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Digging up the Dead: Uncovering the Life and Times of an Extraordinary Surgeon. Druin Burch. Chatto and Windus, pp 276, Â£20 . ISBN 978-0701179854. Rating: ****.
A sparkling book on the great 19th century surgeon Sir Astley Cooper should prompt us to re-examine medicine and medical education in the 21st century, says Roger Jones
In his pomp—for pomp it was—the Guy's Hospital surgeon Astley Paston Cooper was the highest paid doctor in England, with an annual income in 1815 equivalent to over Â£1m today. Cooper walked with kings (and embalmed William IV) but also, famously, rode out one freezing Christmas Day at the request of the revolutionary John Thelwall to visit a friend dying in poverty. In the empirical tradition of William Harvey and William Hunter, Cooper was the pre-eminent surgical anatomist and clinical teacher of his day. He lectured to theatres packed with fee paying medical students in the Borough hospitals of Guy's and St Thomas's, where he also taught John Keats. Cooper's lecture notes formed the core of the earliest editions of the Lancet. He was a relentless dissector and vivisectionist, relying on the ghoulish work of the “resurrection men” (body snatchers) to provide his human material. He was also supplied with specimens from London Zoo and once dissected an entire elephant in front of his house.
Cooper was the father of vascular surgery and made pioneering contributions to the treatment of hernias and the surgery of the breast. His body was placed in a lead lined coffin to protect him from the resurrection men and interred in the crypt of the chapel at Guy's in 1841. I sometimes park my car only a few metres from Cooper's mortal remains and am sure that, if not actually turning in his grave, he is moving uncomfortably to try to get a better look at what is happening to medicine in the 21st century.
Cooper is likely to be surprised by the large number of medical students that we now admit each year and by the heterogeneity of the student body. He might well see these large numbers as a commercial opportunity: the fees paid by students to attend his lectures at Guy's were a major source of income in his early career. He fell out with Thomas Wakley, the founding editor of the Lancet, because Wakley stole his lectures and, by publishing them, reduced the need for students to attend (and pay for) the lectures. Cooper stormed round to Wakley's house to remonstrate with him, posing as a patient to gain entrance. Striding into Wakley's study, Cooper found him correcting the proofs of one of his very own lectures. The element of farce was not lost on either man—both burst into laughter and became firm friends. Cooper would have been disappointed to see how “walking the wards” and the traditional medical firm structures have been eroded and would probably share a widely held concern about the effectiveness of pastoral care systems in medical schools and universities.
Cooper would also have been concerned to see the gradual replacement of cadaveric dissection with prosection and three dimensional electronic images. Dexterity, precision, and detailed anatomical knowledge were, in an era without antibiotics and anaesthesia, prerequisites for safe and swift surgery and, in Cooper's view, could be acquired only through relentless dissection. The Anatomy Act of 1832, passed shortly before Cooper's death, put an end to the lucrative activities of the body snatchers but made dissection the legal fate of the poor—if no one claimed your body, or you were too poor to pay for a funeral, you were sent to the surgeons.
Finally, Cooper would undoubtedly have been horrified by the medical training application service (MTAS), though for reasons different from those that have led to two unprecedented parliamentary apologies. MTAS is designed to simplify applications for medical training posts and to promote equity and selection on merit; Cooper, however, was a great believer in patronage and nepotism. When the governors of the Borough hospitals refused to appoint his nephew and biographer, Bransby Cooper, to succeed him as senior surgeon at Guy's, the ensuing row led to a split between the two institutions, which persisted until the 1982 re-merger.
Burch's book has many vivid and gripping accounts of a truly extraordinary man living in extraordinary times. Comparisons with today's medical leadership are inevitable; Cooper is such a compelling role model, and leaders of his stature are now few and far between. Burch's lucid writing, with more than a little of the Jan Morris about it, is often tinged with the ghoulish and gruesome but is equally leavened by humour and sympathy. The book falls short of a panegyric—Cooper had his faults—and succeeds brilliantly in bringing him to life against the heady background of early 19th century London medicine and late Georgian society.
Digging up the Dead: Uncovering the Life and Times of an Extraordinary Surgeon
Chatto and Windus, pp 276, Â£20