from The Queen's SurgeonDrottningens chirurg (The Queen’s Surgeon), published in 2006, is the first part of a trilogy that continues with Kungens komediant (The King’s Actor, 2007) and Syster och Bror (Sister and Brother, 2009). Agneta Pleijel found inspiration for the books in documents, letters and the stories of her own family.

This first part of the trilogy tells the story of Herman Schützer, surgeon who attended Queen Lovisa Ulrika. It is set in a poor, dirty, stinking Stockholm of the eighteenth-century that in some ways has not moved on from the Middle Ages. Medical science, too, is stuck in medieval times, and as a pioneering surgeon, the ambitious Dr Schützer is blocked and opposed by ignorant or jealous colleagues, many of whom question the validity and importance of surgery. His fascination for the secrets of women’s bodies is viewed with great suspicion, not least by his young wife Nella. We must remember that this is a time when cutting open a body was considered obscene. But by the end of the scene below, the doctor has performed Sweden’s first Caesarean operation, mother and baby appear to be doing well, and Sweden has embarked on its course to become a leading player in the field of surgery at the time.

Fragile friendship, male vanity, royal disfavour, and insatiable ambition all play their part in this novel, which in the words of Mats Gellerfelt, writing in Svenska dagbladet, is ‘borne aloft by the simple yet refined imagery that is Pleijel’s hallmark’.

Ann Lingebrandt (Norrköpings tidningar) sees The Queen’s Surgeon as ‘treading the same ground to which P. O. Enquist returns in novel after novel: the border zone where science merges with superstition, sense with prejudice, where love collides with convention and high-flown theories’.

 

Pleijel’s omission of speech marks has been retained. It is a device increasingly often used in both Swedish and British fiction today. Both Pleijel and her translator agree that the occasional ambiguity this device creates can be both enriching and confusing.

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Prologue

(Maria Charlotte)

One Sunday after morning service a boy knocked on the door of the house of Herman Schützer, an obstetrician well known in Stockholm in his day. The boy was thinly clad and so agitated that he tripped over his own feet and stammered. A woman was in labour in Little Tvärgränd lane. The doctor must come at once. A matter of life and death.

Whose life? asked Schützer.

Both, panted the boy.

Schützer blinked at the snow flakes. It was still only November but it was snowing, and the thin carpet of snow that was settling on the roofs would give no warmth.

Sunday’s a day of rest, he said.

The mother’s very small, said the boy. She’s a dwarf.

When Schützer heard that he didn’t hesitate. Anything unusual and complicated tempted him. He had his coat brought.

 

The boy ran ahead through the alleys. He called back over his shoulder that at dawn the midwife had sent for Assessor Effer, who had come after a while but had no idea what to do; Effer had told the boy to hurry to the consultant Dr Schützer and ask him to come.

Schützer’s sense of anticipation grew; the thought of difficulty focuses one’s concentration.

He held his hat to his head and increased his pace. When he entered the apartment - it faced the courtyard and had several rooms with a fire burning in the largest of them - the woman was lying like a great swollen globe on the dining table. She was certainly very small, her stomach enormous. As he came in she screamed; it was like the cry of a diving-bird.

Effer was standing by the table with his hands on her belly. Schützer fought for breath. He told the assessor to get out of the way and palpated the woman. The baby was fully developed. Without giving himself time to take off his coat he pushed the bedcover aside and examined the mother. The opening to her birth canal was about the size of a small gold coin. He could hardly get two fingers in.

But even when the passage widened towards the coming of full day, it was still too narrow. He pulled off his coat and looked round the room. The ceiling was low and a lot of people had gathered: clearly neighbours standing round the walls, mostly women and staring children.

A white-haired woman, who seemed to be the mother of the woman in labour, seized Schützer’s hands between both her own and pressed them hard, her eyes pale with distress. He nodded to reassure her. By the fireplace he could see a young man with flushed cheeks and staring eyes, presumably the father. He turned back to the woman in labour and laid a hand on her sweaty brow. Her nutbrown eyes were wide open.

Dear Mister Doctor, please save my baby.

Schützer bent over her. What’s your name, child?

Maria Charlotte.

Are you a brave girl, Maria Charlotte?

Yes, Doctor. Just save my baby.

Schützer smiled weakly and stroked her brow.

You’re going to have to put up with a great deal, he whispered.

 

He fetched the bag he had left by the door. At the same time he noticed the home was well-kept and objects like jars, bottles and plates were all kept low down so the little woman would be able to reach them.

He gave a low whistle between his teeth as always when he hadn’t yet decided what to do. A tune came to him, a French song he had learned a long time ago in Berlin from the Huguenot refugees he had looked after in his youth at the Charité hospital. He had almost lost the melody, but now it came back to him. No one in the room said anything. The fire shot out a spark.

Assessor Effer was silent. The woman in labour never took her eyes off Schützer.

