sudden.”
With his left hand pressing down on the exposed end of the bladder sound, the surgeon insinuated the forceps into the incision. The look on his face was one of studied concentration.
The patient gave a piercing shriek.
Hawkwood took a surreptitious glance around. There was more than one student who was looking a bit unsteady; he presumed they were the ones attending their first operation.
Suddenly there was a grunt from the direction of the operating table and a collective gasp from the gallery. Hawkwood turned quickly.
At the foot of the table, Carslow was holding the forceps aloft, a look of satisfaction on his face. Caught in the metal jaws was a round, dark object the size of a hen’s egg. It was dripping blood.
With a flourish, the surgeon dropped the stone into the metal bowl and withdrew the bladder sound from the end of the penis. As if on cue, the onlookers burst into a round of applause.
Carslow held up his hand. The room fell silent.
The surgeon returned his attention to the patient, who was lying motionless, with the exception of his chest, which was moving up and down with the rapidity of a fiddler’s elbow as he fought to recover from his exhausting ordeal.
“Bravely borne, Mr Ashby, the ordeal is over. My assistant, Mr Gibson, will attend to you. Mr Liston and Mr Oliver, you may return to your places.”
The patient gave no sign that he had heard.
The surgeon waited while his two recruits made their way back to the gallery and the envious smiles of their friends, before addressing the audience: “Remember, it is the surgeon’s duty to tranquillize the temper, to beget cheerfulness, and to impart confidence of recovery.”
Behind Carslow’s back, Gibson had turned the patient on to his side and was staunching the blood seepage with pads of soft lint.
The surgeon raised an eyebrow towards one of the medical staff standing on the lowest tier of the gallery. “How long, Mr Dalziel?”
“One minute and forty-three seconds, Mr Carslow.”
A murmur went around the room. Hawkwood wondered if that meant it had taken longer or shorter than expected. To the patient stretched out on the table below, it had probably seemed like hours.
The surgeon accepted the time with a thoughtful nod. “Thank you.” He looked up at the students. “It is said that my illustrious predecessor, William Cheselden, could perform the operation you have just witnessed in under one minute. While swiftness is an admirable trait, never let the desire for speed dictate your actions. Let expediency be your guide. Cheselden was quick because he was a good surgeon and because he knew his anatomy. Anatomy is the cornerstone of surgery. Remember that, and you will not fail …” Carslow paused. “It is also incumbent upon me to point out that Cheselden did not pioneer the operation, he merely refined it. It was, in fact, a man of humble origins, one Jacques Beaulieu, who developed the lateral perineal approach. As you may have gathered from the name, he was a Frenchman. There are no frontiers in Science and Medicine, gentlemen. You would do well to remember that also.”
As the students filed out of the lecture room, their faces animated by what they had seen, Carslow walked over to the pitcher, poured water into the enamel basin and began to wash his hands.
Hawkwood picked up his coat.
In the small waiting room behind the lecture theatre, Carslow finished drying his hands and passed the damp towel to his dresser. “Please inform Mr Savage that rounds will begin on the hour.”
The dresser, with Carslow’s soiled apron laid over his arm, nodded, handed the surgeon his coat and left the room, taking the towel with him. The surgeon watched him go, then turned with a frown.
“Now then, Officer … Hawkwood, was it? What is so important that you feel the need to disrupt my afternoon lectures?” Carslow slipped an arm into his coatsleeve.
There were dark stains running down the legs of the surgeon’s trousers, Hawkwood saw. Many of them looked crusted over, as though they’d been there for some time. Others looked fresh. He remembered the blood that had run from the last patient’s arse and assumed that it hadn’t been the day’s only operation. He suspected also that a lot of the stains weren’t just blood but had probably come from other body fluids. Some of them looked like dried pus.
“The sight of blood disturbs you, Officer Hawkwood?” The surgeon inclined his head.
“Only if it’s mine,” Hawkwood said.
Carslow considered Hawkwood’s response and allowed himself a taut smile. Close to, Hawkwood was struck by the ruddy hue in the surgeon’s cheeks; it was a complexion that would not have been out of place on a gentleman farmer. He wondered about the surgeon’s origins. In the lecture theatre, Carslow’s voice, while not strident, had reached every corner of the room, and his delivery had been clear and concise. But despite the well- modulated tones, there was a detectable burr that hinted at an upbringing some distance from the capital. The occasional rolling consonants suggested somewhere to the east, Suffolk or Norfolk, perhaps.
“Now, sir, I do believe we were on the point of discussing the reason for your visit?” Carslow made a display of shooting his cuffs and moved to a small wall mirror, where he proceeded to adjust his collar and stock.
“Colonel Titus Hyde …” Hawkwood began. “I’d like to know why his Admission Bond at Bedlam Hospital carries your signature.”
The hesitation was so slight that, if it hadn’t been for the tightening of the material across the shoulders of the surgeon’s coat, Hawkwood might well have missed it.
Carslow turned, his fingers playing with the knot of his cravat. “I wondered whether someone might come.”
Hawkwood waited.
“The answer is simple. I signed my name to the bond because I felt it was my duty to do so.”
The surgeon paused, considering his words.
“Titus Hyde and I were students together. We were from different backgrounds, but similar in age. We attended the same lectures. We had the same teachers. Our mentor was John Hunter. You’ve heard of Hunter, of course?”
Only from the book spines in the colonel’s rooms, Hawkwood thought. He shook his head.
Carslow looked surprised. “Really? He was a great surgeon. A pioneer. He taught us so much: anatomy, respiration, the circulation of the blood … Hunter changed the way students were taught. Our lessons weren’t just about medicine. They included chemistry, natural history, physiology, the function of living things; even philosophy. Hunter wanted to sweep away all the old superstitions. He wanted students to question, to think for themselves. He once said that hospitals were not just places where surgeons gained experience before trying their luck on the wealthy, but centres for educating the surgeons of the future. Titus and I worked as his dressers during several of his operations. We were like explorers, charting the oceans, discovering new worlds …”
Apothecary Locke had said much the same thing, Hawkwood remembered. It could have been an echo.
Carslow smiled. “He would tell us not to make notes during our lessons because he was a student himself and his views were constantly changing. I recall someone – it may even have been Titus – challenging him on that, and Hunter said that by altering his views he hoped to grow wiser every year. I know there were some who judged his style too informal, and it was true that he had a tendency to meander, but Titus and I found his methods wonderfully liberating.
“He used to call the body ‘the machine’. He was the finest surgeon of his age, and yet he had a profound respect for the healing powers of nature. He was the one teacher who told us that surgery should only ever be considered as a last resort.” Carslow paused. “He was an inspiration; an exceptional man.”
The surgeon fell silent. The colour in his cheeks deepened. He looked vaguely embarrassed. “Forgive me, Officer Hawkwood; it would appear that I’ve inherited my mentor’s gift for obliquity. You are here, after all, to ask me about Titus Hyde.”
The surgeon collected himself. “After our studies in London were complete, we went our separate ways. I spent time in Paris. Titus travelled to Italy. Their anatomy schools enjoy a particularly fine reputation. When I
