Research – L. T. Meade: Brain Surgery and Patient Consent

I’ve been researching L. T. Meade and rereading stories by her for my ongoing research. Meade’s full name is Elizabeth Tomasina Meade. She published extensively in the late nineteenth and early twentieth centuries.

Meade as a Professional Writer

She was best known for her fiction for children and young women and her medical novels. However, she was also the second most prolific contributor to The Strand Magazine—second only to Sir Arthur Conan Doyle. My work on Meade thus far has focused on the short stories she wrote for The Strand. In her Oxford Dictionary of National Biography entry on Meade, Sally Mitchell credits her with inventing the sub-genre of the medical mystery story. Meade’s contribution to detective fiction in this sub-genre and more generally has often been overshadowed by Doyle’s Sherlock Holmes stories.

Doyle and Meade saw themselves as professional writers and understood the necessity of writing what sells when earning their bread through writing. However, where Doyle came to resent this necessity, Meade embraced it.

Doyle famously tired of Holmes and his popularity. He tried killing him off at Reichenbach Falls only to later cave to pressure to bring him back—first in The Hound of the Baskervilles (set prior to the other stories) and then to fully resurrect him in The Return of Sherlock Holmes. Doyle’s resentment stemmed from his frustration with the relatively cool reception of the works he saw as his true art—his historical fiction. Doyle wanted to be known as an artist, not the producer of engaging, but formulaic detective stories.

Meanwhile, research has shown that Meade had a much more workmanlike attitude toward her writing. In March of 1897, Meade published an essay entitled ‘A School of Fiction’ in The New Century Review. She opens the essay by noting that there are schools of cookery, music, acting, and art, and she thinks there should also be a school for fiction.

Meade expects opposition to this proposal. She says her detractors will claim that ‘the novelist is born, not made; that writing comes by nature; that the novelist is like the lark with his Art all complete; that he needs no reading and no study’ (220).

After making the point that she is not writing of the ‘giants’ of the literary world (Austen, George Eliot, Kipling, Scheiner), Meade explains she is ‘speaking now of the novelist whose name is legion—the novelist who supplies the bookstall and te periodical’ (220). Though some literary giants did publish in periodicals, Meade’s point is that the majority of cheap fiction was not and did not need to be written by literary geniuses.

To support her claim that training is necessary for writers, Meade points out the large portion of their annual income people spend on reading material. She takes her numbers from those reported in the journal Book Bits. She reports that letters sent to the Book Bits editor in reponse to this question showed that people on a small income (<£100 per annum) spent at least 10% of their income on literature, while wealthier respondents report spending larger proportions. Also, two respondents earning £500 per annum report spending 20% (or £100) on literature (222).

Clearly, demand for reading material was high, but Meade despairs that increasing demand has not led to increasing quality (222). Thus, she calls for formal training for writers. She wants them to understand ‘[t]here are rules which belong to the art of fiction which cannot be disregarded if successful work is to be the result’ (225).

Meade was certainly not the first to criticise the poor quality of much published fiction. One important precursor is an essay Marian Evans (pen name George Eliot) published in the Westminster Review entitled ‘Silly Novels by Lady Novelists’ (12 September 1856). Though Evans does not call for formal training for novelists, she does, like Meade, object to novels by undereducated writers.

Meade’s fiction demonstrates that she not only understands rules of grammar and the conventions of characterisation, setting, and plot structure, she is also well-informed about the world she lives in and about which she writes. Many of her stories for The Strand, for example, demonstrate her understanding of current medical practice and the public’s anxiety about scientific advancements.

Brain Surgery on Children

My research has shown that brain surgery became more common, and thus more of a concern in the late nineteenth century. With the acceptance of effective anaesthesia and germ theory, brains surgery became more successful. Also, the understanding of cerebral localisation allowed surgeons to determine the location of a blood clot in the brain, thus allowing them to remove the clot if it was deemed to be in an operable location. Meade’s first series of stories in The Strand, ‘Stories from the Diary of a Doctor’, co-authored with Clifford Halifax, MD, address these issues.

In ‘The Heir of Chartelpool’, Stanhope is suffering from a clot on the brain as a result of a fall. Dr Halifax, the narrator, believes an operation to remove the clot is worth the risk, but Mr Parsons, a famous London surgeon, will not attempt it because the clot is too close to the brain stem; Halifax performs the risky, experimental surgery and the previously unconscious and paralysed child makes a full recovery.

