Sunday, 18 September 2016

"Let me have your wife's head and I will give you a pound." How a tooth extraction which went wrong led to a strange dispute between the surgeons of St. Thomas' Hospital and a sailor man.

Crude techniques could lead to serious complications in early 19th century dentistry 
Wednesday 3rd December 1817. Christopher Smith, wine merchant, former radical member of Parliament for St. Albans and the newly elected Lord Mayor of London took his seat as magistrate and judge in the Lord Mayor’s Court in Mansion House. The Lord Mayor had the powers of a magistrate but as few of them had any legal training or background the average Mayor, as a commentator in the Monthly Repository put it, had to “pretend to be a judge, by being the mouthpiece of certain dicta spoken in his ear as he sits, by a salaried lawyer, called a town clerk or city solicitor.” The writer went on to decry the farce by which the Lord Mayor’s were “as gilded speaking trumpets for the use of that legal oracle Mr. Hobler.” The formidable James Hobler, fluent in French, Spanish, German and Latin, noted for his wit and intellect, a "fine, tall, upright, powdered-headed gentleman of the old school, always neatly, though somewhat eccentrically dressed, in a closely buttoned-up black coat, drab breeches and gaiters” had been legal clerk to the Mayor for more years than anyone could remember and would remain in office until his death in 1843.   Successive Lord Mayors were ephemeral annuals briefly flowering in the presence of that hardy perennial Mr Hobler. Boz adroitly captured the atmosphere of mutual admiration that flourished between the Mayors and their clerk; "the Lord Mayor threw himself back in his chair, in a state of frantic delight at his own joke; every vein in Mr. Hobler's countenance was swollen with laughter partly at the Lord Mayor's facetiousness, but more at his own; the constables and police officers were (as in duty bound) in ecstasies at Mr. Hobler and the Lord Mayor combined; and the very paupers, glancing respectfully at the beadle's countenance, tried to smile, as even he relaxed." Whether Dickens was exaggerating can be judged from the scene that unfolded in the Mansion House on that Wednesday morning in December 1817.

Mr Hobler liked to be prepared and it was his habit to run through the list of applicants and litigants waiting to see the Mayor and carry out a preliminary interview before allowing them into the courtroom.  If Mr Hobler’s extensive experience led him to believe that there was not much in the way of wayward behaviour that he had not witnessed he was to be startled out of his complacency that morning.  A sailor, “a decent looking young man” according to more than one newspaper, presented himself in some agitation wishing to ask the Mayor to intervene with the surgeons of St Thomas Hospital. When Mr Hobler learnt the particulars of the case he could scarcely believe his ears. Once the initial astonishment had worn off Mr Hobler no doubt rubbed his hands together gleefully at the reaction the case would provoke in the new Lord Mayor. The sailor was ushered into the court and told to explain to his Lordship what assistance he required. 
“I would humbly request your Lordship to compel some hard hearted fellows in the Borough to surrender my mother’s head,” said the sailor.
“Your mother's head! For the love of God, is it separated from the body?” barked Sir Christopher.

Portrait of Mr Hobler
“Yes, my Lord, they cut away the head, and told me I might have the body if I pleased. Accordingly I took the body, but I can’t bear to think of leaving the head behind, and I hope your Lordship will see it delivered to me, “said the sailor, quite calmly.
“This is the most strange thing I ever heard of,” Sir Christopher muttered, almost to himself before turning to Mr Hobler and adding “For God’s sake, is the man serious in saying that his mother has lost her head ?”   
“The case is not without foundation my Lord” Mr Hobler said archly before explaining that the sailor’s mother had died some days before in St. Thomas’ Hospital.
“Ahhhh,” said the Mayor, the penny finally dropping, “then, it is of the surgeons of St. Thomas' you complain?”
“Yes, my Lord, of the butchers there. They are willing to let me do what I please with the body, but are determined to keep the head for themselves as a curiosity, for poor mother died of a toothache.”
“Of toothache?” said Sir Christopher, sensing a looming opportunity to exercise his wit and make Mr Hobler laugh, “This is still more extraordinary. I have certainly heard that the most effectual way of curing the toothache is by cutting off the head, but I never before heard that such a complaint would cause death.”  Mr. Hobler, displaying not the slightest sign of amusement and addressing the Mayor as though he were a half wit, began to laboriously explain to the explain the circumstances of the case.
“My Lord,” he said, “the young man means that his mother died in consequence of bungling attempts to extract a tooth, her gums were so lacerated by the operation that gangrene took hold and death soon followed. She was taken to St. Thomas’ Hospital, where the surgeons, no doubt finding that the case presented great novelty, asked for and obtained leave to examine the head.”

