by Peter Ford
The showman seemed to Treves to be unable or unwilling to pass on more than the most rudimentary information about his charge: that he was English born, that he was twenty-one years old and that his name, Treves claimed he told him, was John Merrick. For his own part, Treves felt a frustrating bafflement at the malformations he found himself observing. He was quite unable to account for the condition, to pin on it any label of medical diagnosis or recall ever having come across anything remotely like it in professional experience or theoretical training.
Treves was at the age of thirty-one already a figure to be reckoned with in the medical world. In 1881 he had been invited by the Royal College of Surgeons to give the Erasmus Wilson Lectures, a series of six lecture-demonstrations on specimens from the college’s museum to be delivered before an audience consisting of some of the most distinguished surgeons in the country. He added to this honour the winning of the college’s Jacksonian Prize in 1883 for an original essay on intestinal surgery. In the same year he published Surgical Applied Anatomy, a textbook that lost no time in establishing itself as both a standard reference work and a medical best-seller. If he was disconcerted by his bewilderment before the sorely afflicted frame of Joseph Merrick, he must have been stimulated by the challenge it presented to his diagnostic abilities and to his natural instincts as a scientific investigator.
The explanation offered by Mr Norman to account for his protégé’s deformities at least had the virtue of simplicity. All this came about, he explained, as the consequence of an unfortunate accident. While the Elephant Man’s mother was carrying him during the last few months of her pregnancy, she was knocked over and badly frightened by an elephant from a travelling menagerie. The shock sustained conveyed itself to the unborn child with the result they saw before them. (Dr Bland-Sutton also remembered this story in connection with his visit to the freakshow.) As will be seen, Merrick himself clung to it, finding it to contain a powerful degree of comfort. The extreme rarity of his sensational disorder was no doubt to be accounted for by the scarcity of runaway elephants in rural England.
Frederick Treves’s interest in the case was quite naturally not concerned with exploring it as medical folk-belief. Ignoring the vagaries of superstition, his instincts were to seek to establish scientific fact and, if appropriate, to write up an account of these apparently undescribed abnormalities for publication. His mind was quite made up that he would like to take Merrick back across the road so that he might examine him in detail at leisure in his room in the London Hospital’s Medical College. Tom Norman again proved ready to agree, perceiving some publicity value in the idea. But at this point, wrote Treves, ‘I became at once conscious of a difficulty.’
Considerable problems were invariably to be encountered in transporting this startling being from place to place. The problem remained even when the distance concerned was no more than the few hundred yards to the door of the Medical College, which lay along Turner Street, on the south-west side of the London Hospital’s main complex of buildings. For the Elephant Man to appear on the streets without concealment was to invite the instant assembling of a crowd. In the open, out of his refuge, Merrick’s footsteps were invariably dogged by ever-increasing excitement and clamour, his progress hampered by eager, curious, shocked or frankly incredulous bystanders. The Elephant Man’s journeyings abroad were, it seemed, in the habit of degenerating into public disturbances.
There was a solution to hand – at least, a partial solution – and this, said Treves, took the form of a special set of outdoor clothes the Elephant Man possessed that concealed him from head to toe. The whole outfit consisted of three garments. First there came a pair of huge bag-like slippers in which the feet and lower legs could be encased. Then there was the voluminous black cloak, and this practically touched the ground when draped about its owner’s shoulders. Treves could only remember having seen such a garment once before, and then it had been at a theatre, when it was ‘wrapped about the figure of a Venetian bravo’. He found it difficult to imagine how the Elephant Man came by such a garment, yet the most extraordinary item of clothing remained the hat. It was shaped somewhat like a conventional peaked cap, and was also black in colour. Its dimensions, however, were vast, since it needed to be large enough to fit the Elephant Man’s head. From the edge of the wide peak a brownish flannel pelmet hung down to conceal the face, but in this a horizontal slit was cut so Merrick could see where he was walking.
The sight of the Elephant Man limping slowly along in his outdoor clothing – a slight, bent figure leaning heavily on a stick and engulfed in a huge black cloak, the whole ensemble topped off by the great head in its ‘pillar-box’ hat – could, Treves remarked, have been only a degree or so less alarming than the appearance of the man unclothed. It was decided in the end that Merrick would wear outdoor garments for his visit to the Medical School, but that Treves would hire a cab to carry him from door to door and return him afterwards in the same way.
There remained only the need to ensure the smooth reception of the Elephant Man at the college. So that he might identify himself to the porter and avoid embarrassing delays or misunderstandings, Treves handed Merrick his visiting card. With this gesture the first meeting was over between Frederick Treves, a young surgeon whose ever more ambitious career was opening before him, and Joseph Merrick, the Elephant Man, a humble freak whose hopes for the future were altogether more modest in character.
CHAPTER 2
On the Threshold of Eminence
By any standards Treves cut an impressive figure. He might almost have posed for a monument to what it was possible to achieve by a combination of a peculiarly Victorian trio of virtues: industry, tenacity and talent. He had reached the age of thirty-one with his life a success story.
