John Hunter (surgeon)

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John Hunter
John Hunter by John Jackson.jpg
Painted by John Jackson, 1813, after Sir Joshua Reynolds, 1786
Born (1728-02-13)13 February 1728
Long Calderwood near East Kilbride, Scotland
Died 16 October 1793(1793-10-16) (aged 65)
London, England
Cause of death
Heart Attack
Education St. Bartholomew's Hospital
Known for Scientific method in medicine
Many discoveries in surgery & medicine
Medical career
Profession Surgeon
Institutions St George's Hospital
Research Dentistry, gunshot wounds, venereal diseases, digestion, child development, foetal development, lymphatic system

John Hunter FRS (13 February 1728 – 16 October 1793) was a Scottish surgeon regarded as one of the most distinguished scientists and surgeons of his day. He was an early advocate of careful observation and scientific method in medicine. He was the husband of Anne Hunter, a teacher, and friend of, and collaborator with, Edward Jenner, the inventor of the smallpox vaccine.[1]

The Hunterian Society of London was named in his honour, and the Hunterian Museum at the Royal College of Surgeons preserves his name and his collection of anatomical specimens.

Life[edit]

Hunter was born at Long Calderwood, now part of East Kilbride, Lanarkshire, Scotland, the youngest of ten children. The date of his birth is uncertain. Robert Chamber's "Book of Days" (1868) gives an alternative birth date of 14 July, and Hunter is recorded as always celebrating his birthday on this date rather than 13 July shown in the parish register of the town of his birth. Family papers cite his birthday as being variously on 7 and 9 February.[2] Three of Hunter's siblings (one of which had also been named John) had died of illness before John Hunter was born. An elder brother was William Hunter, the anatomist. As a youth, John showed little talent, and helped his brother-in-law as a cabinet-maker.

In 1771 he married Anne Home, daughter of Robert Boyne Home and sister of Sir Everard Home. They had four children, two of whom died before the age of five. One of his infant children is buried in the churchyard in Kirkheaton (Northumberland), and the gravestone is Grade II listed. Their fourth child, Agnes, married General Sir James Campbell of Inverneill. In 1791, when Joseph Haydn was visiting London for a series of concerts, Hunter offered to perform an operation for the removal of a large nasal polyp which was troubling the great Austrian composer. According to one account, "Haydn, on his visit to London in 1791, [wrote] folksong arrangements, including The Ash Grove, set to words by Mrs Hunter. Haydn had designs on Mrs Hunter. Her husband ... had designs on Haydn’s famous nasal polyp. Both were refused."[3][4]

His death in 1793 followed a heart attack during an argument at St George's Hospital over the admission of students.

Career[edit]

Early education and training[edit]

When nearly 21 he visited William in London, where his brother had become an admired teacher of anatomy. John started as his assistant in dissections (1748), and was soon running the practical classes on his own.[5] It has recently been alleged that Hunter's brother William, and his brother's former tutor William Smellie, were responsible for the deaths of many women whose corpses were used for their studies on pregnancy.[6][7] John is alleged to have been connected to these murders, since at the time he was acting as William's assistant.[8] However, persons who have studied life in Georgian London agree that the number of gravid women who died in London during the years of Hunter's and Smellie's work was not particularly high for that locality and time; the prevalence of pre-eclampsia, a common condition affecting ten percent of all pregnancies and one easily treated today, but for which there was no treatment in Hunter's time, would more than suffice to explain a mortality rate that seems suspiciously high to 21st-century readers.[9][10] In The Anatomy of the Gravid Uterus Exhibited in Figures, published in 1774, Hunter provides case histories for at least four of the subjects illustrated.

Hunter studied under William Cheselden at Chelsea Hospital and Percival Pott at St. Bartholomew's Hospital. Hunter also studied with Marie Marguerite Bihéron, a famous anatomist and wax modeler teaching in London; some of the illustrations in his text were likely hers.[11] After qualifying he became Assistant Surgeon (house surgeon) at St George's Hospital (1756) and Surgeon (1768).

