Treves received his medical education at the London Hospital Medical School, where he was strongly influenced by 2 famous faculty members, the surgeon Sir Jonathan Hutchinson and the neurologist Hughlings Jackson. After a brief period in general practice, he returned to the London Hospital as a house staff officer in surgery and quickly climbed the academic ladder. He was a very effective teacher with a charismatic effect on his students. His lectures were clear, precise, and delivered with a touch of dry humor. He could control an audience of unruly medical students or entertain a crowd of street toughs. Students respected Treves for they knew that royalty consulted him at his private office and that he gave excellent care to the common man at the London Hospital. (This institution, recently renamed the Royal London Hospital, provided indigent care in a rough district of London and treated the largest number of acute surgical cases in England.)

Treves' interests ranged widely. As consultant surgeon to the London Zoological Garden, he was able to dissect many different species, some as exotic as the Sumatran rhinoceros, and published detailed reports of comparative anatomy. He was a trim, athletic man with a commanding presence and a sharp tongue. His teaching method included "a constant flow of sarcasm" directed at his students and house staff officers.¹⁰ When an assistant equivocated on a diagnosis, Treves replied,^11(p28)

The patient is not interested to know that it might be measles, or it might be a toothache. The patient wants to know what is the matter, and it is your business to tell it to him or he will go to a quack who will inform him at once.

Treves was very efficient in the operating room. He would describe each case clearly to all observers, knew exactly what he wanted to do, and did so with excellent results. A crowd of students and visitors from all over the world regularly followed him on hospital rounds. He worked very hard and would often return to the hospital on Sundays to examine patients more thoroughly than he could on teaching rounds. An exhausting bicycle ride of 40 to 50 miles often followed hospital rounds on Sundays. He was a certified master mariner who loved to sail across the channel to France, even when challenged by December weather. His students greatly admired him as a teacher and surgeon, and knew he could better them in nearly any athletic endeavor on land or sea.

His home life was simple and efficient. He would rise at 5 AM every day and write for several hours before breakfasting at 8 AM. The rest of the morning was spent in teaching and hospital rounds. The afternoons were devoted to surgery and private patients. Dinner took place at home with his wife and 2 daughters. He tried to limit hospital and medical society meetings to one evening per week. His quiet family life included one great tragedy, however. Although known as the English master of surgery for appendicitis, Treves was placed in the unenviable position of operating on one of his own daughters when 2 other surgeons demurred. Unfortunately, he operated too late, and she died shortly afterwards. He was more successful in the case of Edward VII less than 2 years later. The King then became his close personal friend and relied on Treves when making many decisions, both medical and social.

In 1907 the King developed a lesion just below the left eye, and Treves arranged for a physician with the curious name of Bismuth to remove it using electrolysis. The King held the leads in each hand, completing an electric circuit, but unfortunately no one realized that one wire rested on a gold chain he wore around his neck. He screamed out "I am being cut in half," startling everyone. Following this fiasco, Treves had the dermatologist who had convinced Sir Arthur Conan Doyle to become an ophthalmologist, Malcolm Morris, complete the removal in a pain-free manner. A piece of radium was attached to the King's spectacles for therapy over several weeks, destroying the lesion.

When Treves was a demonstrator of anatomy at the London Hospital, he was asked to write an anatomy text for surgeons. Surgical Applied Anatomy¹² was first published in 1883 and became a classic used by generations of students, with the last edition published in 1962. His publisher considered him the ideal author because he promised to deliver the manuscript of the text within 4 months, and set the date and even the time it would be completed, to the great pleasure of his editor¹³:

The promise was literally fulfilled—my first and last experience of the kind in a long editorial career. The circumstance revealed to me that one of his chief characteristics was precision—a quality I afterwards found him to exemplify in everything he did. His industry was amazing.

Treves published many articles and books on surgical subjects. He was particularly interested in unusual cases and presented many to the Pathological Society of London. The Elephant Man was his most celebrated case, but he described many others, usually publishing the reports in respected journals such as The Lancet and the British Medical Journal.

In 1921, Treves was asked to write an autobiography that would include anecdotes about many of the famous individuals he had treated. At first Treves hesitated, saying "people don't want to read my muck,"^{11(p vii)} then agreed to write the book. A few months later he delivered the manuscript to the publisher, who found it the best autobiography he had ever read. A week later, Treves called the publisher and asked him to meet at a bank and bring along the manuscript. When they met, Treves grabbed the manuscript and locked it in a safety deposit box, telling the publisher that the medical director of a rival publishing firm strongly advised him not to publish details about his patients, especially any story dealing with his treatment of royalty and the court. After Treves died his widow destroyed most of his papers, saying the public would have to remember him for the work he had done. (Fortunately, at least 2 of the chapters survived the destruction. His descriptions of medical aspects of the lives of the artist Sir John Millais¹⁴ and the actor Sir Henry Irving¹⁵ have been published.) As a consolation prize, Treves offered to write a different type of book about his patients who were relatively unimportant figures. This was the origin of The Elephant Man and Other Reminiscences,⁸ which is a mixture of fact and fiction.

