Long Acre

by Claire Rayner

  ‘Nothing at all, except as it makes you unable to walk safely in our busy thoroughfares, ma’am, and so allows you to make work for surgeons that ain’t in any need of additions to their burdens.’

  He was once again working on Fenton’s leg, slowly removing the last of the bandages Foster had fashioned out of kerchiefs begged from the passers-by in the Strand.

  ‘Hmmph. Good man, Foster. You did remove the tourniquet.’

  ‘Of course I did, sir!’ Foster said indignantly. ‘You taught me so —’

  ‘What I teach and what students do are two very different matters, usually,’ the old man said. ‘But you’ve done well enough — now, Freddy —’ and he turned to the man at his side.

  ‘If it is too much trouble to you to take care of my injured brother, sir, then we shall take ourselves elsewhere!’ Amy burst out, and pushed her way past Foster to stand in front of the old man with her fists on her hips, and her elbows akimbo. ‘I wish no favours from —’

  ‘What does the woman go on about?’ the old man said, and stared at her once more.

  ‘You said we made work for busy surgeons, being Americans and strangers as we are. So, if it too much trouble —’

  ‘Oh, pish, woman, and hold your noise!’ the old man said. ‘You make a fuss over nothing, when I am more concerned over more important matters. Like your brother’s injury. Now, Freddy —’ and he turned again to the hitherto silent man at his side. ‘What do you think?’

  Still silent, the red-haired man also bent over Fenton’s leg, and Amy watched him, still smarting from the old man’s sharpness, but realizing that he was right, and Fenton’s care must come before her offended feelings. And she watched with shrinking horror as the younger man, with fingers steady and very gentle, explored the horrid wound in Fenton’s leg.

  Fenton moaned a little and rolled his head, and she put out her hand, and set it gently on his forehead, and he settled again, his eyes tight closed, and Amy realized that he was neither asleep nor fainting, but found it easier to deal with all that was happening by literally closing his eyes to it.

  He had always done so as a child when he was thwarted in any way, lying with his eyes tight shut and refusing to communicate with anyone, clearly showing his dislike for what was happening around him. In those long ago days such an action had been able to drive his mother to distraction, and she had always given in to his demands. Anything was better than to look at her beloved boy lying on his bed, his eyes tight shut and refusing to say a word or show any sign of understanding of what was said to him or done to him.

  Well, such a trick would not help now, Amy thought mournfully, and stroked his forehead, and felt the guilt well up in her, for was it not her fault that he lay here in such pain, and was so unhappy?

  She turned her head again, feeling her gaze pulled back to the ugly oozing wound and was glad to see that the red-headed man had stopped his probing and was gently covering the leg with a clean piece of old linen.

  ‘Well, now,’ he said slowly. ‘This is not so fearful as it looks at first sight.’

  ‘Hmmph. Looks nasty enough to me. I think the fracture is a simple one — I felt no bone fragments — but the question is, can the bone heal under so extensive a flesh wound, and not putrefy? It is my belief it cannot. I would say immediate amputation is the answer. He sustained the injury in mud and horse manure and dirt — the putrefaction is like to be excessive —’

  ‘No!’ Amy heard the word come cracking out of her. ‘No — you cannot!’

  But the old man ignored her, his eyes still fixed on his younger companion. ‘Well, Freddy, what say you? Will you operate? Or shall I? I have time this afternoon and could manage well enough, I think —’

  ‘Well, sir, I am not so sure he needs such heroic surgery, truth to tell,’ Freddy said and looked at the old man, and smiled fleetingly, and for a moment it seemed to Amy that he looked very like him; but then she thought confusedly, it’s because he too is like the uncles, a man of authority, one who knows —

  And knew better than the old man. It had to be so, and she turned her head and said urgently, ‘Sir — Freddy — I do not know your proper name —’

  ‘I am Frederick Caspar, ma’am, at your service,’ the red-haired man said, and smiled.

