Paul Johnson

An operation for fistula and its creative aftermath

An operation for fistula and its creative aftermath

My book Creators was finished some weeks ago and whizzed off to the publishers without my having fixed on any theory of the creative process. But the problem continues to nag at me. Take this example. In October 1841, Dickens was operated on for fistula. This piece of surgery was then horrific and extremely painful, performed without anaesthetic, of course, and often unsuccessful. Macvey Napier, editor of the Edinburgh Review, told Dickens that he had twice been ‘done’ for fistula but twice ‘bungled’, and only on the third shot had it worked: ‘My flesh still creeps at the recollection.’ Dickens was lucky for his surgeon was the remarkable Frederick Salmon (1796–1868) who, despite opposition in his own profession, opened in 1835 his ‘Infirmary for the Relief of the Poor Afflicted with Fistula and the Diseases of the Rectum’ (it is now St Mark’s Hospital). Working over 20 years almost single-handed, he carried out more than 3,500 such operations without a single fatal result. There ought to be a book about him. The operation on Dickens was, characteristically, a success. But the patient said, ‘I suffered agonies …and did violence to myself in keeping myself to my seat. I could scarcely bear it.’ He made a remarkably rapid recovery all the same, though for a time he could not hold a pen and had to dictate his work to his wife, Kate.

Dickens described vividly to his friend Forster the business of getting back to work after his ‘terrible, frightful, horrible experience’, adding he hoped to be forgiven ‘for thinking it a wonderful testimony to my being made for my art, that when, in the midst of this trouble and pain, I sit down to my book, some beneficent power shows it all to me, and tempts me to be interested, and I don’t invent it — really do not — but see it, and write it down.’

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