She would die trying to push the baby out. Or they would have to cut up the baby in her womb with scissors and try and pull out the pieces with forceps. They would have to decide which life to save. There was also a third possibility. Schützer had read about it in books. It had apparently been used once or twice in Sweden but never successfully, and he himself had never had occasion to try it. He made up his mind.

There’s only one thing to do, he told Effer in a low voice. A Caesarean operation. At that Effer looked up quickly and shook his head.

 

After a short discussion in the entrance hall, quiet but vehement, Effer let himself be persuaded. It was at least a chance to save two lives rather than one and avoid having to decide which. They agreed it was essential to seek as many other opinions as possible; any surgical victory would be a political victory too.

Effer went off with the boy to fetch as many doctors as could be called out on a snowy Sunday like this. Schützer took a short walk in the whirling snow.

Some say this is how the famous Roman Julius Caesar came into the world. The historian Pliny takes it for granted. Bayle believes his description to be unconvincing. But Pliny has given the operation its name; and since his time it has been accepted as a fact that Julius Caesar was born when his mother’s belly was cut open.

His mother Aurelia survived too, for many years, not dying until after her son had crossed the Rubicon.

If this operation worked it would be a huge step forward for surgery as an art. Schützer belonged to a forward-looking school of thought and science (one day he would publish his description of this Caesarean operation in the Proceedings of the Royal Academy of Sciences).

 

The snowstorm thickened and he turned back. Effer returned with Acrel, Pfiffer and Martin. Schützer was relieved to see Olof Acrel, who though sharp-tongued and sarcastic and not altogether easy to deal with, had a great reputation as a surgeon and held a professorship. Barber-surgeon Pfiffer he knew well; a man somewhat given to drink but skilful with his hands and, as luck would have it, on this occasion completely sober. He had never before seen Martin, a physician in ordinary, who was the only one to smile as he came into the room.

They spent a long time carefully palpating the woman’s belly.

They consulted in the entrance hall and agreed: it really did look as if two lives might be saved instead of just one. Acrel started talking about a complicated birth he had recently attended during which the mother had died. Schützer stopped him before he could finish. For the dwarf woman’s sake. She must believe in a happy outcome, and so must they all. Acrel nodded and didn’t protest.

But the woman would have to call on huge reserves of courage, they all saw that.

Schützer told Maria Charlotte briefly what the operation would involve. She did not need to think about it.

Just save my baby, she said again.

The father was a thin-haired foreigner called Jacob Tissermann, German or Danish; he was standing at the window with his hands behind his back. It was clear he was fond of the woman. He was ill at ease, but only the twitching of his fingers behind his back betrayed it. Dusk fell.

The snow beat against the window like blind birds. Between contractions Maria Charlotte kept calm and cheerful. Taking turns to insert their middle fingers into her, the gentlemen could feel the contours of the baby’s thrusting skull.

 

When the moment came, Schützer was aware of great tension throughout his body and felt small needles pricking the palms of his hands. He tried to steady his breathing. They carefully turned Maria Charlotte on to her right side. Her wide eyes shone.

Pfiffer and Effer pulled her flesh together to make a pad; Schützer took the knife and made an incision in the left side of her belly.

Maria Charlotte was unbelievably brave. She hardly uttered a sound when the knife pressed into her. Acrel and Martin held her intestines back with their bare hands. They could see the membranes of her womb, bluish and shiny, in the flickering light of the candle.

As they suspected, her waters had broken.

Now it was Acrel who took the knife. Schützer felt great anxiety for the foetus but managed to calm himself with the help of the little French song which had settled so firmly in his head that he had no need to whistle or sing but only to follow it.

Acrel cut with the finesse of a tailor. Maria Charlotte whimpered but did not scream. The foetus came into view. It seemed asleep with its eyes closed and its hands held together as if in prayer. Pfiffer and Martin lifted it out of the pelvis. Professor Acrel cut the navel-string. Schützer gave the child a slap to fill its lungs with air and they heard it welcome the world.

The grandmother wept as she took the newborn babe in her arms.

Martin took charge of the afterbirth and rinsed coagulated blood from the womb. The child was a girl, very like her mother, with a big head and curved limbs. While all this was happening, Schützer wrote later in the Proceedings of the Academy, I was amazed by the extraordinary courage of the patient, who never let the smallest sound escape her, but while the navel-string was being tied asked cheerfully if it was a boy or a girl.

A little girl, whispered Schützer gently.

At that Maria Charlotte gave a great uninhibited laugh.

 

While they were sewing up her belly, the father took Maria Charlotte’s hands in his own. Whimpering behind closed lips like a puppy, the new mother looked round the room with her nutbrown eyes.

When they had stitched her belly together they smeared it with hot rose oil mixed with wine vinegar and laid compresses with the same medicaments on the stitches. Then with the greatest care they lifted the newly operated woman from the dining table to the bed in the alcove. She remained unceasingly cheerful. The doctors agreed in prescribing a cooling emulsion, and directed that nitrous powder should be applied before night.

Maria Charlotte, said Schützer sternly before they took their leave.

Yes? said the woman and looked up; she was rather pale.

