11 August 1881

The Beranger, a coffee house, was evidently a favourite meeting place for university students. Dark and musty, it was packed with young people drinking and smoking. There were no empty tables and no Vera.

Then, I made my way through thick tobacco smoke to the stairs and up to the second floor. There she was, at a table overlooking Nevsky Prospekt, St. Petersburg’s main street. Vera looked as she did that night when I was with Dostoevsky on the ship, but she was calmer and more refined. She was with three men, one of whom was the sour, stocky, red-headed fellow with the beard whom I had met on the Servia.

“Ah, Dr. Doyle. Welcome. Please, sit... Are you enjoying your stay in our fair city?” she asked.

“Yes, I love the architecture. Reminds me of Paris,” I answered.

“Ah, so have you spent a lot of time in Paris?”

“No, but I have read a great deal about Paris, and St. Petersburg reminds me of what I think it would look like.”

“Peter the Great yearned for this city to rival Paris in its beauty. If only the modern tsars were as enlightened as Peter.”

I had only a moment to order tea when the red-bearded one fixed me with piercing, green eyes. “You were present when Foley died, yes?” he asked.

“Yes.”

“What were his last words?”

I had to think for a moment, and then remembered his words. “He said something very strange. He mentioned a Dr. Hutton and no God and the end of the old regime.”

“He said this?”

“Yes, but his final words were, ‘Tsar die.’”

Red relaxed for a moment. “He was one of us.”

“Silence!” Another student, a slight, owlish fellow with round, dark glasses, raised his hand. “How do we know we can trust this damned Englishman?”

Vera interjected on my behalf. “He saved Dostoevsky’s life.”

“Bah. That old man can write, but sometimes I question his loyalties, too.”

“And this boy’s people, the Irish, were persecuted by the English Crown. He has a natural sympathy with our cause,” Vera said, as she put her hand on top of mine.

“Aye, I have Irish blood, and aye, I am a friend of anyone who befriended my Uncle Declan.” I said.

“I like this Irishman! I am Sviazhky. Welcome to Russia. Lt. Foley was your relative?”

“Aye.”

“Any relative of Foley is a friend of mine.” Red embraced me with a bear hug. “I had a good feeling about you since I first laid eyes upon you. Your uncle was studying our Russian people and intended to go among the peasants, disguised as a priest, to explain Darwin’s theory, debunk God, and stir up the serfs against the church and the tsar.”

I was more perplexed than ever. “But he was an English military officer who fought against your country in Afghanistan. I don’t understand.”

“He knew he was fighting the tsar and the nobility, not the people. He swore vengeance and joined our group in London.”

“What exactly does your group believe?”

“For our revolution to succeed, we must break the peasants of their habit of obeisance to the church and the tsar. They actually believe that he is anointed by God and this belief must be destroyed.”

I nodded and glanced at my watch.

“I apologize. Dr. Bell is giving a demonstration at two,” I said. “Sorry, but it will not look good if I am late. I should go, but hopefully, I will see you there.”

When I arrived at the medical school lecture hall, distinguished physicians and the school’s faculty were seated in the front row. Sun poured in from a skylight and lit the space. The walls were whitewashed and the tile floor showed old blood stains. Glass-fronted cabinets held surgical instruments and rolls of gauze. As in Edinburgh, the room was both a lecture hall and operating theater. What seats were still open rapidly filled with excited students, as motley a bunch as my Edinburgh classmates. Vera and her group sat down near the center, surrounded by roughly-clad young men from the country. Furthest in the back were rather elegant, bored, young aristocrats.

I sat with Dr. Bell in the front row, still at somewhat of a loss to explain my encounter with the young anarchists. Professor Sechenov stood behind a podium and spoke in French. In fact, all the students and faculty spoke French in class.

Sechenov removed his pince-nez and peered at the audience. “Our first patient is paralyzed by a spinal cord tumor. I have invited Dr. Joseph Bell, an esteemed Professor of Surgery at Edinburgh Medical College, to perform the operation. Dr. Bell, if you will...”