The greater understanding of the development of the brain in the nineteenth century also allowed for the possibility of treating conditions such as microcephaly caused by craniosynostosis. This condition occurs when a child’s brain does not develop normally because the skull has fused prematurely. In ‘Creating a Mind’, Halifax performs a craniectomy on a microcephalic child, thus allowing his brain room to develop normally. Within six months of the surgery the intellect of the toddler at the centre of the story has almost caught up to that of his peers. Cranial enlargement was controversial in the 1890s owing to the high mortality rate associated with it, but Meade, rather than engage with this debate, depicts Halifax as an innovative surgeon curing a child.

While these early stories recognise the risk of dying in surgery, and Halifax warns the boys’ mothers of this risk, both Halifax and the boys’ mothers deem it a risk worth taking. In ‘The Heir of Chartelpool’, the child’s mother wants more for her son than the bare existence he would have without treatment. While in ‘Creating a Mind’, the child’s mother both wants her son to be able communicate and to be accepted as his grandfather’s heir—his grandfather refuses to leave his property to a child with compromised brain function. Thus, in these stories, Meade’s attitude toward brain surgery is largely celebratory; both procedures are successful, the boys make full recoveries and have the power of both movement and communication restored to them, and both inherit the family fortune.

Brain Surgery on Women

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My research demonstrates that the stories in which Meade depicts adult women who are subjected to brain surgery are decidedly darker in tone as she considers the threats posed by unscrupulous surgeons and their knowledge of cerebral localisation.  As Anne Stiles argues in Popular Fiction and Brain Science in the Late Nineteenth Century, ‘cerebral localization theories […] undermined a sense of a stable human identity. By suggesting that certain parts of the brain controlled specific emotions and behaviors, localizationists contradicted the popular belief in a unified soul or mind governing human action thus narrowing possibilities for human agency’ (10). The experiments in anatomy and vivisection that led to localisation theory began early in the nineteenth century across Europe, but research activity in the area increased from 1861 when French scientist Paul Broca linked the third convolution of the frontal lobe on the left hemisphere of the brain to ‘linguistic ability’ (Stiles, 2). Meade resists the materialist explanation of human consciousness and identity championed by localisationists—in fact, all of the stories I discuss in this post link the mind and the soul. However, she could not ignore the fact that experiments showed that localisationists knew which part of the brain controlled certain behaviours, and this knowledge gave them the power to disrupt these behaviours. In both ‘Silenced’, a standalone story published in 1897, and the Mrs Kort plot line in Stories of the Sanctuary Club, published in 1899, unethical surgeons use their knowledge to silence their victims by destroying or at least hampering the part of the brain that Broca linked to linguistic ability.

‘Silenced’ is narrated by Nurse Petre; she happens to learn that Captain Gifford, the lost lover of a former patient and dear friend Miss Trefusis, is alive and in the house of her employer, Mr Hertslet. Hertslet is due to trephine Gifford the following day and to marry Miss Trefusis in six weeks’ time. When Nurse Petre tries to take the news of Gifford’s presence to Miss Trefusis, Hertslet silences her; he describes his actions as follows:

“I waited until you dropped asleep, then I administered an anaesthetic. The rest was
easy. With a suitable instrument I made a small opening through the bone at the top of your temple, just over the centre which controls the power of speech. Having made the hole through the bone, I introduced a probe and broke up the brain tissue.” (701)

He then staged an accident to explain the injury on her head and her sudden partial paralysis and inability to speak. Nurse Petre suffers in silence for six weeks, but the morning of the wedding the paralysis is starting to wear off and Miss Trefusis comes to visit. While she is there, Nurse Petre prays that she will be able to speak just enough to warn her about Hertslet; her prayer is answered, the wedding is averted, Hertslet disappears from England, and Miss Trefusis marries Captain Gifford. The resolution in the text is as sudden, and almost as short, as my summary. Though all ends well for most of the characters, Hertslet’s disappearance raises the question of whether or not such practitioners can be policed or controlled in a way that protects the public. This story is written and set well after the major Medical Acts of the nineteenth century of 1858 and 1886, but it raises the concern that though practitioners were required to be properly educated, the regulators had little power over how they would use their knowledge.

