Chapter 4 Volume Two

Sixth Day of March, 1883

All too frequently, it is the case that we, as medical students, are granted access solely to procedures conducted upon the male form. The female anatomy, by contrast, remains shrouded in an almost mystical obscurity, as though it were a sacred domain, reserved only for the most initiated. Instruction is given—oft in great detail—on the manner in which such procedures are to be performed, yet the opportunity to witness them firsthand is withheld.

We are men of science, devoted to the rational pursuit of knowledge, and yet in this realm, reason is eclipsed by modesty, or perhaps by an antiquated sense of propriety. The female body is treated as though it were an ancient riddle, a secret entombed within the pyramids of Egypt, accessible only to those deemed sufficiently worthy. It is a paradox most vexing: we are expected to master the art of surgery, even as vital knowledge is veiled from our gaze.

Our sole opportunity to practice upon the female form comes, regrettably, by way of subjects acquired through questionable means. More often than not, the cadavers presented to us are in such an advanced state of decay that it becomes exceedingly difficult—nay, at times impossible—to discern the anatomical structures upon which we are meant to train.

Only those students deemed exceptional—either through academic favour or social standing—are afforded the rare privilege of observing surgical procedures conducted upon living female patients. Even then, such observation is strictly regulated: the student is only permitted entry once the patient has been rendered insensible by ether, and he must depart before consciousness returns, thereby preserving a degree of anonymity and safeguarding what is considered the patient’s modesty.

Alas, the vast majority of us shall complete our studies having never once beheld a living female subject in the context of operative medicine. It is a grave deficiency in our instruction—one which calls into question the very foundations of medical training as it pertains to the care of women.

If this deplorable deficiency in our instruction is not soon remedied, I fear I shall be compelled to take matters into my own hands. I shall endeavour, by such means as may be necessary, to acquire female subjects upon whom I might practise the surgical art I have so diligently studied. For how else is one to attain mastery, save through direct experience upon the human form in all its natural variation?

It is, indeed, a sorrowful admission—that necessity should drive a man of science to such lengths. Yet what alternative remains, if I am to secure a livelihood and fulfil my duties as a future Fellow of the Surgical Guild, and one day support a family of my own? The advancement of skill, and the alleviation of human suffering, demand not only knowledge, but the opportunity to apply it. Without such, we are but philosophers in coats—learned, perhaps, yet impotent in the face of real affliction.

The First Day of May, 1883

Today marked the celebration of the close of the academic term, and with it, the commencement of the summer holiday. I have elected to travel to France, wishing to witness firsthand the spirit with which the continent ushers in the season. The day has proven to be one not only of festivity, but also of considerable agitation.

Here, the working classes have taken to the streets—both in jubilation and in protest—voicing their grievances against what they perceive as the persistent injustices inflicted upon them by the proprietors of mills and factories, in whose employ so many remain bound. I have been witness to several disturbances verging on riotous, with angry mobs surging through the boulevards.

Tensions escalated swiftly, and clashes ensued between the demonstrators and the gendarmes, as well as with the militia, who had been summoned to safeguard the interests of the industrialists. The atmosphere has been charged, volatile—an uneasy marriage of celebration and discontent that captures, perhaps, the spirit of the age.

It was not, I must admit, a complete waste of my time. Amidst the tumult, I had the opportunity to suture several of the riot’s unfortunate participants. I find that my skill in suturing is becoming quite exemplary, if I may say so without undue vanity.

One particularly inebriated fellow presented with a rather deep laceration just above the brow. I attended to the wound with as much care and precision as the conditions permitted, and upon admiring the neatness of my handiwork, I daresay he shall bear little in the way of a scar—should infection be avoided.

Let us hope, however, that in my absence the wound is kept clean and free from corruption. It is a cruel irony of our art that the success of our interventions often lies beyond our reach once the needle and thread have done their part.

This journey was not, after all, in vain. While in France, I was able to procure a subject upon whom to further hone my surgical skills. One of the riot’s participants—an unfortunate soul—was bayoneted in the abdomen by an overzealous member of the militia. He succumbed to his injuries before any medical aid could be rendered.

Through certain discreet arrangements—requiring only a modest sum of francs—I was granted leave to examine and practice upon the wound post-mortem. The widow, now bereft of both husband and means, revealed herself to be a woman of uncommon pragmatism. Perceiving some utility in the circumstance, she consented to my attendance upon the corpse, permitting me to treat the wound as though it were a case presented in the living.

Once more, my aptitude for suturing came to the fore. I was able to rehearse the proper technique for treating an abdominal wound—both the internal and external closures—under conditions that closely mimicked those of a living operation. It must be noted, however, that the current wisdom suggests such wounds ought, in many cases, to be left open, so as to reduce the risk of septicemia. Nonetheless, the exercise was invaluable to my education.

Month of June 1883

During my sojourn in Paris, I had the peculiar fortune to cultivate an acquaintance of an unusual character—one Monsieur Alexandre, a discreet and obliging functionary in the employ of the Paris City Morgue, situated just behind the venerable Cathedral of Notre-Dame upon the Île de la Cité. Normally, the morgue was a tourist attraction for the macabre. With the modest consideration of a few extra francs, discreetly exchanged, he afforded me private access to the mortuary chambers, wherein I was permitted to undertake examinations and minor procedures upon the recently deceased—principally female subjects, some of whom had but lately quitted this mortal coil.

Though such opportunities tread the fine line between necessity and impropriety, I regarded them as essential to my education. Nowhere else have I encountered so immediate and undisturbed a field for anatomical study, particularly of the female form, which remains—regrettably—so often concealed from the aspiring physician’s view.