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.
"Once his dad David had recovered from his first course of treatment, the two of them resolved to take something positive from their experience.
They spent a year researching the history and science of the disease for a book to help others in a similar situation."
24 July 2006
FOR MY BELOVED DAD
David Wishart died before his 'cancer' book was finished. His son completed it in his memory
By Brian Mclver
WHEN Adam Wishart found out his father had cancer, his ignorance of the disease plunged him into a state of absolute terror.
But once his dad David had recovered from his first course of treatment, the two of them resolved to take something positive from their experience.
They spent a year researching the history and science of the disease for a book to help others in a similar situation.
Sadly, David Wishart would lose his fight before One in Three was finished but his son vowed to see it published in tribute to him.
JUST 12 months after being diagnosed with the cancer that had so devastated his family, David Wishart lost his life to the illness.
Despite grieving for his father, Adam Wishart had wanted to press ahead with completing the book, which is named after the number of people who, statistically, will be affected by the killer disease.
His book tells the story of his father's illness and death but primarily aims to offer sufferers, their relatives, and anyone else who has an interest, a no-nonsense history and factual description of cancer.
Adam, 38, a documentary maker who lives in London, hopes it will give valuable information and precious hope to cancer victims and their families - by sharing the experiences of his dad's treatment and breaking down some of the scary myths about the disease.
He said: "When my dad was diagnosed, I felt a terrible kind of terror and fear and darkness, and that darkness had no limits to it.
"I didn't know if my mother was going to die from it, or my sister, or her children.
"It was just this terrible unbounded fear, and because I knew so little about it, I never had any idea of what was going on.
"I went to a bookshop and thought that 'there must be a book that can help me', and there wasn't.
"I felt very strongly that a book like this would have helped me and I just wanted to write that book.
"To begin with, the stuff about my dad wasn't going to be in the book, it was going to be quite a plain text about the history and the science of the disease, but he became a central part of it."
The family's fight against the disease had begun when David underwent operations to help rebuild his spine, which had sapped due to the aggressive nature of his cancer.
As soon as he was recovered from that bout of surgery, the patient was signed up to help with the book.
No one knew they would only have 12 months together to work on their project.
As he underwent various treatments, David acted as research manager for the book, sending Adam off from his bedside on fact-finding missions to plug the gaps in their collective knowledge.
David, from Fife, had been a studious man all his life and relished the chance to get stuck into a semi-academic project.
He was 73 when he was diagnosed in April 2002, and Adam cherished the chance to spend so much time with him, even though nobody realised just how painfully shout that time would be.
Adam recalled: "I first heard the word 'cancer' when my mum phoned from the hospital and said he had gone into emergency surgery because two vertebrae in his neck had collapsed, and were being rebuilt using a titanium pillar.
They said cancer was a possibility, but didn't know for certain at that time.
"It was a kind of reflex reaction that I thought there was bound to be some kind of book about it, and when there wasn't, I decided to write one to give to my dad.
He was a very bookish man, he did a degree at St Andrews and was a maths lecturer in Aberdeen.
He had that very Scottish tradition of education, he always wanted to know and find out things, and was obsessed with the history of science.
Just out of surgery, it was the first thing he started talking to me about and that for me was like the confirmation that he was alive. He was able to revel in the joy of just being alive to lecture his son again about the history of surgery."
He added: "From that moment on, I'd go away and research something, and come back to tell him about it at bedside. He would read the papers and cut out something about genetic therapies for me to research.
"About 10 or 20 per cent of the book is the memoir of me and my dad and the rest of it is stories of scientific discovery from the Greeks to the Victorians right through to modern times.
"Each story is supposed to tell you a basic piece of science, like what chemotherapy is, what radiotherapy is, what pathology is, what the cells are, for example."
While studying the history of cancer, Adam researched back thousands of years ago, when the disease was killing ancient Greeks and tribal Africans.
His investigations tracked the slow advancement of knowledge about the disease through the centuries.
He also looked into the future, where there are ever-improving treatments on the horizon.
Adam said: "The trouble with cancer is the relentless degradation of our genes throughout our lives.
"Just like our face ages and wrinkles, the same happens to our cells and in the end one in 10 million goes wrong and causes the disease.
"Some people think that cancer happens because you hold your emotions in or are depressed.
"Two thousand years ago, the Greeks had the idea that a melancholic humour caused it.
"In the Fifties, Freudian psycho-analysts arrived and said it was about repressed sexuality. Then the alternative medical community came out and said it was mind over matter, if you battled it you'd be okay - and all of that's rubbish.