  ‘Mr Casper, then — you say my brother’s leg need not be lost? Please sir, you must take care of him and see that it is not — he is an actor, sir, and to lose his leg — oh, sir, Mr Caspar, I insist, indeed I do, that you look after him, and —’

  ‘No one who comes to Nellie’s insists upon anything, madam,’ the old man said harshly. ‘All the insisting is done by us, the surgeons. And I do not hesitate to tell you that if we believe the best way to save your brother’s life is to chop off his leg, then off it shall be chopped! Unless you want his death upon your conscience —’

  Amy felt Fenton’s muscles tighten under her fingers as he clenched his jaw, and a fleeting glance showed her that his eyes were now so tightly closed that they seemed like mere slits in his face, and she patted his forehead with as comforting a touch as she could and turned back to Mr Caspar.

  ‘I speak, sir, to you,’ she said very loudly. ‘I ask you to treat my brother so that he shall not — not be so mutilated as your friend here insists —’

  ‘I do not insist, dammit, woman! You are too full of yourself by half, indeed you are. Are all your compatriots so noisy? Will you listen, and mind your manners —’

  ‘Now, let us be a little cool, if you please! This gains us nothing but headaches.’ Mr Caspar spoke soothingly, and put his hand on the older man’s arm. ‘You will recall all I have told you sir, of Mr Lister’s method? I saw him operate on several occasions during my recent visit to Glasgow, and it was impressive — most impressive. Now let me explain, sir, why I spoke as I did. The bone is not at all exposed in this wound. Were it a compound fracture, I would be less sanguine and share your opinion as to the need for immediate amputation, although Lister’s case was of compound fracture and he succeeded very well with it. But that’s all one — in this case, with a bone protected by the tissues, and only tissue injury to heal as well as a simple fracture I will be happy to try using Mr Lister’s method. I believe that by so doing I can provide this patient with a clean and serviceable limb and no putrefaction at all —’

  ‘Mr Lister, sir?’ Young Foster was staring open-mouthed at Caspar. ‘He uses a spray for the air, does he not? We have been hearing about it all. It sounds very — well — strange —’

  ‘Not at all,’ Mr Caspar said. ‘Not strange in the least. It is but an extension of the method Mr Lackland here has been teaching you these many years, young man! He insists, does he not, that you operate always with clean hands, in a clean well scrubbed operating theatre? Quite so! Well, Mr Lister maintains that even scrubbing does not quite remove all the dirt and the hazards that dirt can bring, and that there is in the air some — shall we say substance — that is involved in putrefaction of wounds. This is an opinion he has obtained from a Frenchman, one Pasteur, who maintains the air contains in it little animacules which cause putrefaction. To speak the truth, I care little for the theory of it all. It is too much for a poor simple surgeon! But I am most taken by the technique, and I have waited all this month for a case upon which I could attempt it. I have brought back from Glasgow one of Mr Lister’s carbolic sprays and I think, sir —’ he turned back to the old man, ‘I think, sir, that with your permission, I will take this case and operate today, and clean his wound, and repair the torn muscles and fascia and set the bone in a splint. If putrefaction commences and he shows undue fever with rigors, why then, sir, we still have time to amputate. But it seems absurd when we have such a patient not to try the new method, when we have the materials ready to hand.’

  There was a short silence between them and suddenly Amy was very aware of the other sounds around them, of the shouting of the nurses and the moaning of the patients, and the clatter of bowls and instruments, and she shivered and tried to
imagine Fenton on crutches, Fenton with one trouser leg pinned up behind him, Fenton on stage —

  She shook her head almost violently and said loudly, ‘I speak not only for myself, but for my brother. He would, if he felt able to speak to us at all — and he suffers greatly from his state, I know — he would refuse, even at risk —’ she swallowed and then went on, ‘even at risk of his life, he would refuse to allow his leg to be — to be lost. Please, Mr Caspar, will you do what you think needs doing? I would not have this — gentleman —’ and she made the word as scathing as she could, ‘I would not have this gentleman set so much as a finger upon him, regarding us as he does, and being so eager as he is to mutilate my brother!’

  The old man gave a crack of laughter and suddenly and to her amazement grinned down at her. ‘Well, you’re a woman of spirit! There’s not many as willing to stand up to me as you did — but I still tell you you’re a fool!’

