From Hell

“From Hell. Well, at least he got the address right” Sergeant Peter Godley reading the return address on a package sent

by Jack the Ripper [[1]]

When I received an invitation from Western Michigan University Honor History College Students to attend and critique the film, From Hell (2001, Metro Goldwyn Meyer), I must admit that I was not terribly enthusiastic about this opportunity. As I inquired with my colleagues about the film, none of them were knowledgeable about it either and did not realize that the film was based on the well written and exceptionally graphic novel by Campbell and Moore.

The students provided me with some additional details on the film and the audience the film was addressing. Even though I have enjoyed some of the excellent work of Johnny Depp, a gifted actor, and recognized the name of the two talented directors, brothers Allen and Albert Hughes, I was still not convinced of the social and historical value of this eviscerating film. At this point, if I was going to accept the invitation, I wanted to address the positive aspects of this work. What I did value was the possibility of a historical review of 19th century England and the status of medicine during these times. These two reasons alone convinced me that I should commit myself to this project and provide my limited expertise to the students.

Once I had accepted the invitation, I began my quest for reviewing all information pertaining to this film, which portrayed the misadventures and horrible events associated with the crimes perpetrated by Jack the Ripper. My main attention for this film was focused on finding possible benefits within the context of humanism and medical history to transmit to the students and later on to surgical residents.

Before analyzing the emotional message provided by this cinematic experience, we must understand and study the full extent of the educational part of this narrative. We must review this film in its entirety. We must persist in corroborating facts, truths, and untruths in order to examine the impact of this bold story.

The film opens in 1888 London, in the Whitechapel district, where extreme poverty, unsanitary conditions, a filthy environment, and a perilous and untrustworthy atmosphere was the standard for the area. Many characters appear on screen, including the victims who were sacrificed by the fury of the surgical knife, equivalent in those times to Liston's Knife, named after Robert Liston (1794–1847), great Scottish surgeon of amputation fame. The film continues with the opening of the abdomen and the extraction and stealing of many organs, including the ovaries and uterus, among others. As the movie progresses, it becomes apparent that the perpetuator of these crimes had to be “somebody with a working knowledge of dissection,” someone who had possibly used an amputation kit or was knowledgeable through other trades such as “a veterinarian or an educated butcher or somebody with knowledge of human anatomy” [[1], [2], [3]].

Throughout the course of the movie, Inspector Abberline, expertly portrayed by Depp, shows us that his dreary Laudanum (opium) dreams give him some of the answers related to the “unfortunate” ladies' crimes of Whitechapel. Mary Kelly, played by Heather Graham, is a lady of the street. She grows close to the absinthe opium saturated inspector and gives him reason to believe that she would be the last of Ripper's horrendous crimes. At the end of the film, she is in fact murdered, and Abberline commits suicide through one of his incredible dreams.

Two eminent surgeons enter the scene, Sir William Gull, the old master and physician to Queen Victoria and Prince Edward, and Dr. Ferral, the young star, who is performing the extraordinary surgeries of the brain, called lobotomies, for the treatment of insanity. The whole operation of lobotomy is clearly presented, including patient selection, anesthesia with chloroform, the patient's restraint, and the actual surgery. According to Sir William, this surgery is a revolutionary operation that could alleviate human suffering. Sir William implies that, because of lobotomy, the treatment of insanity is a problem of the past, violence can be controlled, and the lives and futures of these individuals are secure. In reality, that was not the case since lobotomized patients remained in a vegetative state and could hardly be active members of society. Instead, they were restricted to a prison-like life.

In the middle of the whole story, we have the critical involvement of the Free Masons. Gull, Ferral, the police chief, and many of the most prominent personalities form an integral part of the order. They help and protect each other. In multiple ways, they exert an extraordinary influence in the lives of many members of society. They swear secrecy and full respect to the aspirations of the group. In the final scene, Gull, the distinguished surgeon and elevated royal professor, is discovered to be the Ripper, the assassin of innocent human beings. Once considered a noble citizen and a preserver of life through the practice of medicine, Gull is now seen as a destroyer, a killer, and a robber of the precious gift of life. When he faces the Free Masons' Court, the following exchange takes place [1]:

• Masonic Governor: You stand before your peers, masons and doctors both.

• Sir William Gull: I have no peers present here.

• Masonic Governor: What?

• Sir William Gull: No man amongst you is fit to judge … the mighty art that I have wrought. Your rituals are empty oaths you neither understand nor live by. The Great Architect speaks to me. He is the balance where my deeds are weighed and judged … not you.

Moments before, Sir William had proudly indicated, “One day men will look back and say I gave birth to the twentieth century” [[1], [2], [3]]. Immediately after the intense interaction with the court, he is condemned to be treated by lobotomy. We next see him in an isolated room, in a curled position, in a permanent vegetative state. Meanwhile, Mary Kelly, the secret love of Abberline, is found dead. As the last victim of Sir William Gull, her body is completely destroyed. A continuous and extended tragedy; a tragedy without compare; a tragedy that should remain nameless; a tragedy that can not be described.

