John Hunter

5 Key excerpts on "John Hunter"

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  Medical Theory, Surgical Practice

  Studies in the History of Surgery

  • Christopher Lawrence(Author)
  • 2018(Publication Date)
  • Routledge

    (Publisher)

  5

  Physiological principles in the surgical writings of John Hunter

  Stephen Jacyna

  Introduction

  Since the turn of the nineteenth century John Hunter has been presented as the father of scientific surgery. An influential and persistent historiographic tradition has maintained that Hunter was the first to grasp that surgical practice did not rest upon clinical experience alone, but that it must also be informed by a knowledge of physiological and pathological principles if it were to attain its full potential.1 Hunter himself said as much in the introduction to his lectures on surgery. At the outset he rejected the usual course of treating particular diseases and operations, ‘these being taught by Anatomists and others — The principles are what are the most necessary and these shall be the object of our inquiry.’2 Without a sound knowledge of such principles, Hunter declared, ‘a man cannot be a surgeon’.3 Recent studies of Hunter have tended to consider his physiological theories in the abstract — as one thread in the varied texture of bio-medical thought at the end of the eighteenth century.4 This is to overlook the instrumental character that Hunter himself ascribed to his physiology: the primary use of such knowledge was the improvement of the art of surgery. It is also to ignore the dominant image of Hunter’s significance that has been handed down to succeeding generations of surgeons. In this essay I shall ask whether there are, indeed, discernible areas of interaction between Hunter’s theory and his practice. Was he truly a ‘scientific surgeon’; or is there a discontinuity between Hunter the physiologist and Hunter the medical practitioner?

  Theory and practice in eighteenth-century surgery

  It was a common stratagem among Hunter’s eulogists to portray pre-Hunterian surgery as (with a few honourable exceptions) purely ‘empirical’ in character, in contrast to the ‘scientific’ approach of the post-Hunterian era. It is certainly possible to find bluff assertions of the superiority of knowledge gained by experience over any form of theory in surgical texts of the eighteenth century. In 1765 the Irish surgeon Sylvester O’Halloran denounced previous surgeons who had relied upon their theoretical preconceptions when formulating therapy; ‘by admitting a theory, repugnant to experience, in most instances, have conclusions been drawn, highly detrimental to the sick, and to surgery!’ The diversity and complexity of the phenomena which daily confronted the surgeon proved ‘the futility of attempting to draw general conclusions, from particular experiments’, and supplied ‘concise and cogent reasons’ for rejecting ‘general systems, either of physic, or philosophy’.5 Edward Alanson in 1782 boasted in similar vein that ‘Since all speculative reasoning on these [surgical] subjects is very fallacious, when placed in competition with experience, it has been my aim to deduce the doctrine of this work from practice only.’6 It is worth noting that even a ‘post-Hunterian’ surgeon could in 1814 consider it ‘mortifying to the pride of theory to see how often it is humbled before the conviction of practice’.7

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  Literature and Medicine: Volume 2

  The Nineteenth Century

  • Andrew Mangham, Clark Lawlor(Authors)
  • 2021(Publication Date)
  • Cambridge University Press

    (Publisher)

  Hunter inspired what A. J. Youngston called the Scientific Revolution in nineteenth-century medicine, an event which appeared to have, on the surface at least, less to do with experience and narrative accounts of actual patients, and more to do with laboratory tests and detailed  John Hunter, letter to Edward Jenner,  August , quoted in Ottley, Life, .  Quoted in Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present (; London: Fontana, ), .  Ottley, Life, .   anatomizations.  Xavier Bichat, the French anatomist and pathologist whose labours George Eliot famously described as having ‘acted necessarily on medical questions as the turning of a gas-light would act on a dim, oil-lit street, showing new connections and hitherto hidden facts of struc- ture’,  was, indeed, a leading light in this new scientific culture. His General Anatomy Applied to Physiology and Medicine (), was based on over  human dissections in which careful inductions were motivated by a sense that ‘the vital forces and the excitants which set them in play, since they are incessantly changing in the stomach, kidneys, liver, lungs, heart, etc., result in perpetual instability’.  One can expect no regularities or patterns in medicine because to do so would be ‘to build on shifting sand an edifice solid itself but which soon falls for lack of an assured base’.  There was need, then, for a meticulous approach to biological phenomena, an approach that was not weighed down by ‘some principle à priori’, or ‘the facts related by others’, but was given flight, instead, ‘by the evidence of [one’s] own senses’.  At no point did he say that patient testimonies are not to be trusted; instead, like Hunter, Bichat followed a system of empiricist scepticism that was growing within medicine and which transformed and explored, rather than jettisoned, traditional story- telling practices.

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  Science, Museums and Collecting the Indigenous Dead in Colonial Australia

  • Paul Turnbull(Author)
  • 2017(Publication Date)
  • Palgrave Macmillan

    (Publisher)

  There were also rumours that, like his countryman the philosopher and historian David Hume (1711–1776), he was a sceptic and agnostic as to the truth or otherwise of Christianity. But the main reason he was disliked seems to have been his quickness to anger and refusal to be tactfully oblique, as a true gentleman was expected to be, when discussing money. By his early sixties, Hunter suffered from arteriosclerosis, and when he suffered a fatal stroke in 1793, it was com- monly believed that it had occurred after his heatedly disputing the dis- tribution of student fees with embarrassed fellow surgeons at London’s St George’s Hospital (Qvist 1981, pp. 193–194). Even so, Hunter’s peers could not deny his surgical expertise, nor the value of how he spent his time when not attending to patients or teaching in comparative anatomical research. Hunter was fascinated by how life was sustained and reproduced within Earth’s myriad kinds of animals and plants. Few individual scientists then or since have matched the scale and diversity of his collecting and examination of comparative anatomical specimens. So avid a collector was he that contemporaries were unsurprised by rumours that he had risked the financial security of his family several times to put together what, when he died, was a collection of over 13,600 physiological, pathological and natural history specimens (Dobson 1969, p. 190). A decade after Hunter’s death, memories of his ill-governed tem- per and possible religious infidelity were eclipsed by England’s College of Surgeons representing him as the founder of scientific surgery and 2 EUROPEAN ANATOMISTS AND INDIGENOUS AUSTRALIAN BODILY … 35 a pioneer of comparative anatomical research. This apotheosis was achieved in large part by the astute uses to which the leading surgeons who founded the college put Hunter’s unparalleled collections of Fig. 2.1 John Hunter. Line engraving by W. Sharp, 1788, after Sir J. Reynolds, 1786, Wellcome Library, London