Dr. Bell went into the cockpit. I followed to assist or give the anaesthetic, but was immediately anxious. Operations for spinal cord tumors were rarely, if ever, successful. Was this a cunning Russian trap to make a foreign doctor look bad? I had thought Dr. Bell would teach and maybe see some patients, but I had no idea we were about to engage in major surgery.

The patient, on the wheeled stretcher, was an attractive woman of perhaps thirty years. She was on her back, covered with a sheet. Dr. Bell was clearly not prepared for surgery, and I wondered how he was going to handle this unusual situation.

“Good afternoon. May I have your name, please?” Dr. Bell asked.

“Lydia Sorokina,” she answered in a low-pitched, barely audible voice.

“Miss Sorokina, how long have you been paralyzed?”

“Almost three weeks.”

The professor drew back the sheet, exposing her muscular legs. He examined the soles of her feet and barely touched a callous on her great toe.

“You are a ballerina?”

“Yes, I danced with the Bolshoi,” she whispered. Her eyes filled with tears. “Today, I can no longer dance, and that is why I am here. It is my dream to dance again.”

The professor palpated the muscles in her thighs and calves and struck the patellar tendon at the knee with a reflex hammer. The lower leg responded normally with a jump. Next, he held her ankle and tapped the Achilles tendon. At each tap of the hammer, a muscle contracted and her ankle flexed. He stroked the sole of her foot; the great toe turned down, a normal Babinski reflex.

He then checked her sensation with a long needle. There was no response to a light pinprick or even when he drove the needle a half-centimeter into her skin. She did not flinch.

“Dr. Doyle, would you determine the level of sensory loss?”

I hesitated, then pulled the sheet below her waist, exposing her breasts. The young students in the gallery whistled and made lewd remarks. Professor Sechenov silenced them angrily. “Enough of that, please!”

I overcame my timidity and, commencing at her thighs, first touched her skin with a wisp of cotton, then with a sharp pin. She made no response until, at the level of her umbilicus, she winced at the prick of pin. She had no sensation below the level of her umbilicus. The level of sensory loss had no connection to the nervous innervation but was in a perfect ring around her body and, seemingly, bore no relation to her muscle paralysis. I was completely confused.

Dr. Bell watched her responses with lowered eyelids while a mere hint of a smile played over his lips. It was then that I knew he was up to one of his old tricks.

Suddenly, he upended the stretcher. “Dance again, young lady,” he said.

Had Dr. Bell lost his mind? The students and faculty sucked in their breath as the surprised young woman slid off the stretcher and landed on her feet.

For a second, there was silence. Then, she gathered the sheet about her breasts and shook her fist at the professor. “Damn you!” she shouted.

She walked out on her own two feet and left by the side door. There was much chatter amongst the audience. “Gentlemen, please, quiet down. This is a case of hysterical paralysis. Clearly, there was no need for an operation.”

Many of the students clapped and cheered. Dr. Bell had done it again. Under pressure in a foreign city, he had displayed his mastery of the entire field of medicine and, indeed, the science of psychology.

The professors in the front row were silent until Sechenov stammered a few words. “How did you make that diagnosis?” he asked.

Bell cleared his throat and raised his hand to his chin. “In cases of spinal cord injury or tumor, the deep tendon reflexes of the legs, mediated by the lumbar and sacral nerves, should be absent. Her reflexes were hyperactive, suggesting an emotional state. The loss of sensation to the level of the umbilicus, as demonstrated by my associate, Dr. Doyle, bore no relationship to the normal patterns of the thoracic nerves. Gentlemen, if you enquire closely, I wager you will find a psychological reason to explain why the patient cannot dance.”

Dr. Sechenov tapped the lens of his glasses against his thigh. “Yes, she was dismissed from the Bolshoi a day prior to the onset of symptoms.”

Sechenov restored order with a glance and cleared his throat. “Next, Dr. Bell has been so kind to agree to demonstrate the anatomy of his operation for joint excision on a fresh cadaver.”

Surgeons have often practiced and demonstrated operations on cadavers because it is easier to identify bones, nerves and tendons without the constant flow of blood to obscure the anatomy. This corpse was covered with a shroud, except for his ankles and feet. With a great sense of self-importance, I opened the instrument case on a table and arranged the scalpels, chisels, hammers, probes, and forceps, as if for a real operation. It struck me as unusual that the skin of the ‘patient’s’ feet did not exhibit the usual lividity of death, but was absolutely dead white. I was not sure what to make of the strange pallor.