Now, in a practical way, what can we learn from these events and personalities? How can we convert the events described on film into something real? Can we find hope and understanding? Up to what point can we use the lessons of this story to teach and learn? Is it possible for us to transfer these developments to the medical and surgical world? I believe we can, and let me explain to you how.

These bizarre and absolutely disgusting murders are beyond any rational explanation. No individual with any sense of decency and understanding could explain the evolution of these disastrous events. It would be extremely hard to learn from their abnormal presence. What, then, can we learn? We can find value in discussing the behavior of the characters. Let's take for example, the young and accomplished surgeon Ferral. As he is introduced in the movie, we are informed that, “he suffered from the surgeon's malady of vanity.” We respond by saying that vanity is not a virtue under any circumstances but it is often seen in the surgeon's world. We must encourage our young faculty and still forming residents to view their surgical efforts with patients and colleagues as the sacred temple where they can exert humility and understanding. They need to evolve to a level where the virtue of patience, thoughtfulness, and humility are practiced and understood. They need to advance positive and worthwhile causes to the caring of the individual. They need to respect everyone in the surgical arena.

Now, let us turn for a minute to the old but intensely perturbed surgical master, Sir William Gull, the most arrogant human character, the annihilator of precious lives, the proud criminal who understands no good and proclaims distorted causes. Under these circumstances, our surgical students can certainly learn how not to be, how arrogance, self-importance, vanity, self-love, and similar distorted negative traits of humanity can be harmful to life, family, and work. A well-assured professional is good but not someone who is imperious, presumptuous and disdainful. All are negative qualities which do not have a place in the world of medicine. Surgeons of the likes of William Gull are not welcome in a field dedicated to professionalism, decency, and caring [[4], [5], [6]].

Another significant happening in this movie is the use of lobotomy to overcome violent behavior. The time in which lobotomy is being performed in humans is a few years off from the real historical event. In the cinematographic London, 1888 is the year in which lobotomy is carried out by the upcoming and intrepid Dr. Ferral. The actual operation in humans began in 1890, performed for the first time in six schizophrenic patients by the audacious Swiss neurologist Dr. Burckhardt. Two patients did not survive the lobotomy procedure, and no one else thereafter attempted the already controversial surgery until 1935. In 1935, the American Jacobson, from Yale, realized that frontal lobotomies produced calmer chimps. A crucial piece of information was discovered that same year by the hands of the noted Nobel Portuguese neurologist Antonio Egaz Moniz, who found that if the nerve connections between the frontal cortex and the thalamus were severed, the patients improved their already altered behavior. This work stimulated the inquisitiveness of Walter Freeman and James Watts in the United States. From their first operation performed in 1936, thousands of lobotomies followed thereafter. In a period of 20 years, from 1930–1950, it is estimated that approximately 50,000 operations were performed in the United States alone. Because of the unreliable results associated with this surgery and the potential for worsening findings in one third of patients, the operation was progressively abandoned [[7], [8], [9]].

What can we assimilate from the lobotomy cases performed in the movie and thousand of patients who were received lobotomies in real life? What we learn is that a surgical technique, performed without sufficient validity, was recommended for mental cases because no other appropriate therapeutic alternative existed. What we learn is that lobotomy was more harmful to patients than if surgery had never been performed. What we learn is that lobotomy should not have been applied for any kind of behavioral disorder. What we learn is that no systematic study was ever performed in lobotomized versus non-lobotomized individuals with psychiatric disorders.

Near the end of the movie, the master surgeon villain, William Gull, appears again. He is seen receiving a lobotomy as penalty for the incredibly horrendous crimes that he perpetuated. Hours or days later, we see him suffering the degrading mental consequences of lobotomy. He is then reduced—as he did to many human beings—to no emotional human life. He is nobody. He cannot exhibit a rational thought process. For all practical purposes, Will Gull ceases to exist.

From Hell teaches a surgeon what not to be and what not to do. This movie presents a sad evaluation of the human spirit. It basically “uncovers the view from hell.” The movie shows the malice of man, and it leaves no doubt as to the frightful conditions of these unexpected and heinous crimes. In a lucid moment, Gull ironically characterizes the doings of the young and astute Ferral by saying “he knows all about anatomy and nothing about the soul” [[1], [2], [3]]. This maxim, taken positively, points out to the importance of the soul as the fiber of man, to the significance of the intellect as opposed to the materialistic views, to the relevance of the spirit as compared to the weak flesh of man. What is difficult to accept is that the perverse William Gull gives advice as to the importance of the soul when he does not have one of his own to show.

By watching From Hell, the Western Michigan University Honor History students and the surgical residents of our program will enhance their ability to be better students, be better residents, and of course be better human beings. It is fair to say that the initial reservations that I had about attending this film discussion were completely unfounded. This dark and provocative film provided me with an excellent opportunity to review the historical significance of lobotomies, reflect on the way a surgeon should portray him/herself among patients and peers, and recognize that being a superb technician is not the sole criteria for defining an excellent surgeon. Genuine concern for the human race, compassion, and humility are key criteria for defining an excellent surgeon, characteristics that were clearly lacking in Sir William Gull.