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The Elephant Man in the Room

It would appear that many people love ‘clinical writing’, a distinct genre that embraces doctors, diseases and patients. As a medic I tend to avoid this territory. Stories about medical practice lean either to the sententious (e.g. A. J. Cronin’s The Citadel) or the facetious (Richard Gordon’s Doctor in the House), while the current big sellers favour medical heroics in war zones or harrowing tales from that other front-line of combat, the NHS. Also, I don’t much care for the doctors who appear in novels. Who would employ Dr Tertius Lydgate, the idealistic young physician in Middlemarch, whose pro­fessional ambitions are so easily thwarted by the pretty, but shallow, Rosamund Vincy? And what about Dr Zhivago? Poet, lover and counter-revolutionary but, let’s face it, not much of a physician.

Having said all that, and invoking the exception that proves the rule, I am a fan of one medical book, The Elephant Man and Other Reminiscences, which was written by a splendid Victorian surgeon called Frederick Treves. Published in 1923, the year Treves died, it is a series of vignettes about curious patients and his surgical practice during the last decades of the nineteenth century. It includes, of course, the remarkable story of Joseph Merrick, the Elephant Man, and how Treves rescued this terribly deformed man and helped him to health and happiness. But there are eleven other wonderful stories in this volume, the whole collection forming a gloriously odd anthol­ogy of medical Victoriana.

In the 1880s Treves was a surgeon working at the London Hospital in Whitechapel (now the Royal London Hospital) and specializing in the new field of abdominal surgery which, at the time, was moving from being universally lethal to just highly dangerous. In 1888 he performed the first appendectomy in England and was thereafter in

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It would appear that many people love ‘clinical writing’, a distinct genre that embraces doctors, diseases and patients. As a medic I tend to avoid this territory. Stories about medical practice lean either to the sententious (e.g. A. J. Cronin’s The Citadel) or the facetious (Richard Gordon’s Doctor in the House), while the current big sellers favour medical heroics in war zones or harrowing tales from that other front-line of combat, the NHS. Also, I don’t much care for the doctors who appear in novels. Who would employ Dr Tertius Lydgate, the idealistic young physician in Middlemarch, whose pro­fessional ambitions are so easily thwarted by the pretty, but shallow, Rosamund Vincy? And what about Dr Zhivago? Poet, lover and counter-revolutionary but, let’s face it, not much of a physician.

