Considering his contribution to the worlds of medicine and of letters, there are surprisingly few traces of The Lancet‘s founding Editor Thomas Wakley (1795–1862) in English literature. He receives a mention in George Eliot’s Middlemarch (“I disapprove of Wakley…he is an ill-intentioned fellow”, complains Dr Sprague, the town’s senior physician, who identifies the reforming Dr Lydgate as a Lancet fan); he has three biographies, none widely read today; and is the subject of a clutch of articles, largely focusing on his Lancet years. Nick Black’s imaginative new novel, Bare-knuckle Surgeon, aims to remedy this situation, exploring “why, at the age of twenty-eight, [Wakley] embarked on a venture that in all likelihood would lead to ostracism from the medical establishment if not the whole profession”.
Black, who has had a distinguished career in the UK involving health services research and policy, picks up the story in 1811, with Wakley supplementing his income as an apprentice apothecary in Taunton, UK, with a side-career in boxing; the book ends with the publication of the first issue of The Lancet in October, 1823. This is a period in Wakley’s life of which fairly little is known. Black fills in the blanks with informed speculation about Wakley’s journey from rural Somerset to the heart of London, and the personal and professional frustrations that fuelled the combative approach of his journal.
Black’s Wakley is framed from the start as a fighter; we first encounter him hauling himself to his feet to win a match against a tough opponent in the ring. This aspect of his character, the author suggests, was formed through conflict with his stern father, a farmer, and his service, aged 11 years, on a ship bound for India. Wakley’s entry in the Dictionary of National Biography notes that Wakley never spoke of his time at sea, but that his experiences might have informed his later campaigns against brutal corporal punishment in the armed forces. Black’s fictionalised version of Wakley’s nautical period is certainly full of misery and disaster, as well as an emerging consciousness of social injustice, and a resolve that “No-one was ever going to bully me or humiliate me again.” However, plenty of humiliation is still in store for young Wakley, whether it is at the hands of his dishonest first employer, the surgical establishment in London which freezes him out professionally, or the insurance company that claims Wakley is responsible for a near-fatal assault and arson attack on his own home.
This story of Wakley’s life is plausible in its historical detail and Black’s research is immaculate throughout, but a more seasoned novelist might have made more of the ambiguities in his character. Bare-knuckle Surgeon portrays a Wakley driven by righteous anger, whether at the privileges of social rank or the professional code that, as shown in one memorably horrible scene, leads to botched operations and ruined lives. “I’ve no choice. Maybe it’s what saints say is a calling”, he says at one point. However, it is also possible that Wakley was inspired by personal resentment at being overlooked professionally, and even by commercial savviness. Of course, Wakley deserves to be lauded for his literary and political vision; however, a less straightforwardly heroic protagonist might have led to a richer, more satisfying novel. Secondary characters and dialogue could also have done with more depth.
Bare-knuckle Surgeon‘s strengths lie more in its portrayal of the ferment of Georgian London, a time and place of social and intellectual achievements that still dazzle, as well as violence and horrors that seem utterly grotesque to the modern reader. Black emphasises, rightly, that Wakley’s achievement in founding The Lancet was not only reflective of medical science, but also of the broader political and artistic landscape. He posits a role for Wakley’s wife, Elizabeth, in shaping The Lancet‘s engagement with culture. “Men like Byron are fighting the establishment and tradition too”, she tells her husband. Whether or not this is historically truthful, it does acknowledge the contribution of women, as writers and readers, to the literary milieu of early 19th-century England, and is a welcome element of a tale set in an otherwise male-dominated world.
The final pages of Black’s novel, as Wakley waits for The Lancet to emerge from the printing press, are particularly rich in atmosphere. Black points out the many reasons why The Lancet should not have succeeded—including its gruelling weekly schedule and the antipathy of the medical profession—before a copy of the new journal, still warm, arrives in Wakley’s hands. It is a moment fraught with the equal perils of failure and success. Bare-knuckle Surgeon will appeal to readers who are interested in the history of The Lancet, the life of Wakley, and medical practice in late Georgian England; while it does not completely succeed as a novel, it makes a convincing case for Wakley’s journal as both a pioneering publishing venture, and an embodiment of the spirit of the age.
Lancet 2026;407:751