"Doctors used to lie to patients about their diagnosis. They would say 'it's not cancer' or 'not that bad', because they thought the absolute fear and terror that the diagnosis would provoke would be worse than the disease itself, and because there was nothing you could do, you might as well lie about it.
"That's where the phrase 'The Big C' came from because, in polite society, nobody wanted to say the word.
"But now, if you talk to the most cutting-edge surgeons, they all say it is becoming more and more a disease that we live with rather than die from."
As the pair threw themselves into their project, the outlook seemed positive.
Everyone in the family, including Adam's GP aunt, were convinced things were looking up.
Then, when they weren't expecting it, David succumbed to his illness.
Adam said: "As human beings we have such a demand for life and belief in life, that even though he was close to death, none of us could believe it.
"That moment was very strange. I didn't feel very much, it was like being in the eye of a storm.
"I and my family had been buffeted for the whole year and it just stopped in a moment of calm."
After the death and the funeral, which a disbelieving Adam had helped plan just months before although he was convinced it was years off, he was left with the task of finishing the book alone.
Still grieving and now lacking the loving but firm hand of its editor, Adam vowed to complete it any way he could.
Completing the outline that father and son had sketched together was harder than he expected, and it took him three years to complete, and eventually publish.
He said: "Having started this and been inspired to start this book with him, I felt I had to finish it.
"It was mine and my dad's last project together and only a coward wouldn't complete it. In the year following my dad's death I found it very difficult, but I had to complete it."
He added: "Having written the book has given me a different perspective. Two years ago, my mother, Eva, was diagnosed with uterine cancer.
"That's not a good moment obviously, and I still had the terror that she was going to die, but I felt my attitude to it was different than when I heard about my dad.
"Thankfully, she has now been treated for it and received a clear scan.
"I felt more practical, that here was a biological malfunction and people were going to try to deal with it, as opposed to the blind terror I felt before.
"It was easier to cope."
He finally had One in Three published this year.
Adam fervently hopes the book will inform and comfort the thousands of people who are affected by this terrible disease.
But he knows it has at least helped one person who's lost a loved one to cancer.
'It was mine and my dad's last project together and only a coward wouldn't complete it. It was difficult but it gave me a new perspective'
One in Three by Adam Wishart is available on Profile Books, £15.
I cling to my dad’s enormous hand. With long strides, we are rushing through London. I am six. I am sometimes catching my step, sometimes just being lifted by his forward thrust. I am wearing a bright yellow cape, with a sailor’s hat to keep the rain off, and at every puddle I splash the rushing Christmas shoppers. Dad scolds me, but I know he doesn’t mean it: we are a tight pair. We are coming from an exhibition about some ancient civilisation at the Royal Academy, where he had lifted me high above the crowds so that I could see the twinkling gold swords. Now we have to get somewhere, probably the coffee-bean shop in Soho, for he has very particular tastes. Although we are in a hurry, as we round a corner he stops sharply and I charge straight into his camel-hair coat. It is warm and wet. We have paused because he wants to tell me a story of a man called John Snow whose name and picture is on a pub sign across the road.
Many years ago, Dad says, Dr Snow had hundreds of patients dying of a particularly vicious disease. As Snow had no idea what caused it, he could neither treat nor prevent it. So to discover what connected the patients, he drew a map of London and placed dots where each one lived. Dad sweeps his hand down Broadwick Street, explaining the map: here was dark with dots, but further away the dots became sparser. Dad asks me what linked them. I scratch my head. The doctor didn’t know either. So he questioned the families about their lives. With a flourish, Dad points to the spot where a water pump once stood, and says that Snow realised that all the ill people had used this pump. Some liked the taste of its water so much that they had even travelled from afar. To stop the disease, Snow simply removed the handle of the pump. Nobody became ill again.
Dad tells me it was the first piece of work on demonology. I ask him what kind of demons, but he only laughs. It amused him that I had misheard the word ‘epidemiology’, the science of epidemics, especially since this was a subject he taught to his statistics students.
Being taught about the cholera epidemic of 1854 is my first memory of Dad’s quest to educate me – even though in hindsight Dad’s story was a rather mythologised and childfriendly version of history. From then on, he was always telling me stories about scientists, mathematicians and revolutionaries, from Marie Curie to Benjamin Franklin. From my adolescence it was our habit to stay up late and, with Mum in bed, to sit talking about these things at the kitchen table. For two men who never spoke about their feelings, our intimacy consisted in sharing our interests in politics, history or the progress of science. If I knew history, he thought, then I might be better able to navigate through my life because he had always used the past as a way to understand his place in the world. For as long as I can remember, I was the one who would eventually leave the table. Dad would lock the doors and begin to turn off the lights. I would make my way to bed. The final part of the ritual was that he would open my door just enough for him to stick his head through and wish me goodnight. Then I would listen as he darkened the house before turning in.