“I never had a notion of leaving any part of my mother in their hands!” interjected the sailor. He told Sir Christopher that he had had his mother’s body at home two days and it would stay there until the surgeons yielded up the missing head and he could bury her complete.    
“They certainly are not justified in detaining the head, and should have restored it to you after it had served their professional purposes,” Sir Christopher remarked.
“I suspect that the professional purposes of the surgeons will not be answered until the head is in pickle,” observed Mr Hobler.
“This is indeed a very indefensible practice; besides it will terrify the relatives of patients who die in the hospital, by giving them reason to suppose that when they are following the deceased to their graves they are following bodies without heads, or heads without bodies.” A medical man who happened to be present asked for leave to speak and when this was granted argued that in this situation the interests of science were paramount adding “for my part, if I was going off with a disorder little known to practitioners, I would not care into how many pieces I was cut for the benefit of science.”
“And yet,” said Mr Hobler to Sir Christopher “although it is the common talk of physicians, I never knew one of the profession who had any inclination to have his bones dangling in an anatomy-room, or his head in a bottle.”
“There may be cases of the kind which are concealed in consideration of the prejudices of the weaker sex,” said the physician mysteriously.
“l don't know how we can prosecute resurrection men for stealing dead bodies, if such practices are allowed. Something of this kind is more distressing to the feelings than a church-yard robbery!” said Sir Christopher, “Our habits are such that cannot endure the burial of a body piecemeal. Even in the field of battle we should endeavour to collect the mangled limbs of a friend before we could think of covering an atom of him with earth. At home, then, where the rites of sepulture are attended to scrupulously, it is barbarous to mangle a body and torture the feelings of a son by keeping the head of his mother for exhibition.”

The physician then began to argue the particulars of the case, making it clear in the process that he knew far more about it then anyone had hitherto suspected. He told that court that as a consequence of the gangrene the head had swollen to a “most enormous magnitude and was actually too large to be placed in the coffin with the body.”  He suggested that “the manner in which it might have been prudent to act, would have been to substitute the head of another body, which would be just as useful, at the same time that the imposition would he very excusable, and no detection could take place.” What the hospital would have done with the other headless body, he did not say. The Lord Mayor fulminated against this rather alarming proposal which had been put forward in the name of prudence. 
“The surgeons are highly reprehensible in detaining the head,” he said, “it is notorious that those disturbers of the dead called resurrection-men, who are in many cases robbers of the living, are in the habit of serving the hospital with subjects, and it would now appear as if the surgeons intended to vie with them in their trade against which the public has so great a horror.”
After a final plea from the sailor, who said that “I will go to the hospital, and stay there until my demand is agreed to, whatever reception I shall meet with, even if they were to take it into their heads to cut off my own,” the Lord Mayor ordered Cartwright the marshal to go with the sailor to St Thomas’ and demand the return of the head. i nan, attend the seaman to St. Thomas’s, and inquire the cause of the conduct complained of. An hour later Cartwright returned alone to report what had happened.  The surgeons had explained that the sailor’s father had sold the head to them for a pound. He said the poor son acknowledged he had been present when the bargain was made, but he abhorred the proposal of disposing of the head at any price. In order to satisfy the Lord Mayor that proper arrangement had been made about the head, the principal surgeon sent word that he would wait upon his Lordship the following morning. And there, as far as know, the matter ended.  

(This post is based extensively on an account entitled ‘Strange Case’ which appeared in many British newspapers during December 1817)

I originally thought this was a depiction of a dissection given that the lady on the table seems to be under little restraint for an operation being carried out before the introduction of anesthesia. The rather crude removal of the leg seems inappropriate for a dissection and entirely in keeping with the butchery of surgery. And then I noticed one of the medical gentleman holding the ladies hand, presumably to comfort her, which implies, despite her rather relaxed attitude to having her leg hacked off, that she is still alive.  

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