Similar research questions are raised in Stories of the Sanctuary Club. These stories are narrated by Dr Cato, who founded the club with Dr Chetwynd. In the third story, Dr Kort joins the establishment, and his wife moves into rooms in the Davos suite shortly after. Over time, Cato and Chetwynd notice that Mrs Kort is cheerful and intelligent when they visit her in her rooms, but when she ventures out into the rest of the house she often becomes extremely forgetful and ill. They also notice that after Kort joins their practice, quite a few of their patients meet suspicious and violent ends. In the final story, Cato and Chetwynd insist on speaking to Mrs Kort alone and the truth comes out. Kort is a murderer; he murdered both to conceal what he had done to his wife in the name of research and for money. However, as horrific as these crimes are, they pale in comparison to what he did to Mrs Kort.

She explains that they met when they were both studying medicine in Vienna. She was engaged at the time, but Kort mesmerised her periodically and used his influence to persuade her to break off the engagement and marry him. After their marriage, he reveals his ambitions to his horrified wife:

He told me on one special awful night that it was his belief that every thought or motion arises, not from a spiritual source, but merely from a physical change in certain cells in the brain. He said it would be possible to prove this by stimulating these cells, so that character, moral sense, even conscience itself, and all that had hitherto been accepted as belonging to the spiritual part of our nature would be really at the mercy of the physiologist. (674)

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He says he can only prove his theory through human experimentation, and then mesmerises her and makes her his experimental subject. To test his theory, and control his wife, Kort depresses a section of bone above the area Broca linked to linguistic ability. At an ordinary level of atmospheric pressure—in London today it’s about 15 pounds per square inch—this causes extreme pain and forgetfulness and would eventually cause death. To prevent this, Kort fits her with a small metal cap that relieves the pressure on her brain; she can only survive without the cap at lower pressures—in Davos today the pressure is about 12 pounds per square inch. He makes sure she knows that if he removes the cap she will die if she is not in a pressure controlled space. Once she is established in the Davos suite he can control her by removing the cap, thus preventing her from revealing the truth about him when she leaves her rooms; in her rooms, she is under the careful watch of a nurse in his employ. He furthers her torture by telling her the details of his murders; his first murder victim is her former fiancé.

Through Kort’s experiment on his wife, Meade engages with two important scientific debates of the fin-de-siècle: the theory of cerebral localisation and the practice of vivisection. It is, of course, well-known that antivisectionists were concerned with cruelty to animals and the infliction of unnecessary pain. But even those who were not against the practice of vivisection had long had serious reservations about it. For example, according to David Agruss, Jeremy Bentham, who was not an anti-vivisectionist, nevertheless worried that if the act of vivisection did not serve ‘purely scientific ends’ it could cause problems for the vivisector and ‘For Bentham, the danger of vivisection is that it risks veering from “medical experiment” to “bad habits” and to “amusement” at the sight of suffering’ (267-68).

Furthermore, Bentham worried that practicing vivisection on animals could lead to practicing it on humans (268), a fear shared by fin de siècle anti-vivisectionists. Kort’s experiment on his wife confirms these fears are well-founded. When he first tells her he needs a human subject on which to conduct his research, she expresses pleasure in the idea that he will never be able to prove his theory because he cannot experiment on humans. That is when he reveals the discrepancy between their moral or ethical codes: he has no qualms about experimenting on her or anyone else. He seems to think anything justified in the name of research when he asks her, ‘“What is your life? … “What is the life of any woman, any man, compared to the knowledge which through you I am gradually obtaining?”’ (675). These are exactly the sorts of questions Bentham and many others feared physiologists would ask, and gothic literature in the 1890s questions time and time again. To name just a few examples, the issue is central to James Machen’s The Great God Pan, Arabella Kenealy’s short story ‘A Human Vivisection’, Bram Stoker’s Dracula, and Robert Louis Stevenson’s The Strange Case of Dr Jekyll and Mr Hyde. These texts share with Meade concerns about issues of patient consent, human autonomy, and the nature of the mind. Unlike the gothic texts, however, Meade’s more realistic narrative of Mrs Kort’s suffering has a happy ending. She is finally allowed to tell her story and Cato and Chetwynd restore her health by repairing her skull. After their restorative surgery, however, she has absolutely no recollection of her marriage or any of the suffering that followed it. Cato, in a rather paternalistic way sees this as a blessing and he and Chetwynd never tell her what she’s forgotten. There is no indication that withholding this information is a violation of her rights or of her sense of self. Finally, though Kort is hanged for the murders he committed, he is not punished for his experimentation on his wife; as in ‘Silenced’, Meade leaves open important questions about the possibility of effectively regulating medical practitioners, which leaves open avenues for research.

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