The Knife Man
Chapter 1
St George’s Hospital, Hyde Park Corner, London
December 1785
The patient was faced with an agonizing choice. Above the pitiful cries and moans of fellow sufferers on the fetid ward, he listened as the surgeon outlined the dilemma. If the large swelling at the back of his knee was left to continue growing, it would eventually burst, leading to certain and painful death. If, on the other hand, the leg was amputated above the knee, there was a slim chance he would survive the crude operation – provided he did not die of shock on the operating table, or bleed to death immediately after, or succumb to infection on the filthy ward days later – but he would be permanently disabled.
For the 45-year-old hackney coach driver either option would have seemed unthinkable. Since he had first noticed the swelling in the hollow behind his knee three years ago, the lump had grown steadily until it was now the size of an orange; it throbbed continuously and had become so painful he could barely walk. Extended on the hospital bed before him, the leg and foot were hideously swollen while the skin had turned an unsightly mottled brown. Once the coachman had gained admittance to St George’s, successfully persuading the governors he was a deserving recipient of their charity, the surgeon on duty had lost no time in making a diagnosis. Examining the tell-tale lump, which was ‘so large as to distend the two hamstrings laterally’, he had no doubts about the verdict. The surgeon had seen popliteal aneurysms at exactly the same spot on numerous occasions before and knew all too well the prognosis.
It was a common enough problem in the cab driver’s line of work: popliteal aneurysms could happen to anyone but appeared to occur with unnatural frequency among coach drivers, postillions and others working in equestrian occupations in Georgian London. Aneurysms could develop in arteries anywhere in the body either through injury or, more commonly, due to a medical condition in which the artery walls lose their elasticity. Coach drivers who already suffered an underlying tendency towards the condition may quite possibly have exacerbated the problem by wearing high leather riding boots which rubbed at the back of the knee. Whatever the cause, the weakened section of artery would begin to bulge and develop into a sac which eventually became filled with clotted blood; when these occurred behind the knee, in the popliteal artery, they were not only extremely painful but made walking exceedingly difficult. The outcome, in whichever case, was often an early death, if not from the condition itself then from the treatment generally meted out in remedy. To lose his leg, even supposing the coach driver survived such a drastic procedure in an era long before anaesthesia or antiseptics, would inevitably mean never being able to work again. But to carry on working, navigating his horse-drawn carriage over London’s rutted and congested roads, would be clearly impossible if the lump was left to grow. Either way, the cabbie faced destitution and the workhouse.
But there was a third choice, the surgeon at his bedside now confided on that day in early December, for a coachman sufficiently willing or desperate. In his slow Scottish lilt, redolent of his humble Lowland farming origins, the surgeon laid out his scheme for a daring and novel operation. Surrounded by the poxed, maimed and diseased bodies of London’s poorest, huddled in their beds on the draughty, bug-ridden ward, the cabbie resolved to put his life in the hands of John Hunter.
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