John Hunter

john hunter



As you may have detected, I subscribe to the "great man" approach to history - that events and consequently history, are shaped by great men (and women).  I believe that consequential historical occurrences are shaped by, to some extent controlled by, the great men and women of the era, and that studying these great men leads to a better understanding of history- a sort of "biographical history" approach.  

As I mentioned in the entry to this gallery, John Hunter probably never gave the vermiform appendix much thought.  But he gave surgery a great deal of thought.  In many ways, John Hunter took the medieval Barber-Surgeon, and by insisting on professional standards and education, and by his extreme fascination with anatomy and physiology, Hunter created the modern surgeon - a scientist who operates.  That accomplishment is why this Hall is dedicated to John Hunter, and why he is regarded as the "father of modern surgery."

Early Life

WilliamHunter

John Hunter was born in 1728 as the tenth of 10 children in a rural village in Scotland.  He did poorly in school, and is thought to have had dyslexia.  His brothers entered professions, and John followed his brother William Hunter to London, where William had become a surgeon and anatomist of some note, specializing in obstetrics at St. George's Hospital in London.  

In the practice of the day, William had set up his own anatomy school for aspiring surgeons.  John was hired as a dissection assistant, preparing the questionably obtained corpses for the instruction of William's paying students. 

John rapidly became known for his facility at dissection and his comprehensive knowlege of anatomy.  He came under the tutelage of William Cheseldon, the surgeon who first cured blindness by removing a cataract), and then of Percival Pott, the surgeon who not only made great advances in the study of diseases of the bone (Pott's disease - tuberculosis of the bone - was first described by him) but he also was among the first to track and link a disease using epidemiology - scrotal cancer in chimney sweeps.

With the assistance of his brother and mentors, John Hunter was admitted at St. George's Hospital as an Assistant Surgeon (what we now consider a Resident) in 1756.  In 1760 he was made an Army surgeon, and made two expeditions in service, including combat service in the Portugal expedition.

John Hunter left the Army in 1763, opened his own anatomy school in 1764, and was appointed a Surgeon at St. George's Hospital in 1768.  

Graverobbing

the dissecting room

“THE DISSECTING ROOM.” By Rowlandson.

The figure standing up above the rest is William Hunter; his brother John is on his
right-hand side, and Matthew Baillie is the next figure to William Hunter on the left;
Cruikshank is seated at the extreme left of the picture, and Hewson is working on
the eye of the subject on the middle table.


Hunter developed a keenness for experimentation, and was known for his complete dedication to anatomy and dissection.  A surgeon in London with an anatomy school was forced to live in two separate worlds - the relatively respectable world of the surgeon and healer, and the far more nefarious life of obtaining fresh bodies for dissection.  In his unparalleled zeal for dissection, John Hunter developed an unequalled network of body snatchers, nicely termed "Resurrectionists" in his employ. 

Body-snatching was difficult and dnagerous work.  The Hunters, as well as the other surgeons of London paid well.  It seems that they also never asked too many questions.  One aspect of body snatching later referred to as "Burking," after William Burke who in 1828 was executed for murdering 17 people by asphyxiation to sell their bodies to a Dr. Knox, an Edinborough surgeon and anatomist.  The work of the body snatcher is well related in the anonymous memoir - "The Diary of a Resurrectionist."

One of Hunter's students Astley Cooper  even testified to a Parliamentary Select Committee, "There is no person, let his situation in life be what it may, whom, if I were disposed to dissect, I could not obtain."

Fetus in uterus

John and William Hunter were implicated by rumor in the murders of pregnant women whose gravid uterii appeared in William Hunter's masterwork "The Anatomy of the Gravid Uterus."  Given the high maternal and fetal mortality rate of the time, it is possible that no mothers were harmed to produce the work, but rumors persisted in London society, which, however, did not taint the reputation or perceived value of the work.  It is known that John Hunter paid a graverobber £500 to obtain the body of the famous 7'8" giant, Charles Byrne, after relentlessly stalking him for two years.  Mr. Byrne had been horrified at the thought of being a specimen and had expressly requested burial at sea.  Hunter and his associates substituted the body with rocks, and his skeleton later appeared at Hunter's home on Leicester Square.  Charles Byrne's skeleton remains on display at the Hunterian Museum of the Royal College of surgeons.

Charles Byrne

The skeleton of Charles Byrne, Irish Giant (left) at the Hunterian Museum


Experimentation

I realized as I was writing the previous section that there seems to be very little to honor or celebrate in my description of John Hunter so far.  In fact, John Hunter's dual life seems to be a "Jeckyl and Hyde" existence.  In fact, Robert Louis Stevenson based a good part of "The Strange Case of Dr. Jeckyl and Mr. Hyde" on John Hunter, even having Dr. Jeckyl's house, "bought from an eminent surgeon" be a complete description of John Hunter's home on Leicester Square.