Many years later, when Dad became ill, we began spending more time together again and we continued to tell those stories, although this time they would be about the scientists, doctors and patients who had struggled against cancer across the centuries. I searched for a book that we could both read and then discuss. There were memoirs of celebrities who had ‘battled’ through the disease, but I knew that Dad would have no interest in those. There were selfhelp guides that presented basic information but provided no wider context. There were books that described the science in detail, but they didn’t seem to connect to the experience of being a patient. And there were academic histories, which did not seem to bring the past alive.
Even without a book to fall back on, Dad pondered the big questions. Why was there no cure yet, for instance? And I would search libraries for biographies of those who had tried and the reasons why they had failed. Dad would show me a newspaper cutting about the latest genetic cancer cures, and I would try to paint in the background with my recently acquired knowledge. It was like some game from my childhood, but with dark undertones, because the purpose was to provide a distraction from the blizzard of pain.
This book is, in part, the culmination of that journey. It tells the history of cancer medicine, from the Victorian surgical solution to the latest developments in gene therapy, through a dozen stories of scientific endeavour. These are stories of maverick doctors searching for a cure although their colleagues thought them to be charlatans, and of patients campaigning to stay alive. Running through them is a vein of the wider history of medicine, and of the development of science’s understanding of human biology. At the same time, these stories address some of the basic questions that Dad and I had about cancer: what is the biology of the disease, how does a tumour grow, why is it so difficult to detect sometimes, and how does radiation or chemotherapy work?
Dad’s illness mirrored these historical moments. At times, medicine’s history had direct relevance to his own experience. At others, the spirit of some historical age seemed to resonate with the mood of the family. As a consequence, the story of Dad’s illness forms a counterpoint to the broader history of humanity’s struggle against cancer.
It is almost four years since that moment when I was told that Dad was ill and I became filled with fear. I wish that I had known then what I know now. Because learning something about cancer calmed some of those terrors.
When I began writing this book, I thought not only that the disease was becoming more common, that more and more people were dying from it, but that medicine had failed to cure it. But as I met more doctors I realised that, in fact, the last decade has been historic for cancer research: death rates have been falling, in the UK, the US and across Europe, for the first time; and we now understand the biology of cancers in much greater detail than ever before. As a result, in the last few years the first treatments based on understanding the genetic mechanism of the disease have arrived on the market. Many doctors are therefore predicting that in just a few decades cancer will become a disease more like diabetes, one that we will live with rather than only die from.
Most importantly, this book has prepared me for the next time the disease strikes – whether that be within myself, against one of my friends or within a member of my family. I know that this will come, because one in three of us will develop the disease in our lifetimes. When we count our families, our friends and our work colleagues, it is evident that we will all be touched, in some way. And I have learnt that an amalgam of fear, archaic prejudices and ignorance is no way to deal with it. It is time that this disease is no longer shrouded by a dangerous taboo.
Adam Wishart, February 2006
""Cancer is about mutated genes,, as is life's diversity. You couldn't have evolution without the ability of genes to be robust and mutable. It's entwined with how human life works. Dad might have died from it, but there was little that could have prevented that and his life probably couldn't have been extended. Death and life are part of the same thing."
From The Times:
On a visit home for lunch one Sunday four years ago, I found Dad chopping and cooking vegetables — but instead of charging around the kitchen as usual, he was sitting on a stool. He was hunched-up and his head had retreated into his shoulders. He said that he had a little back pain.
His GP made an appointment for an X-ray, which revealed that one of the neck vertebrae had crumbled and a second was cracking. The hospital couldn’t be sure of the cause but my mother, a doctor, was certain. “The odds are it’s cancer,” she told me in her plain and doctorly way.
My first reaction was to search for a book that we could read and discuss. I found memoirs of celebrities who had battled the disease, self-help guides containing basic information and others that described the science in detail. None seemed to connect.
I started talking to doctors with the idea of writing the book that I could not find. Like many people, I believed that cancer was becoming more prevalent and that medicine had failed to cure it. But as Dad underwent surgery to remove his tumour, I learnt that the past decade has been historic for cancer research and that in a few more decades it will be a disease that we live with rather than die from.
The Dana Centre are putting on an event:
The 'C' Word: Demystifying cancer
Break through the malignant myths surrounding cancer with scientists and those affected by the disease. Death rates are falling and our understanding of cancer is increasing, yet damaging misconceptions prevail. Join the discussion challenging the way we think about cancer.
Professor Karol Sikora will be speaking. As will Sandy Craine, a one time leukemia patient, and so will I.
Come along its free!