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  An Epitome of the History of Medicine

  • Roswell Park(Author)
  • 2014(Publication Date)
  • Perlego

    (Publisher)

  It will be seen that the excision of the joints was peculiarly an English method, the elbow-joint having been first excised in 1758, by Wainman, and the knee-joint by Filkin, of Northwich. The man who permanently attracted the attention of surgeons to these new operations was Henry Park, a bold surgeon, who wrote in 1782. The merits of these methods were then soon forgotten, however, and were revived in the present century by Liston and Syme.

  One of the best-known London surgeons was Percival Pott (1749-1787), who became especially eminent through his studies upon hernia, spinal disease, and diseases of the bones and joints; his complete chirurgical works appeared in London in 1771.

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  William Hunter (1718-1783), of Scotch parentage, originally a theological student, and a pupil of Cullen, went to London in 1741, began to lecture on anatomy and surgery in 1746, and soon acquired a great reputation as a surgeon, obstetrician, and anatomist. He achieved enormous success in practice, and spent £100,000 upon his house, library, and private collections. The latter now form the Hunterian Museum in the University of Glasgow. His magnificent plates illustrating the gravid uterus required the labors of twenty years and appeared in 1774.

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  John Hunter (1728-1793), younger brother of William, enjoyed even greater reputation than the latter. He was a pupil not only of his brother, but also of Cheselden and Pott. Beginning the practice of surgery in 1763, he became surgeon to St. George's Hospital in 1768, and Surgeon-general of the English forces in 1790. So memorable were the labors and services of this man that at the Royal College of Surgeons, of London, there is given annually an "Hunterian Oration," intended in some way to commemorate his labors or to draw some lesson from his life and work, To do justice to John Hunter would require a volume, hence we must at present dismiss the subject with this brief reference.

  Almost equally famous as a surgeon, though by no means such an omnivorous student as Hunter, was Benjamin Bell, of Edinburgh, who died in 1806. He employed tubes of lead and silver for the purpose of drainage. Sir Charles and John Bell, also of Edinburgh, are eminent names pertaining to the latter part of the eighteenth and first part of the nineteenth century. The latter was Professor of Anatomy, Surgery, and Obstetrics, a busy practitioner, a fertile writer, and not only one of the most successful operators of his day, but an excellent classical scholar; his Principles of Surgery appeared from 1801 to 1807. Sir Charles, who died in 1842, belongs more to the present century, but was equally distinguished as an operator, surgeon, and writer, and best known, perhaps, lor his Bridgewater Treatise on the Hand

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  A History of Surgery

  Third Edition

  • Harold Ellis, Sala Abdalla(Authors)
  • 2018(Publication Date)
  • CRC Press

    (Publisher)

  Hunter’s most famous technical contribution to surgery was his operation of ligation of the femoral artery in the subsartorial canal of the thigh, often now called Hunter’s canal, for aneurysm of the popliteal artery. This was common in those days in coachmen and horse riders, probably as a result of repeated pressure from the upper edge of the high riding boot on the artery. Up to the time of Hunter, surgeons either refused to operate or tied the artery immediately above the aneurysm, where the vessel was frequently diseased and could easily rupture with consequent death from haemorrhage. After animal studies, in which he showed that there was an excellent collateral circulation after ligation of the artery in the thigh, Hunter carried out this procedure in 1785 with great success. This patient was described by Sir Everard Home in 1793:

  Mr Hunter, from having made these observations, was led to propose that in this operation the artery should be taken up in the anterior part of the thigh, some distance from the diseased part, so as to diminish the risk of haemorrhage, and admit of the artery being more readily secured, should any such accident happen. The force of the circulation being thus taken off from the aneurismal sac, the progress of the disease would be stopped; and he thought it probable, that if the parts were left to themselves, the sac, with its contents, might be absorbed, and the whole of the tumour removed, which would render any opening into the sac unnecessary.

  A number of specimens of successful Hunterian ligations, in patients who survived for years after the operation, can be seen today in the Hunterian Museum.

  In Scotland, the leading surgeon of his time was Benjamin Bell (1749–1806). He was born in Dumfries and studied in Edinburgh, Paris and London, here as a pupil of the Hunters, before returning to join the staff of the Edinburgh Royal Infirmary. He wrote a six-volume System of Surgery , which was designed to become a comprehensive text in competition with Heister’s book. It went through seven editions and was translated into German and French. Bell also wrote a book on venereal diseases in which he corrected one of the errors made by John Hunter, who, as a result of experimental inoculations of venereal matter, believed that syphilis and gonorrhoea were the same disease. The error probably arose because the scrapings of pus Hunter used were presumably taken from a patient with both diseases.

  Benjamin Bell’s two sons both became Edinburgh surgeons, as did two of his grandsons. One of these, Joseph Bell (1837–1911), a brilliant teacher of clinical observation, had as one of his pupils Arthur Conan Doyle, who used him as the model for the famous fictional detective Sherlock Holmes.

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