Time as an army surgeon[edit]

He was commissioned as an Army surgeon in 1760 and was staff surgeon on expedition to the French island of Belle Île in 1761, then served in 1762 with the British Army in the expedition to Portugal.[12] Contrary to prevailing medical opinion at the time, Hunter was against the practice of 'dilation' of gunshot wounds. This practice, which involved the surgeon deliberately expanding a wound with the aim of making the gunpowder easier to remove. Although sound in theory, in the unsanitary conditions of the time it increased the chance of infection, and Hunter's practice was not to perform dilation 'except when preparatory to something else'[13] such as the removal of bone fragments.

Post-Army career[edit]

Hunter left the Army in 1763, and spent at least five years working in partnership with James Spence, a well-known London dentist. Although not the first person to conduct tooth transplants between living people, he did advance the state of knowledge in this area by realising that the chances of an (initially, at least) successful tooth transplant would be improved if the donor tooth was as fresh as possible and was matched for size with the recipient. These principles are still used in the transplanation of internal organs. Although donated teeth never properly bonded with the recipients' gums, one of Hunter's patients stated that he had three which lasted for six years, a remarkable period at the time.[14]

Hunter set up his own anatomy school in London in 1764 and started in private surgical practice.

Earl's Court house[edit]

In 1765 he bought a house near the Earl's Court district in London. The house had large grounds which were used to house a collection of animals including 'zebra, Asiatic buffaloes and mountain goats', as well as jackals. (In the house itself, Hunter boiled down the skeletons of some of these animals as part of research on animal anatomy.) A newspaper article reported that many animals that were 'supposed to be hostile to each other but among which, in this new paradise, the greatest friendship prevails', and this image may have been the inspiration for the Doctor Dolittle literary character.[15][16][17]

Self-experimentation[edit]

Hunter was elected as Fellow of the Royal Society in 1767. At this time he was considered The Authority on venereal diseases. In May 1767, he believed that gonorrhea and syphilis were caused by a single pathogen. Living in an age when physicians frequently experimented on themselves, he inoculated himself with gonorrhea, using a needle that was unknowingly contaminated with syphilis. When he contracted both syphilis and gonorrhea, he claimed it proved his erroneous theory that they were the same underlying venereal disease (this is an often-repeated legend, but does not appear to be true - see e.g.[18] The experiment reported in Hunter's A Treatise on the Venereal Disease (part 6 section 2) does not indicate self-experimentation, this was most likely performed on a third party). He championed its treatment with mercury and cauterization. He included his findings in his Treatise on the Venereal Disease, first issued in 1786. Because of Hunter’s reputation, knowledge concerning the true nature of gonorrhea and syphilis was retarded, and it was not until 51 years later that his theory was proved to be wrong, by the French physician Philippe Ricord.[19][20]

Late career[edit]

In 1768 Hunter was appointed as surgeon to St George's Hospital. Later he became a member of the Company of Surgeons. In 1776 he was appointed surgeon to King George III.

In 1783 Hunter moved to a large house in Leicester Square, where today there stands a statue to him. The space allowed him to arrange his collection of nearly 14,000 preparations of over 500 species of plants and animals into a teaching museum.

Also in 1783 he acquired the skeleton of the 2.31 m (7' 7") Irish giant Charles Byrne against Byrne's clear deathbed wishes—he had asked to be buried at sea. Hunter bribed a member of the funeral party (possibly for £500) and filled the coffin with rocks at an overnight stop, then subsequently published a scientific description of the anatomy and skeleton. The skeleton today, with much of Hunter's surviving collection, is in the Hunterian Museum at the Royal College of Surgeons in London.[21]

In 1786 he was appointed deputy surgeon to the British Army and in March 1790 he was made Surgeon General by the then Prime Minister, William Pitt.[22] While in this post he instituted a reform of the system for appointment and promotion of army surgeons based on experience and merit, rather than the patronage-based system that had been in place.[23]

Legacy[edit]

Contributions to medicine[edit]

In 1799 the government purchased Hunter's collection of papers and specimens, which it presented to the Company of Surgeons. Among his contributions to medical science are:

  • study of human teeth, and bone growth and remodelling
  • extensive study of inflammation
  • fine work on gunshot wounds (see above)
  • some work on venereal diseases, in addition to his work following his likely self-experimentation.
  • an understanding of the nature of digestion, and verifying that fats are absorbed into the lacteals, a type of small intestine lymphatic capillary, and not into the intestinal blood capillaries as was generally accepted.
  • the first complete study of the development of a child
  • proof that the maternal and foetal blood supplies are separate
  • unravelling of one of the major anatomical mysteries of the time – the role of the lymphatic system

Hunter's Idea of Life[edit]

While most of his contemporaries and others since have regarded Hunter as a great anatomist, he undertook anatomy not only because it was practical and allowed for the direct observation of nature in the true Baconian tradition ("his mode of studying nature was … strictly Baconian. Hunter, unlike his contemporaries … sought the reason for each phenomenon[24]), but because it afforded him the opportunity, given his empirical rather than rational bent, to study his main interest - life, in all its forms.

The scope of Hunter's labours may be defined as the explication of the various phases of life exhibited in organized structures, both animal and vegetable, from the simplest to the most highly differentiated. By him, therefore, comparative anatomy was employed, not in subservience to the classification of living forms, as by Cuvier, but as a means of gaining insight into the principle animating and producing these forms, by virtue of which he perceived that, however different in form and faculty, they were all allied to himself.[24]

Hunter's interest in the question of life puts him in the tradition of Romantic medicine. In what does life consist? is a question which in his writings he frequently considers, and which seems to have been ever present in his mind. Life in living organisms is seen in repair and maintenance (a sustaining power) but also capable of generation and regeneration. Life for Hunter was a principle independent of matter or form, an agency functioning under the control of law in various modes and degrees. It was not reducible to the stimulus of sensation, but also acted independently (see Brunonian system of medicine).

The living principle, said Hunter, is coeval with the existence of animal or vegetable matter itself, and may long exist without sensation. The principle upon which depends the power of sensation regulates all our external actions, as the principle of life does our internal, and the two act mutually on each other in consequence of changes produced in the brain." (Encyclopedia Britannica 1911)[24]

Hunter also discovered that there exists in animals a latent heat of life, set free in the process of death (his Treatise on the Blood, p. 80), and with William Harvey, held that blood contained a vitality of its own, 'fire' element. Further, life for Hunter was an interplay between the blood and the body. He even inclined to the hypothesis that chyle has life, and that food becomes "animalized" in digestion.[24]

Hunter held that life went beyond explanation by means of inertial science.

Mere composition of matter," he remarked, " does not give life; for the dead body has all the composition it ever had; life is a property we do not understand; we can only see the necessary leading steps towards it.
As from life only, said he in one of his lectures, we can gain an idea of death, so from death only we gain an idea of life. Life, being an agency leading to, but not consisting of, any modification of matter, " either is something superadded to matter, or else consists in a peculiar arrangement of certain fine particles of matter, which being thus disposed acquire the properties of life."[24]

Hunter also differentiated between organic and inorganic growth, such as in certain crystals. He further held that from the diversity of fossils and allied living structures, various periods of stability, lasting thousands of centuries, were interrupted by great climatic variations. These observations of the fossil record also led him to conclude that "the origin of species in variation" as Darwin would later present, was not possible.

Hunter considered that very few fossils of those that resemble recent forms are identical with them. He conceived that the latter might be varieties, but that if' they are really different species, then " we must suppose that a new creation must have taken place." It would appear, therefore, that the origin of species in variation had not struck him as possible.[24]

As with John Brown, for Hunter pathology was a science of physiology. Dr. Richard Saumarez, who wrote his A New Physiology in 1798, was clearly indebted to Hunter's idea of the living principle and the many facts of observation he brought to bear on its existence:

Mr. John Hunter … disclaimed the doctrine that ascribed to matter the power of kneading itself into organs, or which vainly supposed that life could ever arise out of death; much less that it could ever be an effect, of which material action was the immediate cause… and … proclaimed the existence of a principle of life, which was the cause (not the effect) of organization and action, and to which it had a prior existence.[25]

Samuel Taylor Coleridge, a key figure in Romantic thought, science and medicine, was also knowledgeable about Hunter's work and writings and saw in him the seeds of Romantic medicine, namely as regards his principle of life, which he felt had come from the mind of genius.