Having said all that, and invoking the exception that proves the rule, I am a fan of one medical book, The Elephant Man and Other Reminiscences, which was written by a splendid Victorian surgeon called Frederick Treves. Published in 1923, the year Treves died, it is a series of vignettes about curious patients and his surgical practice during the last decades of the nineteenth century. It includes, of course, the remarkable story of Joseph Merrick, the Elephant Man, and how Treves rescued this terribly deformed man and helped him to health and happiness. But there are eleven other wonderful stories in this volume, the whole collection forming a gloriously odd anthol­ogy of medical Victoriana. In the 1880s Treves was a surgeon working at the London Hospital in Whitechapel (now the Royal London Hospital) and specializing in the new field of abdominal surgery which, at the time, was moving from being universally lethal to just highly dangerous. In 1888 he performed the first appendectomy in England and was thereafter in demand as the country’s leading abdominal surgeon. His surgical skill was needed in June 1902 when King Edward VII developed acute appendicitis two days before his coronation. The King was utterly opposed to an operation. Treves was insistent, famously stat­ing that if he was forbidden to operate there would be a royal funeral, not a coronation. The operation was duly performed on a table in the Music Room at Buckingham Palace and the following day Edward was well enough to sit up in bed and smoke a cigar. A grateful mon­arch elevated Treves to the Baronetcy. Treves wrote throughout his professional life, his early publica­tions being papers in medical journals and surgical textbooks. In 1900 he published The Tale of a Field Hospital, an account of his experiences as a combat surgeon in South Africa during the Boer War. This was hugely successful and spurred Treves to the ultimate act of surgical bravery: he retired. Treves maintained that a surgeon’s technical dexterity deteriorates after the age of 50, a truism which is sadly as ignored today as it was back then. Once he had given up his surgical practice he travelled the globe and wrote a series of books based on his adventures. The most charm­ing (but least glamorous) is his Highways and Byways of Dorset, in which he documented the villages, people and customs of his native county following a series of epic bicycle journeys. In recognition of this devotion to all things Dorset he was elected the first president of the Society of Dorset Men (the second being his great friend Thomas Hardy). While Treves’s travel books have long since been forgotten, The Elephant Man and Other Reminiscences continues to fascinate. It is a fabulous piece of medical writing in which doctors, patients and the practice of medicine are blended to produce a book rich in colour and texture.
What a strange company they are, these old patients who crowd into the surgeon’s memory after a lifetime of busy practice. There they stand, a confused, impersonal assembly, so illusive and indistinct as to be little more than shadows . . . However among the phantoms of the casebook are some who are remembered with a completeness which appears never to have grown dim.
Although Treves uses the clinical casebook format, the contin­gency of medical practice is offset by his psychological acuity. His stories are about patients as people: what interests him is the person behind the illness and the curious way diseases and disorders shape and misshape our lives. One story, ‘A Case of Nerves’, is recounted by the patient, a young married woman who is suffering from patho­logical anxiety. She talks about her morbid fears and in recording them Treves delivers a masterclass in the psychiatric and physical symptoms of depression. ‘The Idol with Hands of Clay’ is a caution­ary tale of an inexperienced but ambitious surgeon who is foolishly persuaded to operate on his young wife . . . To those of us who have been present at an operation which goes wrong, the nightmarish panic that follows is almost too horrible to bear. However, the gem in the collection is of course ‘The Elephant Man’, the story by which Treves achieved fame beyond medical cir­cles. It is the extraordinary tale – all entirely true – of Joseph Merrick, a young man hideously disfigured by congenital abnormalities, who at the time we first meet him is being exhibited as a freak in a travel­ling show. Most of us will know the story from the 1980 film in which Anthony Hopkins plays Treves, and John Hurt, unrecogniz­able in prosthetic make-up, is Joseph Merrick. Treves’s account begins in 1884 when the Elephant Man was being held captive by his ‘impresario’ in a deserted shop opposite the London Hospital. Frederick Treves managed to secure a private viewing:
The showman pulled back the curtain and revealed a bent fig­ure crouching on a stool and covered by a brown blanket . . . The most striking feature about him was his enormous and misshapen head. From the brow there projected a huge bony mass like a loaf, while from the back of the head hung a bag of spongy, fungous-looking skin, the surface of which was comparable to a cauliflower . . . The osseous growth on the forehead almost occluded one eye . . . From the upper jaw there pro­jected another mass of bone. It protruded from the mouth like a pink stump, turning the upper lip inside out and making of the mouth a mere slobbering aperture.
Poor Merrick – his deformities were horrifying, his existence unspeakably degrading. Following this first encounter Treves’s initial act was to spirit Merrick into the hospital for a clinical examination of his anatomical abnormalities, subsequently published in the British Medical Journal. Merrick was then released back to the ‘impresario’ and to his life on the road. Two years later, however, in Brussels, he was abandoned by his tormentor and placed on a boat back to London. He finally reached Liverpool Street station where, starved and mute, he was found in a state of collapse. Treves’s card was among his possessions and so he was duly shepherded to the London Hospital and into Treves’s custody. Treves arranged for Merrick to be admitted to a small room over­looking the yard where the hospital beds were stored, known as Bedstead Square. This room became his home for the rest of his life. Once he was installed and secure in the hospital’s care, Treves befriended him and, beneath the disfigurements, discovered an intelligent, affectionate man. The rehabilitation of Joseph Merrick is chronicled with wonder and tenderness, a transformation which is echoed in Treves’s own increasing astonishment as his patient is revealed to be a man supremely receptive to the beauty of life. Despite being abandoned as an infant, Merrick revered the mem­ory of his mother and was convinced of her beauty. He took to reading romantic novels and, in his imagination, cherished an emotional and idealized devotion to women. Alas the hospital nurses were unable to hide their revulsion and so Treves, recognizing the importance of feminine company, asked a young widow friend to pay Merrick a visit.
The effect upon poor Merrick was not quite what I had expected. As he let go her hand he bent his head on his knees and sobbed until I thought he would never cease. The interview was over. He told me afterwards that this was the first woman who had ever smiled at him, and the first woman, in the whole of his life, who had shaken hands with him.
Word spread of this remarkable young man and soon society peo­ple, including Princess Alexandra, began to visit Merrick in his room overlooking Bedstead Square. Treves documented his delight in this extraordinary transformation. ‘Merrick, I may say, was now one of the most contented creatures I have chanced to meet. More than once he said to me: “I am happy every hour of the day.”’ Treves was a devoted friend to Merrick and ensured that all was done to enrich his existence and mitigate the horrors of his previous life. But his health was fragile and in 1890 Merrick died from asphyxia at the age of 27. Treves, who performed the autopsy, suggested that his airway had been occluded by the weight of his head as he lay flat, a sleeping posture incompatible with his deformities.
He often said to me that he wished he could lie down to sleep ‘like other people’. I think on this last night he must, with some determination, have made the experiment. The pillow was soft. And the head, when placed on it, must have fallen backwards and caused a dislocation of the neck.
Following his death Merrick’s skeleton was displayed in the hospital’s museum until, in the 1980s, a group of medical students from St Bartholomew’s Hospital abducted him. Happily, Merrick was repatriated and on his return to the London his bones were carefully stored in the hospital’s pathology department where they remain. The hero of ‘The Elephant Man’, however, is not Treves or Joseph Merrick. It is the London Hospital. If there is a moral to this fable (a true fable) it is that in a civilized society there are institutions of refuge which exist to protect vulnerable people. The London Hospital has a long history of caring for East Enders, people who live in a socially disadvantaged part of the metropolis. In 1886 the hospital found a way to house Merrick and to nurture him. It is, I suppose, a version of The Hunchback of Notre Dame; the outcast who finds sanc­tuary in one of the city’s charitable foundations. I find this thought both reassuring and deeply moving.

Extract from Slightly Foxed Issue 72 © Daniel Creamer 2021


About the contributor

Daniel Creamer is a dermatologist at King’s College Hospital, London. During his training he worked at St Thomas’s, Guy’s, St Mary’s and St George’s hospitals in London, but never at the London Hospital.

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