Esprit de Corps

Can any profession be more altruistic and noble than medicine? It comes as rather a scandalous suggestion that doctors may themselves be sick. Not just overworked and exhausted, and statistically liable to alcoholism, drug-dependence and suicide: but actually deficient in their psychological make-up. This shocking possibility has recently been floated by Glin Bennet, who argues that medicine holds special attractions for those suffering from flawed personalities. In The Wound and the Doctor, Bennet claims that for many such people, medicine satisfies an immature hankering to play the big guy, basking in glory, the apparent self-sacrifices involved assuaging feelings of guilt and providing ego-defence. The heroics of the operating-theatre or the ‘fire brigade’ drama of the emergency call gratify Boy’s Own Paper cravings for adventure, and above all the authority structures of this most hierarchical of professions confer power: ‘Scalpel, nurse.’ Men who cannot cope with the give-and-take of normal human relations lord it over the patient unconscious on the operating-table. Within this psycho-pathology of medicine, anatomists and surgeons are of course the most suspicious types, the profession’s Rambos. In which other occupations is sticking a knife in someone’s back the very acme of the enterprise?

In case Bennet’s theories sound like ignorant gall, it should be noted in his defence that he himself trained and practised as a surgeon before seeing the light and turning psychotherapist (he presumably believes that psychotherapists, unlike surgeons, are sound chaps). This biographical fact may not help his credibility, but lest his opinions then be taken as mere psycho-philosophical balderdash, it should be said that views such as his have an eminent pedigree within the medical profession itself. The great William Hunter, doyen of the anatomy teachers of 18th-century London, delighted in offering his students a peculiarly chilling vision of the medic’s mentality. Surgeons, he told them, were eaten up with ‘emulation and contention’, operating in a dog-eats-dog trade. ‘It is, he said, ‘remarkable that there is scarce a considerable character in anatomy that is not connected with some warm controversy.’ The truth of this Hunter knew from personal experience, having crossed swords with all the leading practitioners, with his own assistants, and not least with his own even more eminent brother, John. Hunter proffered a sinister materialistic explanation for the anatomists’ psychic violence: ‘the passive submission of dead bodies, their common objects, may render them less able to bear contradiction.’

No finer case exists of just that psychological profile of the melancholy of anatomy advanced by Hunter and Bennet than the vitriolic Granville Sharp Pattison, whose medical career, spanning the first half of the 19th century, went from one acrimonious controversy to another. Born in 1791 the youngest son of a rich Glaswegian merchant, Pattison took up one of the predictable career options, medicine, studying at his native university from 1806 to 1812, where he came under the influence of the charismatic James Jeffray. For Jeffray the key to medicine was the corpse, and he never ceased to dragoon students into the dissecting-room. He was also the first in Glasgow to electrify the dead, thereby stimulating the nerves and producing macabre smiles, grimaces and apparent breathing. The Gothic horrors of Frankenstein seem but a test-tube away.

Pattison soon discovered that anatomy was his destiny, becoming assistant demonstrator at the College Street Medical School at the raw age of 18, a dandified young man, idolised by his students. It was there that scandal first struck. Anatomists required bodies, but cadavers were in short supply (Burke and Hare were soon to find a novel solution to this bottleneck). As Ruth Richardson argues in her original anatomy of the Anatomy Acts, sentiment had always run strong throughout society against the desecration of the corpse. Popular piety went in awe of the shades of the departed, while traditional Christian orthodoxy decreed that bones should lie in holy ground awaiting the Last Trump. The rich treated their dead as private property (sometimes setting traps round tombs rather as they secured pheasants from poachers), and the poor performed their communal rituals to protect the dead. Yet doctors claimed that to protect the living they needed cadavers to dissect for the sake of medical training and research. The law had long established its own middle road, allowing surgeons only a strictly rationed supply, the remains of executed murderers. The homicide rate proving insufficient, anatomists found the need to improvise, sidestepping legality and employing ‘resurrectionists’ or ‘sack-’em-up-men’ to exhume the recently-deceased for specimens. So long as this was done discreetly, and no illustrious corpses were disturbed, the authorities generally winked at the practice.

In 1813, however, Pattison’s cronies, showing more zeal than prudence, dug up from Ramshorn Kirkyard the freshly-buried body of Janet McAllaster, an eminent merchant’s wife. The family was outraged; official inquiries led to Pattison, and his lab – indeed, his apron pocket – was found littered with suspicious ears, upper lips, lower jaws etc, which her relatives claimed to recognise. It almost led to a lynching; it did lead to a sensational trial for body-snatching at Edinburgh High Court. Pattison’s defence hinged in part on the bold legal technicality that it was not Mrs McAllaster’s body that had been discovered on his premises, but at most, an assortment of her organs. A ‘not proven’ verdict gave him a narrow escape.

Almost immediately he was plunged into further controversy. As junior surgeon at the Glasgow Royal Infirmary, he performed two amputations in 1816 contrary to the advice of, or without properly consulting, the senior medical staff. Both patients died. Pattison was suspected of indulging in reckless experimental surgery for its own sake rather than for the patient’s good. Accused by his superiors of professional misconduct – indeed of ‘damned butchery’ – Pattison challenged a fellow physician to a duel, or what we might call surgery carried on by other means.

