wall and then go down to the river to throw sticks on the ice.

I tell Izzy that we’ll ask Miss Davies for a rule and measure our arms and that’ll tell us how big the Big Tree is round the bottom but she jist says I want to sook up to the teacher ‘cos I love her, so I thump her.

Then we see John, he’s my big brother but he doesn’t stay at my Auntie Mary’s, he stays ower near Kirkhill but he works for Mr Alexander here all the same. He’s eighteen and he’s the cowman and he’s got a black-and-white dog, Meg who comes up to have her heid petted though she’s got cow-shit on her fur.

“Hello, wee scallion,” he says to me and he rubs my heid as though I’m a dog too and I hit his hand. “You take care on the ice, now, it’s no’ thick enough yet. I jist saw the young doctor back the way and he was talkin’ about the season’s curlin’ and hopin’ for a big freeze. He was askin’ after you, Caesar, and I tell’t him ye was jist as daft as ivver.”

“Ye didnae!”

“Nae, I didnae,” John laughs, “or he’d be ower here wantin’ to look intae yer heid. But ye’ll be glad to know that you’re an uncle now. Uncle Caesar, eh! How do you fancy that? Willie and Jean have got a wee daughter.”

“I’m an uncle!” I pull a face at Izzie and Tom and I waggle my shoulders a bit and stand up tall. “I’m important! Like Uncle Gordie.”

John’s still laughing. “Come on then, ye big chiel. I’m going to drop in on Auntie Mary to tell her the news and then ye can all help me feed the coos if ye’ve a mind.”

Izzy doesnae like coos, she says, and she’s away off hame, so Tom goes too.

 ***

 John tells Auntie Mary and Uncle Gordie that Willie and Jean are going to call the baby Janet after Mam, and they say that’s guid but I can see Auntie Mary is sad too.

“It’s a shame that neither your Da nor your Mam are still here to know they have a grand-chiel,” she says.

“Aye well,” John says and he sort of shrugs.

I didnae see my Da, I’ve always stayed with my Auntie Mary. And I never knew my Mam, they said she died when I was born. My Da died aboot then too, he was found deid in the snow, I think he kill’t hissel’, but  I’m no’ supposed to know and naebody’ll tell me if I ask. They havenae tell’t me where he’s buried, but Auntie Mary took me to the churchyard where my Mam is, near Willie’s. Willie has a new house, he works in the paper-mill He used to work with horses but he gave that up, the money was nae good he said.. We went in the summer, and we went in big gates and past a big house. We went in the church looking for a book because Auntie Mary wanted to show me my name, but it was cold, and then we looked for Mam’s stone and I left some flowers Auntie Mary’d made me pick. It didnae have Mam’s name on it, but Auntie Mary said it was her stone, any road, that’s where she was buried.

Margaret, she’s like my sister but she’s Auntie Mary’s daughter and she works in the wash-house up at the farm, she says she wants to go to Glencorse and see wee Janet. John says that Willie tell’t him there was smallpox no’ far away at Loanheid, but Uncle Gordie says it’s of no account ‘cos the old doctor vaccinated us and we’re all safe.

“Am I safe too?” I ask, and I don’t know why they all laugh.

“Aye, Caesar, you were one o’ the first to get the jag, you were no’ much more than a year old,” Uncle Gordie says. “Doctor Robert and young Doctor John, they’ll look out for ye. But don’t let it go to your heid!”

 March 2011

 

Notes:

Janet (Jean) Hyslope was recorded as being buried on February 10th 1800 at Penicuik

‘Janet Hyslop’: exists only as a “skeleton showing mellites osseum (puerperal osteomalacia), in the Charles Bell Collection at the Surgeons’ Hall Museum, specimen BC.I.3.M.25

 Her name, (Jean or Janet Hyslop) and that of her son (Caesar) were discovered and other important details recorded in the excellent paper by Kaufmann & Jaffe (see Bibliography)

Additional archival research from Old Parish Records was carried out for me by the wonderful archival detective, Anne Carroll, from the Perth Library, thus:

1786, Penicuik: ‘Anderson William, son of William Anderson and Janet Hyslop his spouse, born 28th March  bap‘d 9th April wits James Kemp J Lowrie’

1788 Glencorse: ‘John Hyslop (‘Anderson’ has been added by a different, less ‘educated’ hand). William Anderson & Janet Hyslop his spouse, residens in Old Woodhouselee had a son born 27th January and baptised February 10th called John’

1800 Glencorse: ‘Hislop Caesar Anderson. Hislop Caesar, son of William Anderson and Janet Hislop his spouse was born Wednesday 29 January and baptised on Sunday 2nd February 1800′

My thanks again to Anne Carroll who also found the account of Mr Renton (probably Robert) vaccinating residents of Penicuik against smallpox: Caesar Hislop Anderson (“who was brought to the world by the Caesarian operation”) is one of those who were inoculated with the cowpox. (Edinburgh Magazine, 1801, vol 18)

Bibliography:

MH Kaufman & SM Jaffe 1994, An early Caesarean operation (1800) performed by John and Charles Bell. J R Coll Surg Edin 39, 70-75

Charles Bell, 1813. On the muscularity of the uterus. Med Chirurg. Trans 4, 338-360

G Gordon-Taylor, 1954. The life and times of Charles Bell.  Annals of the RCSE

John Wilson, 1891. The annals of Penicuik, being a history of the parish and village.

Some information about the Penicuik and Woodhouselee areas during that period was also gleaned from the relevant chapters of the First Statistical Account of Scotland (1791-1798),  and the ‘New’ Statistical Account (1834-45)

Additional notes:

Sir Charles Bell (1774-1842) Moved from Edinburgh to London in 1804, and with his brother John took over the Great Windmill Street Anatomy School (started by William Hunter) from 1812-1825. Married Marion Shaw.

The major part of his anatomical collection was sold to RCS Edinburgh in 1825, the sale overseen by Dr Robert Knox; Janet Hislop’s skeleton thus returned to the country of her birth.

Dr John Renton, keen curler, and ‘active in all matters relating to the good of the village and the welfare of its people’: the ‘Good Doctor’ retired in 1839 and moved to Edinburgh where he died in 1865. (Various pieces of information gleaned from eg British Medical Journals for that period)

John Shaw (1792–1827), surgeon and anatomist. At the Great Windmill Street Anatomy School he acted as superintendent of the dissecting-room, The greater part of the experiments which led to Bell’s discoveries on the nervous system were performed by Shaw, and he also took a large share in the work of forming Bell’s anatomical museum.