  He looked at his red-headed colleague then and said sardonically, ‘Well, Freddy, you can have your way. Here’s the patient’s sister gladly giving you permission to use her brother to do your experiments upon. I never seek permission from patients for aught, since I always know better than they do, but you are more tender in such matters so you should be happy! I wash my hands of the whole matter — the patient is yours! And you may make what cat’s meat of him you may. I have others to tend who will value me and my skill and advice more highly!’

  He turned away from the table and shouted over his shoulder and one of the aproned nurses came hurrying up with two of the frock-coated young men in her wake.

  ‘Well, woman, what else have you waiting for me here this afternoon? I have no more time to waste on wilful screaming women!’ and he went stamping away and Mr Caspar bent over Fenton’s leg and examined it once more.

  ‘You must not mind him, ma’am,’ he said in a low voice, not looking up, ‘He and I have many such arguments, but you know, he is a very wise, not to say wily, surgeon, with great experience. He agrees with me, in fact, and believes that I can repair your brother’s injury. He would not have left me in command otherwise, I do promise you.’

  Amy was trembling now, and she felt her eyes fill with tears. It had been easy to keep calm while the old man had been there, stirring her to a courage she did not know she had. But now she felt shaky and frightened and said piteously, ‘Are you sure, sir? I know I said it would be dreadful for Fenton to lose his leg, but oh, sir, it would be much worse to — to lose Fenton. He is my very dear brother and —’

  Caspar looked up and smiled, his face once more cracking into a faintly familiar shape, so that again he looked like the old man who was now dealing with an injured child on the other side of the big noisy room.

  ‘Of course he is, and you must not fear. We can make no promises, of course, but I believe I can do a good piece of surgery here. And so does my grandfather, or he would not, I promise you, he would not have allowed me to have my way. He may be gruff and he may seem harsh, but he is indeed a great and experienced operator. We are agreed on your brother’s care, and you will see — all of us here at Nellie’s will do the best we can to ensure a swift recovery for him.’

  ‘Your grandfather?’ Amy said, staring at the old man’s back across the room. So, the two master surgeons had a reason to look alike. ‘Well, sir, so he may be, but I do not scruple to tell you that I think he is hateful, plumb hateful. And I am glad, indeed I am, that you will take care of my Fenton.’ And she looked at Freddy Caspar and suddenly produced a smile of such brilliance that he blinked. ‘I trust you, indeed I do, to do all that is needful.’

  ‘And so shall I, Miss — er, ma’am,’ Foster said behind her. ‘So shall I, I promise you. I shall take a very special interest and care in your brother. He shall have only the best —’

  Caspar’s lips quirked as he looked at the young student and then at Amy, now bending over Fenton and whispering softly into his ear. Clearly the young man was set upon his ears by this pretty and spirited young American. And equally clearly, this patient would not want for a moment of attention if Mr Foster had his way.

  Nor, he thought then, from me. The chance to use Mr Lister’s antiseptic system was one for which he had been waiting eagerly for some time. Now it had presented itself, there was not a moment to waste. And he lifted his head and called imperiously to one of the nurses, and began to give her instructions about the operation he would perform in a couple of hours’ time.

  CHAPTER FOUR

  Below her she could see the table in the middle of the room looking foreshortened and somehow lonely and she stared at it almost ferociously, trying to force her gaze to remain fixed upon it. That was the only way she could prevent herself from looking at all the other horrible and menacing objects in the room.

  But it was no good; she could not prevent her gaze shifting and she looked about at the whitewashed walls with their gas sconces, flaring with a yellow blaze, and at the big table upon which was spread a white cloth, itself covered with an array of instruments that made her face blanch as she looked at them.