Pattison moved on, but only into further trouble. Gaining the chair of anatomy at Andersons Institution, he quickly fell out with Professor Andrew Ure, best known for his later celebration of the joys of factory labour; soon he found himself accused of adultery with Ure’s visibly-pregnant wife: more mucking around with bodies, it seemed. Ure sued for divorce, and Pattison was involved in another court case. He pleaded innocence, claiming he was victim of collusion and conspiracy between the married pair.

Forced to resign under a cloud of ignominy, it was time, after three quick-fire scandals, to quit Scotland. Pattison migrated to the States, to become professor at the University of Maryland. Almost immediately he was at the centre of yet another explosion, this time with a Professor Chapman from Pennsylvania. Pattison delivered his by now routine challenge and, when Chapman declined, posted him a liar, coward and scoundrel. A paper duel followed, with vicious pamphleteering on both sides and even an element of fisticuffs. The climax came two years later when Pattison fought a duel at last with Chapman’s brother-in-law, General Thomas Cadwalader. The general suffered an excruciating injury: a bullet entered his raised arm at the wrist and passed along the length of it, lodging in the elbow. Pattison remained in Baltimore for most of the 1820s, battling through further medical controversies, mainly arising out of priority disputes over anatomical discoveries.

In 1827 he returned in triumph to Britain, to take up the chair of morbid anatomy at the newly-founded University of London, and there followed the three most stormy years of his life. Endless petty but vicious squabbles erupted between Pattison, the professor of physiology, Charles Bell, Pattison’s own demonstrator, Bennett, and the University’s Managers. Above all, Pattison, despite his reputation as a glamorous and acclaimed lecturer, alienated the London students, who accused him of grossly inept teaching (‘one long course of puff and nonsense’). Encouraged by salvoes of anti-Pattison articles in the Lancet – they ran to 79 pages! – his students launched such a programme of boycotts and riots that the Managers, despairing of the pandemonium, dismissed him. Just turned 40 and with his career apparently in ruins, Pattison resumed his picaresque wanderings in America. At last, the old abrasiveness showed signs of mellowing, and he spent his last twenty years with some distinction in a succession of anatomy chairs, including that of New York University. Perhaps age and experience taught wisdom; possibly his marriage in 1832 had something to do with it.

Dr F.L.M. Pattison has recounted the story of his great-great-great uncle with admirable objectivity and real insight into the ways of 19th-century medicine. Avoiding either apology or accusation, he necessarily poses the question of why Pattison was so unfeeling as a surgeon and truculent as a colleague, the Lermontov of the anatomists: impulsive, occasionally generous, yet all too often deadly. The author is inclined to back a psychological explanation. Pattison spent his youth basking in all the privileges of the rich. Then, when he was 15, the family business crashed and his father died soon after. Suddenly, in his mid-teens, Pattison was left effectively penniless and, worse, humiliatingly déclassé. His subsequent aggression was an explosive mix of inborn arrogance and indolence with a desperate rage for revenge against a cruel world.

There is something in this, just as there may be something, too, in the psychological observations of Bennet and Hunter. But social history must also come to the assistance of psychology. For it was not only Pattison among the practitioners who suffered from the disease of vituperation: it was endemic throughout the medical profession. Paper wars litter the medical history of earlier centuries, and real duels were not unknown (two Jamaican doctors managed to slay each other at ten paces in the 18th century). Prima facie, this occupational violence runs against all expectation. For wasn’t medicine a ‘profession’? And haven’t sociologists been telling us all these years that the characteristic esprit de corps and ethics of a profession create precisely that intra-occupational harmony proper for serving patients (or, more cynically, for milking them)?

But this is to describe ideals or models, not reality. ‘Professionals’ or not, doctors in earlier centuries were operating in highly competitive and for the most part vastly overstocked markets, handling a public who (with much justification) was deeply suspicious of their competence and their goings-on. It was a precarious business; to be noticed, to clinch one’s place in the sun, practitioners needed to be aggressive, and even ruthless, behind the surgical mask of civility. Classical sociology of the professions, as expounded by Talcott Parsons and his school, all too readily took over – indeed, was taken in by – the ideological eyewash of the professions themselves, regurgitating it in fancy jargon. The real, and frequently Hobbesian, history of the professions and their place in a market society still needs to be demythologised. Biographies such as this, examining how professional careers were built in the 19th century, afford a valuable start.

Richardson, too, in her powerful reconstruction of competing cultures of death in the age of the bodysnatchers, shows how it is social history which can best shed light on the doctors’ dilemmas. Popular rituals, such as ‘watching’ the corpse, emphasised the community between the living and the dead. The medical profession, by contrast, fortified itself with clinical distance and detachment, but thereby found itself precariously poised, at once powerful yet vulnerable to being identified as Death’s double. This divide between the people and the profession produced the culture clash embodied in the Anatomy Act of 1832, which gave medics rights over all unclaimed pauper corpses, at a stroke dramatically extending the state’s jurisdiction over dead bodies politic. The conflict lives on today in the perennial bush war between doctors and their patients: whose body is it anyway?