Innocent tumours

When I was a student I lodged with musicians. One of them was fascinated and horrified by my pathology textbooks, though by comparison with such books of past eras, they were, well, less pathological.

I was reminded recently of the days when my musician friend used to leaf through my books and cry out, “Oh no, look at that!” (and then search for something even worse) when I bought a copy of the third edition of Sir John Bland-Sutton’s Tumours Innocent and Malignant (1903) in a small secondhand bookshop in the spa town of Malvern. I bought it because it was inscribed by the author (to W Perry Briggs, whom I have not been able to trace) and I suffer from the absurd notion that the signature of an author in a book somehow puts one in closer relation with him, rather as spiritualists believe that séances do.

Sir John Bland-Sutton (1855-1936) was a most remarkable man. The force of his personality emanates almost palpably from his entry in the Dictionary of National Biography and its accompanying photograph. He was a small man who was said to have resembled Napoleon. As a surgeon he was dextrous and decisive. He had a ferocious—but constructive—determination to succeed, and he was generous to his juniors.

He was born the second of nine children to parents who were by no means rich. His father was, among other things, an animal slaughterer and market gardener, but also an amateur taxidermist from whom the young John learnt an interest in natural history. He trained to be an elementary school teacher, but was always determined to be a surgeon; he scrimped and saved enough to go to medical school, where in his first years he dissected 12 000 specimens, from fish to stillborn fetuses (numbering 800), becoming—among other appointments—pathologist to the Zoological Society of London.

He was for many years a friend of Rudyard Kipling, and appeared as the character Sir James Belton in Kipling’s story “The Tender Achilles.” One of the other characters in the story imitates Belton-Bland-Sutton: “In the few precisely articulated words, one could see Sir James himself, his likeness in the face and carriage to the hawk-headed Egyptian god, the mobile pursed lips, and the stillness of the wonderful hands.” This is no mean compliment.

Two things puzzled me about Bland-Sutton’s Tumours (his double-barrelled name, incidentally, was assumed by deed poll, the union of his middle name and his surname): firstly, the dramatic nature, or grossness of the pathology, of the cases illustrated; secondly, the recognisability of the people who suffered from that pathology.

As artistic artefacts, the illustrations, though of the ugliest possible phenomena, are beautiful, and of enormously skilful draughtsmanship. But do such extreme cases, does such gross pathology (for example, of chondromata), exist nowadays? If not, is it because it does not occur in the first place, because surgical alleviation always attenuates it or because we hide it away, as the Victorians were supposed to have hidden piano legs?

There is no attempt in the book to conceal the personal identity of the afflicted, and in some cases they are even named. Yet oddly enough, the impression given is neither of disrespect nor of prurience, but of sympathy and compassion.