The professor removed his coat, rolled up his sleeves, and, rather dramatically, took up the razor-sharp, steel scalpel in his right hand.

“If this was an operation, instead of an anatomical dissection, we would first prepare the skin and all instruments with a solution of carbolic. However, since this man is deceased, it is not necessary.”

He then applied the knife and incised the skin from the lateral malleolus of the ankle down the lateral side of the foot. There was an immediate muffled groan, and then a piercing shriek as the ‘patient’s’ foot lifted from the table.

“Good God!” Dr. Bell stepped back and, with a single motion, applied the scalpel to the cloth and opened the shroud. He exposed the face and torso of a strongly-built, middle-aged man. His colorless lips were drawn back in a rictus of terror.

“Heavens, the man is alive!” Dr. Bell shouted. “What is the meaning of this? Is this some type of prank?”

“No, no, no. I apologize.” Professor Sechenov’s face went livid. He turned to his assistant. “Pavlov, this is an outrage. What is going on?”

“He was the subject for this morning’s experiment; we removed all his blood. He should be dead. Dead!” Pavlov exclaimed.

With that declaration, the patient’s head jerked up and down. His eyes closed. He shuddered and then became completely still. His skin was white as fresh snow, and his lips were colorless. If he was not dead when he was wheeled in, he was truly dead now.

“I am appalled.” Dr. Bell lifted the right arm of the deceased. “What is this?” There was a long incision down the medial side of the arm and the brachial artery was severed. Bell sniffed at the man’s mouth. “It appears as if some damned criminal performed surgery on this man without anaesthesia. What in heaven’s name is going on here? This is barbaric!”

“Let me explain.” Dr. Pavlov was perfectly at ease. “I am a doctor and not a criminal. I injected cocaine into the skin this morning. The operation was completely pain free. I drained blood from the artery for my work on blood coagulation. This man was found guilty of plotting against the tsar; he chose to be an experimental subject, rather than face torture and a military firing squad.”

In an instant, Dr. Bell’s rage gave way to his keen scientific interest. “Wait, did you anaesthetize the skin, rather than administer ether or chloroform?”

“Exactly! German chemists have isolated the active ingredient of the South American coca leaf.” Pavlov held out a small container of a white powder. “Test a bit on your tongue. Your entire mouth will go perfectly numb.”

Dr. Bell applied his index finger to the powder, then placed it on his tongue. “Yes, by God, my tongue is completely numb!” he exclaimed, after a moment. He bit down and drew blood from his tongue. “By Jove, Doyle, we must try this new drug. It will revolutionize surgery!”

Pavlov shook with excitement. “Simply dissolve the powder in water and inject the solution into the skin. The patient will feel nothing.” Pavlov gave the container of cocaine to Dr. Bell. “Here, Doctor. Test it.”

Dr. Bell placed the vial in his jacket pocket and then appeared as if all was normal. I thought, for sure, he would refuse to continue a sham operation on this newly-deceased man, but Bell didn’t think twice about going ahead.

“Well, gentleman, since our subject is now truly dead, we will proceed,” Dr. Bell said. And, just like that, he continued.

Dr. Bell was a church deacon and highly ethical. This was totally out of character for the professor. Had the cocaine affected his judgement?

It seemed as if his love of science blotted out his finer instincts. Had his moral principles had suddenly deserted him? He lectured as he dissected and demonstrated the anatomy of the foot and ankle with unusual brilliance.

I was horrified and repelled by Bell’s display, but the others were taken in by his charisma and brilliance. The audience was truly captivated.

At the end of the demonstration, in late afternoon, Bell was mobbed by professors and doctors from all of St. Petersburg who excitedly begged him to dinners and to see their patients in consultation.

I was sickened. The more I watched these great men of science, the less I wanted to be a doctor. I had worked my whole life to become a man of medicine, but here was the heartlessness of pure science. I wanted no part of it.