The Indian Medical Service surgeon had stayed in the bungalow many times before, and always slept in the right-hand bedroom. However, this particular evening the narrator's servant placed the surgeon's belongings in that room. The surgeon did not look forward to spending the night in a room that had all the discomforts of a prison cell. He locked the door that led to the common room and bolted the door that led from the bathroom outdoors. When the only lamp was blown out, the room became pitch dark, silent, and stifling. A brief period of sleep was interrupted by the pattering of animal feet coming toward the bed and a musky odor. He heard a rat climb onto the bed, another crawl over his clothes, while still one more hit his shoehorn, creating a clatter. Finding this more than he could take, he jumped out of bed, screaming. There was a scuttle of small feet toward the drain hole in the outer wall of the bathroom. When silence resumed, he tried to go back to sleep, but the patter of feet and sickening odor returned. Suddenly a sound arose from under the bed "that made every vein in my body tingle." It was a scraping he felt was due to a belt buckle rubbing the cement floor, worn by a man crawling on his stomach. At the same time a small animal with cold paws and hot fur crawled over his bare foot. He jumped out of bed, shouted, and lit a match. The room appeared empty, but he could not see under the bed. He used another match to light the lamp which he placed on the floor. A skull-like object came into view. It was only a dried up piece of bread the rats had been dragging around the room that had made the scraping noise.

Now convinced the room was empty, he moved the bathtub to the outer wall to block the drainhole. He returned to bed and left the lamp lit. He was able to sleep again and fell into a dream that continued the evening's events. He dreamt that the bathroom door began to open and a hand emerged, followed by the body of a middle-aged Indian man, lean, sinewy, naked, and blind. The eyelids were closed and the sockets were as sunken as a cadaver. The native used his left hand to navigate along the wall and held a stone mason's pick in his right hand. The narrator realized this was the man that the surgeon had described earlier that evening. The native had learned of the surgeon's arrival, knew which room he usually occupied, and had come to murder him. Dreaming still, the narrator^8(p148)

was so fascinated by the sight of this unhuman creature moving towards me that I could not stir a muscle. . . . I was so filled with the sense of a final calamity that I felt I had ceased to breathe.

The figure crept along, his teeth glimmering and breath audible.^8(p149,150)

In another moment that awful pick would crash into my skull or plunge into my neck. . . . I was mesmerized as would be a rabbit in a corner within a foot of a snake.

The sound of the lamp flame crackling aroused him to roll off the bed quietly onto the floor, between the couch and the wall. While laying on the floor he could see the sinewy feet of the man and hear "the awful hand moving stealthily over the very pillow."^8(p151) From under the bed he seized the man by the ankles and jerked him forward, so that his head crashed on the hard floor. The doctor ran out the bathroom door onto the Indian plain where the air was refreshingly cool, the sky full of stars, and a faint sign of dawn was visible in the distance. The sense of relief was only temporary, replaced by the panic. Had he killed someone? He returned to the bedroom, where the lamp was still lit, but the man was gone. A patch of blood lay on the floor where the man's head had hit the cement floor. He awoke, feeling alarmed, cold, and tired. Finding no blood on the floor, he was relieved to know it was all a nightmare but found it nearly impossible to believe the events were not real.

The Elephant Man and Other Reminiscences⁸ is written in a style typical of turn of the 20th century British fiction. It is comparable to Sir Arthur Conan Doyle's Round the Red Lamp,¹⁷ a collection of 15 medical stories based on Doyle's experience as a physician. Even though Doyle specialized in ophthalmology before forsaking medicine in favor of fiction, his book does not emphasize eye problems. Doyle's preface can serve as an answer to critics who objected to the stark realism of the tales in Treves' The Elephant Man and Other Reminiscences.⁸ Doyle wrote "if you are anxious to make your doctors something more than marionettes, it is quite essential that you should paint the darker side."¹⁷ Doyle realized that doctors do see some beautiful aspects of life, including "fortitude and heroism, self-sacrifice and love" but felt that these attributes result from bitter sorrow and tribulation. "One cannot write of medical life and be merry over it," he stated. Doyle felt painful situations are aspects of reality and appropriate subjects for an author. Doyle thought a shocking story such as "A Restless Night" may be bitter, bracing, and more effective than a saccharine tale.

The Elephant Man and Other Reminiscences⁸ was widely reviewed, nearly always favorably. The New York Times praised Treves for his sympathy, understanding, and ability to look into "the inner consciousness of a strange company of people with emotional experiences of life common alike to the caveman and the man of the twentieth century."¹⁸ The New Republic described Treves as a good raconteur, a surgeon with a vast supply of haunting tales that were not for those with a queasy stomach.¹⁹ The British Medical Journal admired his skill in bringing out "in sharp relief some aspect of human life and character," and Treves' ability to achieve a vivid effect "with economy of language," incorporating humor, tragedy, and even terror.²⁰ The Lancet noted,²¹

Anyone who has worked for years in a great hospital must have accumulated a store of facts dealing with various aspects of human nature in which the pathetic and the comic are intimately blended. Few, however, put their recollections into print, and fewer could do so with the blend of humour and charity

of Sir Frederick Treves. In the case of the Elephant Man, Treves had a true story that simultaneously repelled and attracted the public, for Merrick was a spectacularly ugly man with an engaging personality. Capitalizing on the theme of sympathetic ophthalmia, Treves was able to develop a totally different medical subject into an entertaining horror story.