So what then is the attraction?  

four humors

John Hunter challenged Galen.  As I mentioned in A Brief History of Surgery, Medicine and Surgery had been in a dogmatic thrall with the writings of Galen from 1600 years before.  It was very rare to challenge Galen, his drawings and description of the anatomy and physiology of man were held to be beyond dispute.  Little was said that Galen described anatomy from drawings of dead animals, had never dissected a human, and that his "four humours" model was, if actual observation from life was used, utter nonsense.  

John Hunter set about to change that approach.  Instead of rote memorization of the writings of a 3rd century bon vivant, the surgeon should use direct observation, dissection, and experimentation as the basis of practice.  

jenner vaccine

Students flocked to Hunter's school, including Edward Jenner, who using Hunter's experimental approach to Medicine, developed the smallpox vaccine, and even coined the term "vaccination" derived from "vacca" Latin for "cow."  At one point Jenner was asking Hunter about his theories, and Hunter reportedly replied, "I think your solution is just but why think, why not try the Experiment?"

Hunter's approach to experimentation in surgery was novel for the time, and remains the standard for surgical research to this day.  When trying to understand a surgical problem, the first step is to obtain a thorough understanding of the anatomic and physiologic issues from careful study and observation of live patients, and from dissection of the dead.  Further understanding is obtained through vivisection.  A hypothesis is developed, a theory of an operation, which is then tested, again on animals.  Finally, when the results of animal surgery have been validated, then the operation is tried on live patients.

Here again, Hunter's approach was novel.  Hunter very strictly maintained that he would not perform an operation on a patient that he would not have performed on himself.  He always approached the patient, no matter their education status, and bluntly but candidly explained their options - he obtained his patents' informed consent prior to performing surgery.

Since Hunter was not the least bit squeamish about the dead, it was known by his patients that if he operated upon them and they died, that he would be dissecting their remains to examine their surgery to determine what happened - he rigorously followed the results of the operations he performed, studied outcomes, and made adjustments.  This practice continued until very recently as a routine demand made on surgical residents was to obtain autopsies on surgical patients who had died.

Hunter monograph

Hunter personally applied these methods to studies of gunshot wounds and inflammation and changed how British Army surgeons approached wounds.  He also studied teeth transplants and reimplantations, and coined the terms "incisor" and "molar".  He is best known, perhaps for his treatment of aneurysms of the popliteal artery behind the knee, called "coach drivers' disease."  The space carrying the main artery of the thigh is called "Hunter's canal" in his honor.

It is hard to convey to modern audiences how incredibly novel this approach was in the 18th century.  Please keep in mind that the overwhelming majority of Hunter's contemporaries were still observing the teachings of Galen, despite the evidence in front of their eyes.

Teaching

Hunter's legacy was made great, however, by his teaching, of his ability to convince the next generation of the correctness of his ideas.  The notions that Hunter overturned were nearly two thousand years old.  Change did not, could not, occur overnight.  Like any change agent, Hunter was villified by some of his contemporaries, those threatened by a new way of thinking.  Hunter's scientific method lived on through his students, who in addition to Edward Jenner and Astley Cooper, included Phillip Syng Physick (considered the father of American Surgery and the inventor of soda pop),  John Abernathy, Joshua Brookes (founder of the Brookes anatomy museum in London).  

Hunter's students fanned out across the world, passing in turn, scientific surgery on to progressively larger groups.  

Two interesting stories about the rapidity of change.

Benjamin Rush was a famous American physician, prig, and patriot, who received good training in Edinborough, then returned to the United States where he was a member of the Continental Congress, the Surgeon General of the Revolutionary Army, a signer of the Declaration of Independence, and an avid advocate of bloodletting.  He received widespread condemnation during the Yellow Fever epidemic in Philadelphia in 1793, where he bled as many as 500 people to death.  When he became ill himself, he was not bled, and was under the care of the Hunter pupil Phillip Physick.

Nearly a hundred years later, on July 2, 1881, President James Garfield was shot in the abdomen.  He died eleven weeks later of sepsis after his wound was "dilated" numerous times by his "surgeons" in an ill-advised effort to remove a bullet that was not causing him harm.  The practice of "dilation and bullet retrieval" was firmly opposed by John Hunter in his monograph on gunshot wounds, published in 1794.  Joseph Lister based his theory of antisepsis, which he published in 1865, in part on Hunter's monograph.  The unnecessary death of President Garfield created a tremendous uproar in the medical community and led to the fairly rapid development of American surgery along Hunter's principles afterward.


 


jsedlack@appendicitis.pro   © Jeffrey Sedlack 2012