You are a woman of remarkably sanguine temperament, but now you must try to keep still.

Yes, yes! Maria Charlotte looked up into his eyes. She would keep still.

 

They separated outside the house in Little Tvärgränd lane.

Of course there may be complications, that’s natural, said Acrel, but if the child is a strong as it seems, everything will be fine.

They all praised the woman’s courage.

Even a soldier having his leg cut off couldn’t have been braver, declared Pfiffer. But that’s how it is with women, he added. When a lot depends on it, and the child can be saved, and there’s no alternative, a woman will fight like a lioness.

Schützer turned for home.

The snow crunched under his feet. But it had stopped falling and the night was starry and light, especially directly above his head, so he had no difficulty finding his way. He sent thanks up to Heaven for having allowed him to be the first in Sweden to perform a Caesarean section. The historian Pliny must be celebrating in his grave.

 

Sunrise found Schützer sitting humming at his harpsichord.

The French chanson the Huguenots had taught him during his year of travel in Europe - the song that had helped him in the night - unrolled itself, word for word, every verse of it. His wife Petronella, who had heard his description of the dwarf woman giving birth, was listening. After a while she laid her soft arm round his neck. He was extraordinarily happy and sang out at the top of his voice.

Then he went off to tell his father what had been happening.

 

Herman Schützer had been born in Stockholm of German descent. His father Salomon Schützer had come there from Danzig in 1701. As a young man Salomon had joined the Swedish army on the north coast of Germany where his own father had been commandant of a fort.

As a beard-clipper.

In German Bart, In Plattdeutsch barde, In Dutch baard, in English beard and in Latin and a whole lot of other languages barba. The Swedish king Gustav Vasa had decreed that the beard-clippers should enlist with the colours. In 1571 it was laid down among their privileges that the beard-clippers’ guild should supply manpower to the navy and army. Men of every language enrolled in the Swedish armies.

A beard-clipper’s duties extended beyond the clipping of beards. Just as often he cut off ears and noses. Or rotting legs and slashed arms. He tried to help those whose mouths had been destroyed to drink. And those shot in the lower back to defecate painfully as best they could.

When he reached Stockholm, Salomon enrolled in the guild of barbers as a journeyman. Some years later he distinguished himself as a barber-surgeon in Stenbock’s army, and after the Swedish victory over the Danes he was promoted to General Staff Surgeon.

In Stockholm he bought the privileges of a dead barber-surgeon of the city and became anatomiae et chirurgiae operator publicus (which meant dissecting corpses in the presence of a paying public), and in due course head of the Society of Surgeons, whose function was to protect the guild from quacks and unscrupulous medical men.

Surgeons trained in war like Salomon Schützer have quite often developed their sense of touch until their hands have become as sensitive as their ears and eyes.

It was from his father that Herman Schützer learned his craft.

 

As a boy Herman had travelled winter and summer at his father’s side everywhere from debtors’ prisons to common lock-ups. He had practised using the knife on ulcerated chilblains and tumours, swellings, bumps and fistulas. He had helped at the female workhouse and house of correction when women young and old, dead and alive, were cut open. Nothing excites more interest than the inside of a woman.

That was the secret source that had not yet been explored. It was his habit to tell his father, now elderly, all about the more notable surgical operations he was involved with.

It delighted him to be able to tell the story of his Caesarean section. Not even the thought of his battle with the physicians put him out of humour, those venomous physicians who regarded the inside of the body as their own territory and elbowed surgeons aside.

Calling them quacks.

And upstart barbers or worse. But from having been at one time a despised craft performed by hangers-on in the wake of the armies, surgery was now respected and coming near being accepted as a science. Surgery threw a bridge between body and soul. It was Herman Schützer’s firm view that everyone must learn to co-operate with everyone else, even physicians with surgeons. All knowledge must be united and the dark shadows surrounding humanity dispelled.

But birth is the most difficult thing of all. And for that reason it deserves our greatest interest.

 

He had already been fortunate enough as court surgeon to attend Lovisa Ulrika when she gave birth for the first time. It had been a difficult birth though it produced an heir to the throne, Gustav. The Queen, still Crown Princess at the time, had been terrified and kicked out wildly.

She had screamed with fury and hit out at the doctors, obstructing their attempts to help her. She had fought back when she should have given way. No thought of the baby but only of herself. This despite the fact that they were standing round encouraging her and pleading with her. In Schützer’s outspoken opinion she herself had been responsible by her behaviour for the distortion of the prince’s forehead and the weakness of his leg. While little Maria Charlotte had been braver than a general.

By comparison with hers, the Crown Princess’s confinement had been nothing and any problems mostly caused by the Crown Princess herself.

No sooner did he think of Maria Charlotte than he could hear the music again.

Ships were lying close by the quayside with their sails furled. Gulls were screaming and whirling about the sky. Snow was lying deep on the ground but no more was falling. An easterly wind was gusting intermittently from the sea. Out among the seaward skerries, blue-black clouds clustered above the horizon and drove towards land. Everything seemed to indicate the wind would get stronger.