Giant, Royal Opera House review ★★★★★

Bloodied apron on, hacksaw in hand, when John Hunter butchers the bodies on his slab, it is not because humanity means nothing to him, but because it means everything. If he can unlock the secrets buried in diseased muscle and bone, he can help save future lives. Promising himself 'never to look away', even when the tiny cadaver is that of his own son, he chops and slices, boils the bone, in search of the recipe for good health.

'The opportunity of death brings knowledge to this house,' he sings in a startling new opera by Sarah Angliss, staged in London for the first time after its premiere in June at the Aldeburgh Festival. In Giant, this unflinching look at unsavoury but necessary 18th-century practices has a dreamlike quality, as timeless creatures float through the action, and with a score that is aptly skeletal.

Slight amplification gives every note an elusive veneer, but there is harsh reality here too: are we sitting in the audience, hale and hearty, partly because of the medical breakthroughs facilitated by grave-robbers and ruthless anatomists?

The giant of the title is a historical figure, Charles Byrne, who towered at nearly 8 feet, his exhausted, etiolated body destined for an an early grave. In his lifetime too much of a celebrity, he planned an inconspicuous burial, at sea. But Hunter, at his most ruthless, had other ideas. Befriending him, and studying him, he pledges his help, but Byrne's body too is stolen, and taken apart so hastily that important evidence of his condition is lost.

Byrne himself, sung with tenderness by Karim Sulayman, defies expectations. This gentle, poetic soul's first utterances are in praise of the natural world; indeed, the whole of Ross Sutherland's libretto has an elegiac quality. Hunter is sung with zeal by Jonathan Gunthorpe. Galina Averina is the celebrity Byrne's fixer, Rooker.

Handbells, evoking clocks, funeral knells and the soundscape of City churches, ring constantly through Angliss's spare and surprising score, directed from the keyboard – itself occasionally on harpsichord setting – by Ben Smith. Alongside him, on stage, are a string quartet, but with the raw bass viola da gamba in place of the usual creamy cello. Percussionist Stephen Hiscock and recorder player Olwen Foulkes work busily stage left, and flow into the action.

Hyemi Shin's set is a jumble of props in constant motion, as actors arrange and rearrange the detritus of a makeshift life and the objects rounded up for a nascent collection of curios. Until 2017 you could still have viewed Byrne's skeleton at the Hunterian Museum at the Royal College of Surgeons in Lincolns Inn Fields, picking your way through bottled foetuses and a range of abnormalities. But modern sensibilities have triumphed, and this opera, directed with compassion by Sarah Fahie, is an altogether more respectful memorial to the man.

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Giant is sung in English with English surtitles. Further performances are on 12, 14 and 15 March. Click here for returns