Treves was a Dorset man from the county town of Dorchester, the youngest son in the family of William Treves, a well-to-do furniture salesman and upholsterer. William Treves kept a large town house above his shop, which stood in one of the main streets of the town. It was there, at 8 Cornhill, on 15 February 1853, that Frederick Treves was born.
Little is recorded of his early life. At the age of seven his education began at the small Dorchester school where his brothers were taught before him. The headmaster was the Reverend William Barnes (1801–86), a formidable scholar and linguist who was also a dialect poet of sensitivity and a figure of more than regional importance in English literary history. Both Gerard Manley Hopkins and Thomas Hardy acknowledged a debt to his influence in their poetry.
When he was writing the Dorset volume for the Highways and Byways topographical series on the English counties, Treves remembered the extraordinary range of his old master:
He was familiar with all European languages … He could read Hindustani, Persian, Arabic and other unwonted tongues. He was a very accomplished musician, playing himself the flute, the violin, and the piano. He wrote innumerable books besides his well-known poems, and was learned in geology and archaeology. More curious still, he was a competent engraver on both wood and copper, so that he illustrated not only his own works … but also the books and monographs of his friends.
Treves was only at William Barnes’s school for two years, but the impression left on him by this Dorset genius, who managed to combine an austere and rigorous regard for learning with a broad humanity and a delicacy of vision, was life-long. When he entered school, Treves told his publisher Newman Flower many years later, he ‘was very frightened by the austere figure in black, sitting there like some grim Inquisitor in the high chair’. Mary Hardy, Thomas Hardy’s younger sister who was also a pupil at the school, remembered Treves as a shy and even timid child who would, the moment lessons were over, run to hide in the cloakroom behind the coats of the other pupils until the family maid came to escort him home. Despite all this, Treves wrote that his recollection of Barnes was:
… that of the gentlest and most kindly of men. His appearance was peculiar. He had white hair and a long white beard, and always wore knee b
reeches and shoes with large buckles. Out of doors he donned a curious cap and a still more curious cape, while I never saw him without a bag over his shoulder and a stout staff. During school hours he was in the habit of pacing the room in a reverie, happily oblivious of his dull surroundings. I remember once that some forbidden fruit of which I was possessed rolled across the schoolroom floor, and that I crawled after it in the wake of the dreaming master. He turned suddenly in his walk and stumbled over me, to my intense alarm. When he regained his balance he apologized very earnestly and resumed his walk, unconscious that the object he had fallen over was a scholar. I have often wondered to which of his charming poems I owed my escape from punishment.
In due course, when he was eleven, Treves was sent to London, where his father had enrolled him at the Merchant Taylors’ School. He stayed at Merchant Taylors’ until he was eighteen, but as a scholar seems to have left an undistinguished record. It was only in sports, and in football in particular, that he excelled, and holidays were always a time of happy return to his home county. Throughout his later life he was to speak with deep nostalgia of the region he called ‘the Dorset beyond the hills’.
It was decided eventually that he should follow his eldest brother, who had been a medical student at St Thomas’s Hospital, into the medical profession. For the youngest Treves boy, though, a place was sought at the Medical School attached to the London Hospital. It was perhaps an unexpected choice. Of all the hospitals in London which then had medical schools attached to them, the London Hospital was generally considered to be the least attractive.
First and foremost there was its geographical situation. While it could claim at this time to be the largest hospital in England, it was set in the midst of the poorest large population in the country. Its 690 beds drew patients from a maze of alleys, courts and back streets that stretched along the river behind the wharfs and docks of the lower Thames. It was, after all, the hospital of London’s East End. Patients would arrive on handcarts from the markets of Billingsgate, on stretchers from as far away as Tilbury Docks and from every noisome rat-infested slum between. The poverty of the area, the overcrowding and dirt, were almost indescribable. Portman Square off Orchard Street, for example, was a small court twenty-two feet wide with a common sewer running down the middle. Yet it served twenty-six three-storeyed houses and almost a thousand people regarded the square as home. In Wapping, the courtyards were deep in filth, and the children, often virtually naked, would crawl to search for vegetable parings in the refuse. The Thames itself, which had become the great sewer for the entire metropolis, was so offensive that Members of Parliament at Westminster complained they could not use the room overlooking the river.
The London Hospital could therefore claim to have no shortage of good clinical material on its doorstep, but it was still hardly surprising if many students coming down from Oxford or Cambridge preferred to go to some other hospital to complete their studies. If the surroundings were depressing, however, the opportunity was there to study under some of the greatest medical names of the day. The teachers included such men as Jonathan Hutchinson, a tall bearded surgeon who excelled in every field of medicine and who made so many original observations that his name is still to be found in modern textbooks of surgery; Hughlings Jackson, a brilliant and eccentric physician who has come to be recognized as one of the founders of neurology; Langdon Down, a specialist in the problems of mental deficiency who first recognized the existence as an entity of mongolism (now known more correctly as Down’s syndrome); and Andrew Clark, a doctor remembered not so much for his contributions to medical science as for the fact that he was chosen as personal physician by members of the royal family and by the Liberal prime minister, W. E. Gladstone. The young Robert Louis Stevenson travelled from Edinburgh to London to consult Clark about the condition of his tuberculous lungs.