  There were saws and chisels and hammers all as clearly recognizable as the implements that their old gardener, who had dabbled in a little carpentry about the place, had kept in the outhouse of their Boston home. There were knives and forceps and strangely-shaped pieces of gleaming metal and tortoise-shell whose function she could not imagine, but which looked capable of inflicting sickening injuries. There were even, she saw, as one of the frock-coated men moved to come up to the table, a row of outsize needles and heavy thread, and she closed her eyes, trying not to visualize them being pushed through Fenton’s flesh —

  ‘Are you all right, Miss Lucas?’ Foster hissed softly in her ear, and she opened her eyes and looked at him and he went on worriedly, ‘I should never have agreed to bring you here — it is not fitting for you to see such things — it was wrong of me —’

  ‘Indeed, it was very right of you, and I would have been dreadfully upset if you had not brought me!’ she said stoutly, and conjured up her most brilliant smile for him, at which he visibly softened, and relaxed and smiled back. Amy, who had been able since her childhood to judge to a nicety the degree to which she had enslaved an admirer, patted his hand and returned her attention to the room below. She knew she had an ally in this young man who would do anything she asked of him, and could be trusted slavishly to satisfy her every whim, and she was glad of the fact, although in time, no doubt, it would be tedious to fend off his amorous declarations. But let tomorrow and its problems take care of themselves; at present she was here, waiting for Fenton to be made well by the red-headed Mr Caspar, determined to watch every step of the way.

  Her determination was based mainly on guilt; she would have much preferred to remain in the casualty ward, huge and malodorous and noisy though it was, but it was her fault that Fenton had been so dreadfully injured, and this was the only recompense she could make. She could not be beside him while he underwent his agony; not even the adoring Mr Foster could arrange that. But she could sit up here in the students’ observation gallery and see what happened. And so she had determined she would. And she settled herself grimly in her place, and fixed her eyes on the empty table in the brightly lit area below her, and waited.

  She did not have long to wait. The little group of young men in the room below suddenly became more alert and turned away from their desultory conversation as from just below Amy’s vantage point there was a sound of arrivals. Then, as she leaned forwards, craning her neck, he appeared; the red-headed man.

  He was now without his coat and appeared in his shirtsleeves, with the cuffs rolled up above his elbows, and she could see his strong forearms with their dusting of sandy freckles, and the power of the muscles beneath the cambric over his shoulders, and shivered a little. Such strength seemed frightening suddenly, and she drew a deep breath and tried to concentrate entirely on what she could actually see and hear, so that her mind did not run away with itself, conjuring up horrible visions o
f Fenton lying in a blood-boltered bed, or with only one leg —

  Below her, Mr Caspar turned and looked up to the gallery, and she shrank back to get out of his sight.

  ‘Gentlemen,’ he said loudly, ‘I am glad to see so many of you have presented yourself for instruction this afternoon. I am about to perform a repairing operation upon the leg of a young man who suffered an injury under the wheels of a cart this afternoon in the Strand. He has several deep lacerations, involving mainly the muscles of the extensor digitorum longus. There is some injury to the gastrocnemius, but less than I had feared. There appear to be simple fractures of both the tibia and fibula, which I hope to be able to reduce adequately following the repair to the musculature. You may be a little surprised that we are attempting such a repair since, as you will see, the injured area is extensive and the risk of putrefaction high. However, I shall be using Mr Lister of Glasgow’s method, and operating under the protection of this —’

  He turned and lifted his hand and one of the young men came forward, pushing a small round table. Upon it stood a brass object some twelve inches high, and egg-shaped, on the top of which was the handle of a plunger. From one side of the brass egg came a tube and from the other a bell-shaped extrusion. Altogether it looked very strange, and Amy stared at it, puzzled, as did all the other occupants of the gallery, who leaned forwards eagerly to stare down at all that was happening.

  ‘This will be used to spray the air above the patient with a fine carbolic mist. Carbolic, I must tell you, is a substance devised from coal tar and developed in Manchester by one Calvert, who used it to disinfect sewage in Carlisle —’

  There was a snort of laughter from somewhere at the back of the gallery and one of the students made a ribald remark at which Caspar raised one eyebrow.

  ‘Some of you, gentlemen, may find it amusing that we use the same material for the prevention of wound putrefaction as we use for the problems of sewage putrefaction. Both are equally disagreeable, as Mr Kent, whose voice I believe I recognized, will discover when he acts as night soil man for the whole of hospital for the rest of this week. You will see then, Mr Kent, as you deal with those slop buckets, just how severe a problem putrefaction can be, whether it is to be found in a chamber pot or in an injured man’s body. So be it, Mr Kent?’