This is one of my favourite stories from the book. Its also one of the goriest, the rest of the book isn't quite as bloody. The picture is from the original article - unfortunately it was never included in the book. So now the story has been mentioned in the NY Times seems good to publish it here.
On Saturday 9 April 1831, a year before the passage of the Anatomy Act, but a few months after the opening of the world’s first purpose-built passenger railway, a crowd of men in top hats and coat-tails showed their ‘hospital tickets’ and entered the operating theatre of Guy’s Hospital in London. Hundreds of others jostled on the street outside. An attempt had already been made by the hospital authorities to prevent a scrum by moving the date forward by three days, but the tight, gossiping community of London’s doctors had defeated the ruse.
The patient in question was a 32-year-old Chinese labourer called Hoo Loo, who had disembarked at the Royal Docks from a sailing ship, a so-called East Indiaman, with some difficulty three weeks previously. He was carrying an enormous tumour four feet in circumference, which hung from his lower abdomen, enveloping his penis, to below his knees. It was ‘of a nature and extent hitherto unseen in this country’. Although the size of Hoo Loo’s growth made it exceptional, lumps, boils and malignancies were often seen to disfigure the human form in the age before routine surgery. Hoo Loo’s had been growing for ten years, but his doctors in Canton had refused him treatment. Because it had continued to grow, he had travelled for six months to London in the belief that there the art of surgery was somewhat more advanced and that the profession would have no such qualms in operating on him. On arriving at Guy’s Hospital he must have been aware of the excitement, for as he lay waiting for the operation his days were interrupted by ‘a great number of persons of all ranks’ keen to examine this oriental curiosity.
Because of the swelling crowds, it was announced that the operation was to be held in the ‘Great Anatomical Theatre’. A ‘tremendous rush’ ensued as 680 gentlemen pushed their way into the auditorium. Fifteen minutes later, Hoo Loo was carried in and laid on the dissecting table, which was still stained black with blood from previous guests. Two nurses tied his limbs to the table so that he would not be able to flinch from pain – there being no such thing as anaesthesia then – and Hoo Loo looked on, seeming to contemplate the operation with a fortitude ‘never exceeded in the annals of surgery’. The nurses then covered his face so that he might not see the imminent procedure.
Then entered Sir Astley Cooper, the greatest physician of his day, renowned for helping to embalm the body of King George IV, for stealing a dog for the purpose of vivisection and for having boasted to a parliamentary committee of his close relationship with bodysnatchers. Having been reprimanded once for arriving at the royal chamber wearing a morning coat still covered in someone else’s viscera, he was probably similarly attired on the day of Hoo Loo’s operation. Together with the surgeon, Charles Key, he decided that the operation should attempt to preserve the genital organs.
Mr Key stationed himself in front of the tumour and made the first incision just below the right side of Hoo Loo’s abdomen. With barely a groan or a gasp from the patient, Key continued for six inches down the right-hand side of the penis and around the tumour. ‘The quality which is considered of the highest order in surgical operations, is self possession,’ Sir Cooper had once lectured. ‘The head must always direct the hand.’ Key repeated the manoeuvre on the patient’s left side, connecting the two cuts below the base of the penis. Then Key lifted the tumour up, and cut around the urethra. The audience was silent, craning to see and hear Hoo Loo. Cutting veins, Key reached for silk threads to tie them, possibly holding the bloodied scalpel in his teeth, as was the practice. The patient ‘firmly set his teeth and resignedly strung every nerve in obedience to the determination with which he had first submitted to the knife’. After each incision, Hoo Loo was given some time to recover from the ‘fits of exhaustion’, as without anaesthetic the trauma of the knife was often almost as dangerous as the cuts themselves. Then, with ‘great neatness’, Key attempted to cut around the penis in order to separate the tumour. As more than a hour had passed since the first incision, cooper began to worry that its protraction was detrimental to the patient, most other operations being over in a few minutes. So he insisted that the operation be completed as quickly as possible by sacrificing the genitals.
Hoo Loo was drifting in and out of consciousness. The nurses rubbed his toes and injected brandy into his stomach in a bid to keep him awake. But already a pint of Hoo Loo’s blood had been lost, some of it congealing around the operating table. Students in the audience offered to give their own blood for Hoo Loo’s life, and a transfusion of a quarter of a pint had been attempted. Key continued to cut and, one hour and forty minutes after beginning, he freed the tumour from the body. It weighed fifty-eight pounds. With a final gasp, Hoo Loo collapsed into unconsciousness. The doctors sensed his heart ‘gradually and perceptibly’ sinking. Then he died.
The following week, the medical journal The Lancet criticised the surgeons for killing Hoo Loo, reasoning that his operation had taken place too early – before he had the opportunity to acclimatise to the British weather – and because his vital force had been constricted by the lack of air in the room. In the following weeks, its correspondence columns also criticised sir Astley cooper’s recklessness. ‘I think that this operation could neither advance science of surgery,’ wrote W. Simpson of Hammersmith, ‘nor be otherwise beneficial to the human race; that it was neither sanctioned by reason, nor warranted by experience.’
Hoo Loo was an extreme example of the brutality, and often futility, of surgery in the early nineteenth century. Even the relatively simple excision of a breast tumour created a ‘terror that surpasses all description & the most torturing pain,’ wrote the novelist Fanny Burney. ‘When the dreadful steel was plunged into my breast – cutting through the veins, arteries, flesh, nerves – I needed no injunctions not to restrain my cries. I began a scream that lasted un- intermittingly during the whole time of the incision – & I marvel that it rings not in my ears still!’
In general, operations were to be avoided, and were only carried out when a tumour had become so enlarged or was bleeding so profusely that it was imminently threatening life.