For the students, work at the London seems to have been haphazard and largely unsupervised, but its basis was unremittingly practical. Their help was necessary to cope with the scrimmage of patients who came in through the hospital doors like a tide continually on the flood. In ‘The Old Receiving Room’, a companion essay to ‘The Elephant Man’, Treves left a series of vivid vignettes of the mêlée of human distress that was likely to gather in the casualty department in his student days, when the cry that went up in the event of an accident in the London streets was not yet, ‘Call for an ambulance!’ but still, ‘Send for a shutter!’
The receiving unit consisted first of the hall, which served as waiting room and where there could always be someone waiting:
It may be a suffering woman who has called for her dead husband’s clothes. It may be a still breathless messenger with a ‘midwifery card’ in her hand, or a girl waiting for a dose of emergency medicine. There may be some minor accident cases also, such as a torn finger, or a black eye like a bursting plum, a child who has swallowed a halfpenny, and a woman who has been ‘knocked about cruel’, but has little to show for it except a noisy desire to have her husband ‘locked up’.
Then, on either side of the hall, were two dressing-rooms, assigned respectively to men and women, where surgeons and dressers worked on the emergencies on a wide couch, sinisterly covered in thick, black and much-washed leather.
It may be a man ridden over in the street with the red bone-ends of his broken legs sticking through his trousers. It may be a machine accident, where strips of cotton shirt have become entangled up with torn flesh and a trail of black grease. It may be a man picked up in a lane with his throat cut, or a woman, dripping foul mud, who has been dragged out of the river.
Finally, there were the solemnly silent processions that accompanied every street casualty all the way to the hospital gates in the days before the introduction of ambulances, any diversion from life’s hard routine no doubt being more than welcome.
It is a closely packed crowd which moves like a clot, which occupies the whole pavement and oozes over into the road. In the centre of the mass is an obscure object towards which all eyes are directed. In the procession are many women, mostly with tousled heads, men, mostly without caps, a butcher, a barber’s assistant, a trim postman, a white-washer, a man in a tall hat, and a pattering fringe of ragged boys …
The object carried would be indistinct, being hidden from view as is the queen bee in a clump of fussing bees. Very often the injured person is merely carried along by hand, like a parcel that is coming to pieces. There would be a man to each leg and to each arm, while men on either side would hang on to the coat. Possibly some Samaritan, walking backwards, would help hold up the dangling head. It was a much prized distinction to clutch even a fragment of the sufferer or to carry his hat or the tools he had dropped.
In fact the busy unsupervised atmosphere at the London Hospital seems to have suited Treves exactly. He began to display a determinedly practical approach to the problems he encountered. The firm decisions and decisive actions inherent in the surgical approach to patients seemed ideally suited to his personality, and it was to this branch of medicine that he found himself increasingly attracted.
After four years at the London Hospital, Treves’s studies were completed, and in 1874, at the age of twenty-one, he took the diploma of the Society of Apothecaries. The following year he passed the examination to become a member of the Royal College of Surgeons. He then undertook a term of duty as a house surgeon at the London Hospital to build on his experience before accepting an offer from his elder brother, who was now honorary surgeon to the Royal National Hospital for Scrofula at Margate, down in Kent. There, though it was only to be for a few months, Frederick Treves became resident medical officer. Even in this brief period he managed to apply himself to an intensive study of scrofula, then still a disease of unknown origin.
By 1877 he felt the time had arrived for him to try his hand at general practice. It was a difficult time in which to start such a career, capital being necessary either to buy a share in a practice or simply to support a young doctor as he built
up a practice of his own. There were also many young doctors competing for the patronage of those wealthy patients who made such a career possible and profitable. At this point Treves married Anne Elizabeth Mason, the youngest daughter of a Dorchester merchant. She brought some private money to their marriage, and it was probably this which enabled the young couple to set up home in the small town of Wirksworth, Derbyshire. Here Treves bought his way into a partnership in an isolated community, set in one of the beautiful Derbyshire vales. The practice extended for many miles to take in neighbouring farms and villages. It looked as though a dream had been realized.
In the event the idyll did not last. Treves’s strong personality and the impression of confidence he conveyed to the patients precipitated jealousies among his senior partners. Within a year he was back near London, attempting to set up in general practice in the suburb of Sydenham. When, in 1878, the chance presented itself of filling the post of surgical registrar at the London Hospital, the opportunity seemed too good to miss. This relatively humble post was to provide the springboard for his whole future career.
The rungs of the ladder that Treves now mounted were placed as follows. First, in 1879, he became assistant surgeon to the London Hospital, and shortly afterwards also an assistant at the Royal London Ophthalmic Hospital. This led to his being made lecturer and demonstrator in anatomy to the London Hospital Medical School, a position he used to pioneer research in the whole new range of abdominal operations that anaesthesia and new antiseptic techniques were making possible. His research notes from his work on scrofula provided him with the material for his first book, Scrofula and Its Gland Diseases (1882).