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November 08, 2007

Druin Burch's life of Astley Cooper is intelligent, compassionate and lively yet it is unsatisfying - David Wootton explains why and draws conclusions for history writing in general: Digging Up the Dead - Druin Burch

Posted by David Wootton

Digging Up the Dead: Uncovering the Life and Times of an Extraordinary Surgeon
by Druin Burch
London: Chatto and Windus, 2007
Hardback, 20

Druin Burch has written a remarkable first book. It is a gripping account of the life of Astley Cooper (1768-1841), the most successful surgeon in England in the first half of the nineteenth century. The Cooper story involves grave-robbing and vivisection, not to mention the blood and gore of operations before anaesthesia, when speed was of the essence.

But Burch's book is also a meditation on what it means to be a doctor. Here history and Burch's own experiences are intertwined. One of Burch's achievements is to show that John Keats the poet, who worked under Astley, gave up a medical career not because he was unable to qualify, but because he decided not to practise - this is the first account of Keats as a medical practitioner written by someone who understands the medical profession of the day. Keats's choice haunts this book.

This is the best introduction I know to surgery before anaesthetics (1846), antiseptics (1867), and blood transfusions (1914), when death rates were high, and surgeons had to be able to operate under the worst of conditions - their patients writhing and screaming, and the slightest slip likely to prove fatal.

Burch seems slightly puzzled by Astley's daily routine of dissections (some on animals, but, for Astley's career predated the Anatomy Act of 1829, many on bodies stolen from graves) and vivisections. Astley wrote:

If I laid my head upon my pillow at night without having dissected something in the day, I should think I had lost that day.
He was a pupil of the great anatomist John Hunter, and part of his purpose was to improve the knowledge of anatomy and surgical technique: he published on the thymus gland, hernias, and the anatomy and surgery of the breast. But much of this work was the equivalent of a professional musician playing scales or running through a piece of music in private - the goal was to maintain and develop the dexterity required to operate successfully.

Astley arranged for his nephew and later biographer Brandon Cooper to take on a post at Guy's on his retirement, despite the fact that there were doubts about his competence. A scandal soon broke out when Brandon allowed an operation, which should have lasted a few minutes, to drag out for an hour: the patient died shortly afterwards. Brandon, one feels sure, did not make dissection a daily routine.

This book has every good quality one might think one wanted: learning, intelligence, compassion, liveliness, a vigorous prose. It also has a wonderful and entirely unexpected chapter on the French revolution. It has been deservedly well-received. And yet I found myself engaged in a peculiar internal struggle as I read it, and I still don't know quite what I think of it.

Part of the answer is that it is difficult to know how to judge Astley's achievements, which were necessarily, for all his heroic efforts, very limited. How can one weigh the desecration of the dead and the injuries inflicted on living animals against Astley's remarkable success in operations for bladder stone (only one in eight of his patients died)? There was only so much that anatomical knowledge and dexterity could achieve in the absence of anaesthetics and antiseptics. Part of the answer is that Burch himself doesn't quite know if he wants to be a doctor, or to follow the example of Keats.

But this doesn't quite explain the profound sense of unease that this book left in this reader at least. Thinking about this, I've come to the conclusion that I am far more in agreement with Hayden White than I had imagined possible: White's views are laid out with admirable clarity by Vicki Rea here: http://www.lehigh.edu/~ineng/syll/syll-metahistory.html

At the heart of White's approach (which is inspired, I assume, by Northrop Frye) is the belief that, whether they like it or not, historians tend to write stories that conform to the four basic plot structures: romance, satire, comedy, and tragedy. Great historians work with the generic limitations of prose narrative; everyday historians constantly trip over them. According to White's theory, if a history is to be successful, it must be clear to the reader that it belongs predominantly to one or other of these four genres. White's complex and sophisticated argument can be summarised in a single short sentence: History is inescapably an art.

Now it is a simple fact that in history departments we don't teach students how to conform to generic expectations. Most history, I fear, seems rather muddied and muddled because it fails to conform to these expectations. I am, alas, as guilty in this respect as most of my colleagues.

But Burch provides a particularly striking illustration of the relevance of White's argument. For Burch's book is generically confusing for the reader; and this is because its author has tried to avoid choosing between two genres. On the one hand his book is a tragedy: so many people killed, so much suffering inflicted, so many bodies desecrated, and all to satisfy the vanity of one ambitious doctor. On the other hand it is a romance: such valiant and resourceful struggles for new knowledge, so many obstacles overcome, and in the end better surgery than the world had ever seen before.

At this point I hear you muttering against White and against me. The real world, you want to say, is complex, not simple. The life of Astley Cooper may indeed combine contradictory elements. And of course this is true. But when we read we want the story to make sense; and when we want it to make sense we want it to conform to a generic stereotype. This is not because the real world conforms to these stereotypes; it is because we as readers rely on these stereotypes to make sense of the world.

In my view Burch's book would have been a more satisfying read if it had been more obviously either a tragedy or a romance. It would not have been a better argued book, but the reader would have known where they stood. I understand Burch's desire to avoid choosing between the two genres; but as a reader I deplore it.

Readers have had all sorts of difficulties with my own recent book, Bad Medicine. (I should declare an interest here: Burch gave it a very favourable review in the TLS, so I am in his debt). One of the problems with Bad Medicine is that the book defies the reader's expectations: it is first tragedy; then satire; then romance; then comedy. Until 1865, doctors killed their patients - tragedy; between 1450 and 1850 they claimed they were making progress, but nothing was happening - satire; after 1865 there was remarkable progress; but even this progress didn't amount to much - comedy. These twists and turns puzzled some readers (even though there is a certain generic simplicity to the book's structure).

I'm told that in one forthcoming review the reviewer finds the final twist an insult to his intelligence. If he was bright enough, he would have realised that it was not his intellect that found my argument problematic, but his sense of generic appropriateness. How could an author unpick an argument he had just laboriously constructed? Or rather, how could he offer romance, and then callously substitute comedy? Unless, of course, he is Shakespeare.

If Burch is going to follow Keats, he will have to give more thought to these questions of genre. And so will I. I'm trying to write a biography at the moment. Is it a comedy, a romance, a satire, or a tragedy? The answer is not obvious, but Hayden White may have a point: perhaps it needs to be. It should be said though that White's preoccupation with generic conformity may (for all that he is a leading postmodernist) prove somewhat old-fashioned. In a postmodern world genre bending may become the norm.

David Wootton is Anniversary Professor of History, University of York. He is the author of Bad Medicine: Doctors Doing Harm Since Hippocrates.


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