WHEN we stand before the bust of John Hunter, or as we enter the magnificent museum furnished by his labours, and pass slowly, with meditative observation through this august temple, which the genius of one great man has raised and dedicated to the wisdom and uniform working of the Creator, we perceive at every step the guidance, we had almost said, the inspiration, of those profound ideas concerning Life, which dawn upon us, indeed, through his written works, but which he has here presented to us in a more perfect language than that of words - the language of God himself, as uttered by Nature. That the true idea of Life existed in the mind of John Hunter I do not entertain the least doubt...[26]

Literary references[edit]

Hunter was the basis for the character "Jack Tearguts" in William Blake's unfinished satirical novel, An Island in the Moon.[27] He is a principal character in Hilary Mantel's 1998 novel, The Giant, O'Brien.

It is possible that his Leicester Square house was the inspiration for the home of Dr Jekyll of the Robert Louis Stevenson novel The Strange Case of Dr Jekyll and Mr Hyde. Hunter's house had two entrances, one through which the living area for his family was accessible, and another, leading to a separate street, which provided access to his museum and dissecting rooms. This pattern echoes that of the house in the story, in which the respectable Dr Jekyll used one entrance to the house and Mr Hyde the other, less prominent, one.[28]

Hunter is mentioned by Dr Moreau in Chapter XIV of H.G. Wells's The Island of Doctor Moreau (1896).

Memorials[edit]

A bust of John Hunter stands on a pedestal outside the main entrance to St George's Hospital in Tooting, South London, along with a lion and unicorn taken from the original Hyde Park Corner building. There is a bust of him in the South West corner of Lincoln's Inn Fields, and one used to stand in Leicester Square in London's West End.

The John Hunter Hospital, the largest hospital in Newcastle, New South Wales, Australia, and principal teaching hospital of the University of Newcastle, is named after Hunter (as well as two other historically significant John Hunters). The John Hunter Clinic of the Chelsea and Westminster Hospital in London is similarly named after him.[29]

His birthplace in Long Calderwood, Scotland, has been preserved as Hunter House Museum.[30]

Character[edit]

Bust of Hunter, Leicester Square, London

Hunter's character has been discussed by biographers:

To the kindness of his disposition, his fondness for animals, his aversion to operations, his thoughtful and self-sacrificing attention to his patients, and especially his zeal to help forward struggling practitioners and others in any want abundantly testify. Pecuniary means he valued no further than they enabled him to promote his researches; and to the poor, to non-beneficed clergymen, professional authors and artists his services were rendered without remuneration.[31] His nature was kindly and generous, though outwardly rude and repelling.... Later in life, for some private or personal reason, he picked a quarrel with the brother who had formed him and made a man of him, basing the dissension upon a quibble about priority unworthy of so great an investigator. Yet three years later, he lived to mourn this brother's death in tears.[32]

He was described by one of his assistants late in his life as a man 'warm and impatient, readily provoked, and when irritated, not easily soothed'.[33]

Racial studies[edit]

Hunter claimed that originally the negroid race was white at birth, and that over time because of the sun, they turned black. Hunter also claimed that blisters and burns would likely to turn white on a negro, which he believed was evidence that the negros' original ancestors were white.[34]

References[edit]

