Two hundred students filled the stands …

…looking down at the revolving wooden operating table beneath the skylight high above, the patient already lying under white sheets; Ephraim and Burns adjusted their sightlines from the sixth tier. What would the surgery be?Laennec auscultating a TB patient, Paris, after T.Chartran wellcome.ac.uk

The buzz of speculation quieted as Dr Wood entered, his black silk gown fastened tightly at neck and wrist — modestly black, as he had no need to display its evidence of previous operations, unlike boastful surgeons so proud of their blood-stiffened whites. His house surgeon followed, wearing an everyday suit, its left buttonhole dangling a dozen or so waxed ligatures ready for service.

In Chapter 13 Ephraim continues and completes his three-year medical course, with training practice at Bellevue Hospital in New York, 1858-59. The surgery demo scene (thankfully not pictured above!) is historically true, as is Dr James Rushmore Wood (1813-1882). Medicine had a long way to go and Ephraim grows with it. But for now, the 29-year-old has to wait to learn what destiny his sponsors plan for him. My thanks for medical history and the image to the Wellcome Library. In 1860, a year after Ephraim’s graduation, the college changed its name to Columbia Medical School

Once his life as a medical student…

…had settled to a routine, the course of study at New York’s College of Physicians and Surgeons was intensive. The college had two main halls — the upper, with a skylight, was for anatomy, physiology and surgery. The afternoons saw Ephraim next door in the lab building, training in dissection and sciencemuseumukchemistry. His entire being — even that part of him committed to the Lord — was engaged, stimulated and challenged by the pace and breadth of learning. He thought of his father forbidding such worldly learning. He tried not to think of Mama at all.

In Chapter 12, Bellevue, Ephraim embarks on three years of sponsored medical study and training, finding friends and a new mentor but now severed from his wife and beloved Mama. It’s 1856-7 when advanced medicine relied on ‘heroic therapy’ — drastic treatments including purging, sweating and bleeding. Photo here is from the Science Museum, London, a case and lancet for opening a vein. It is dated 1792, but bleeding was the common treatment from earliest known history up into the later days of Ephraim’s practice as a physician.