JOHN HUNTER – THE FATHER OF SCIENTIFIC SURGERY
By Wendy Hughes
Do you know of John Hunter? Maybe not, but he will be remembered for transforming surgery from a mere craft into a branch of experimental science.
Born in Long Calderwood, East Kilbride, Lanarkshire in 1728, John was the youngest in a family of eleven children. He had little formal education, but enjoyed studying plants and trees. At the age of 16 he moved to Glasgow to lodge with his sister and her husband, a cabinet-maker, from whom he acquired his mechanical skills. Three years later he set off on horseback to join his brother William, ten years his senior, a surgeon-accoucheur at the Middlesex Hospital in London, a journey that took him two weeks to complete.
On arrival it was soon discovered that John preferred the taverns and theatre galleries to book learning, but his brother took him in hand and set him the task of dissecting an upper limb. The excellence of his work as an anatomist was immediately recognised and he was asked to assist with dissections. He showed such great ability that he was sent to study under two great surgeons, Cheselsden at the Chelsea Hospital, and Pott at St Bartholomew’s.
In 1753 he became a master of anatomy, and in 1760 appointed staff-surgeon to an expedition to Belleisle where he studied coagulation of the blood, and gained his unique knowledge of gunshot wounds. He served with the army in Portugal and Brittany returning to London on half-pay in 1763 and started a practise in Golden Square. A year later he bought two acres of land in Earls Court and built a house with facilities for research, keeping and dissecting animals. He dissected over 500 different animals, and any new animals that arrived into the country were offered to him for study.
In 1767 he was appointed surgeon at St Georges’ Hospital where his fellow surgeons referred to his experiments as ‘going beyond the bounds of lawful knowledge’. Hunter justifiably replied that ‘knowledge can only be increased by going outside its present bounds, and who believes that not to be is a fool.’ He was often called the reluctant surgeon because he felt he had failed the patient if he had found it necessary to amputate.
Although he was a brilliant surgeon, his lack of education made him a poor lecturer and he was often outwardly rude. If crossed, he was apt to paw the air like a high spirited stallion. In 1760 he publicly quarrelled with his brother accusing him of claiming as his own some observations he had made.
However he had a kind generous nature, varying his fees in accordance to the patient’s circumstances. Working men were treated first, because time was money to them, and he didn’t take fees from authors, artists or clergymen. Over the years he attended the Boswell family, Byron, who had a club foot and Gainsborough, who had a malignant swelling. He performed an autopsy on Reynolds, whose liver was enlarged.
Hunter’s observations of the collateral capillary circulation in the antlers of deer he observed in Richmond Park led to his method of treating aneurysm. He established that aneurysms due to arterial disease should be tied higher in the healthy tissues by a single ligature instead of securing them between two ligatures and emptying the contents. This idea, although not credited in Hunter’s lifetime, has saved ‘thousands of limbs and lives’.
The modern treatment for thrombosis in the area behind the knee derives from Hunter’s experiments on deer too. He severed a main artery to the antler and proved that the circulation can be restored by binding up the affected channel and allowing nature to take its course. This was revolutionary, as amputation was the standard
procedure to such problems.
Hunter was the first to study teeth in a scientific manner. He introduced the four classes, cuspids, bicuspids. molars and incisors and was the first to recommend the complete removal of the pulp when filling teeth. He also detailed, and devised appliances to correct malocclusion, a condition in which the upper and lower jaws are abnormally related.
In his determination to prove that gonorrhoea and syphilis were the same he deliberately infected himself with the syphilitic bug. It proved to be one of the rare occasions when he was wrong, as they are quite different organisms. He subsequently went through the first two stages of syphilis and delayed marriage so that he could observe and treat the condition. Some historians believe this to be untrue and that he infected a beggar man, offering him a home in return for treatment.
In 1771 he married Anne Home, a poetess and ‘pop-song’ writer of the day. She wrote the words of several songs, including ‘My Mother Bids me Bind my Hair’, which were set to music by Haydn. Two years later he began his lectures on the theory and practice of surgery – the first time that surgery was treated on a scientific basis. He was appointed surgeon-extra-ordinary to George III, and deputy surgeon-general to the army in 1786, and promoted to surgeon-general and inspector-general of hospitals four years later.
In 1773 he developed angina and on 16th October 1793, whilst attending a meeting of the Board of Governors at St Georges’ Hospital, he suffered an apoplectic seizure during an argument over his opinions of the causes of George III’s attacks of insanity. Hunter maintained that there were genetic factors, a fact that subsequent research has proved. A few minutes later he was dead. Knowing he had angina, he once said; `My life is in the hands of any rascal who chooses to annoy and tease me.’ He was buried in the church of St Martin’s-in-the-field, and his remains transferred to Westminster Abbey some sixty years later.
Sadly Sir Everard Home, his brother-in-law and executor of his estate, destroyed all Hunter’s notebooks and manuscripts in 1823, having published many of the observations as his own.
During his life-time Hunter collected over 13,000 specimens to illustrate disease in man and animals. His prized procession was the skeleton of James O’Brien, an eight foot two inch giant. Hunter was fascinated in the size of O’Brien and wanted to dissect his body when he died. However, O’Brien arranged that on his death his body was taken out to sea and buried. Hunter paid a body snatcher £500 for the body and today the skeleton can be seen in the Royal College of Surgeons. His specimens formed the basis of Hunter’s museum which was bought by the Company of Surgeons (now the Royal College of Surgeons) in 1800 with a grant of £1300 for the nation. In his lifetime it had cost Hunter more than £75,000. Unfortunately approximately two thirds of this collection was destroyed in an aid raid on London during the 2nd World War.
Reynolds painted a portrait of Hunter which now hangs in the Royal College of Surgeons. Initially his wife was in the background of the portrait, but she asked the artist to obliterate her ‘because my life is one of triviality compared to the Parnassus from which my husband addresses the world.’ Although John did not make any great discoveries, in a sense he was the originator of many discoveries. His writings are full of fresh observations which have pointed the way for other pioneers, and he will always remain one of the great names in the history of surgery.