  1. ^ Moore, p. 316
  2. ^ Moore, p. 43
  3. ^ Williams, Nicholas “Haydn seek: The Haydn Trail, Wigmore Hall, London”, The Independent, 23 September 1997.
  4. ^ Moore, p. 482
  5. ^ Brook C. 1945. Battling surgeon. Strickland, Glasgow. pp. 15–17
  6. ^ Shelton, Don 2010. The Emperor's new clothes. J. Royal Society of Medicine, February.
  7. ^ Shelton, Don. The real Mr Frankenstein: Sir Anthony Carlisle, medical murders, and the social genesis of Frankenstein. [1]
  8. ^ Founders of British obstetrics 'were callous murderers', Denis Campbell, 7 February 2010, The Observer, accessed May 2010
  9. ^ Inglis, Lucy. "Burking and Body-Snatching: The Deadly Side of Medicine in Georgian London".
  10. ^ "Deaths in childbed from the eighteenth century to 1935"
  11. ^ June K. Burton (2007), Napoleon and the Woman Question: Discourses of the Other Sex in French Education, Medicine, and Medical Law, 1799-1815, Texas Tech University Press (2007), pp.81-82.
  12. ^  "Hunter, John (1728–1793)". Dictionary of National Biography. London: Smith, Elder & Co. 1885–1900. 
  13. ^ Moore, p. 188, quoting Hunter's The Works,vol 3 p. 549
  14. ^ Moore, p. 223-224
  15. ^ Moore, p. 291-292, citing Laszlo Magyar's John Hunter and John Dolittle www.geocities.com/tapir32hu/hunter.html[dead link]
  16. ^ Goddard, Jonathan (2012). "The Knife Man: the Extraordinary Life and Times of John Hunter, Father of Modern Surgery". ncbi.nlm.nih.gov. Retrieved 9 March 2012. 
  17. ^ Conniff, Richard (2012). "How Species Save Our Lives - NYTimes.com". opinionator.blogs.nytimes.com. Retrieved 9 March 2012. 
  18. ^ http://cid.oxfordjournals.org/content/41/1/128.1.full
  19. ^ Dr. Charles "Carl" Hoffman, Library of the History of Medical Sciences, Marshall University
  20. ^ Moore, p. 268, citing Deborah Hayden's Pox:Genius, madness and the mysteries of syphilis (2003) and Diane Beyer Perett's Ethics and Error: the dispute between Ricord and Auzias-Turenne over syphilization 1845-70 (1977)
  21. ^ Doctors: the biography of medicine by Sherwin B. Nuland.
  22. ^ Moore, p477, citing Peterkin, Johnston & Drew, Commissioned Officers in the Medical Services of the British Army 1660-1960 (1968) vol 1, p. 33
  23. ^ Moore, p478
  24. ^ a b c d e f Encyclopedia Brittanica 1911. "John Hunter". Retrieved 28 July 2012. 
  25. ^ Saumarez, Richard (1798). A New Physiology,2nd Edition, 2 vols. USA: Gale Ecco Print. ISBN 1171030495. 
  26. ^ Coleridge, Samuel Taylor. "Towards the formation of a Theory of Life". Retrieved 30 September 2012. 
  27. ^ Damon, S. Foster. A Blake Dictionary: The Ideas and Symbols of William Blake (Hanover: Brown University Press 1988; revised ed. 1988)
  28. ^ Moore, p. 430, citing The Sketch of 24 February 1897, which related that Stevenson 'is said to have chosen' Hunter's house as his inspiration.
  29. ^ "John Hunter Clinic". Retrieved 19 January 2014. 
  30. ^ Moore, p. 546-7
  31. ^ Encyclopædia Britannica, 11th edition.
  32. ^ Garrison, Fielding H. 1913. An introduction to the history of medicine. Saunders, Philadelphia PA. p. 274
  33. ^ Home, p. lxv cited in Moore, p. 346
  34. ^ Marvin Harris (2001). The Rise of Anthropological Theory: A History of Theories of Culture. Rowman Altamira. pp. 85–. ISBN 978-0-7591-0133-3. Retrieved 18 April 2012. 

Bibliography[edit]

  • Home, Everard, (1794) 'A short account of the life of the author' in A Treatise on the Blood, Inflammation and Gun-shot Wounds, by the late John Hunter
  • Moore, Wendy (30 September 2010). The Knife Man. Transworld. ISBN 978-1-4090-4462-8. Retrieved 8 March 2012. 

Further reading[edit]

  • Dobson, Jessie. Curator Hunterian Museum. John Hunter, E&S Livingstone Ltd, Edinburgh and London, 1969, ISBN 443 00647 4
  • Kobler, John, The Reluctant Surgeon. A Biography of John Hunter, Garden City, New York, Doubleday & Company, Inc, 1960.
  • Rogers, Garet. Brother Surgeons, Corgi Books, 1962.

External links[edit]