Eminent doctors: Their lives and their work; Vol. 1 of 2

by G. T. Bettany

In 1772 Hunter began to lecture on the theory and practice of surgery, at first to his pupils and a few friends admitted gratuitously, but afterwards on payment of a fee of four guineas. This may be accounted the first introduction into this country, perhaps to any, of the idea of principles of surgery, and the necessity of a rational explanation of processes of repair, and of a scientific basis for operations. Instead of a study of anatomy alone being required by a surgeon, he elevated pathology into its true position, and brought in all the aids with which physiology and comparative anatomy could at that time illuminate the subject. But in advance of any of these aids was his own clear insight, which penetrated to the core of a question, and often brought out truth which he could not himself explain, or only imperfectly. He never overcame his difficulty in lecturing; at the commencement of each course he always composed himself by a draught of laudanum. His lectures, delivered on alternate evenings from October to April, were given from seven to eight o’clock. His class was usually comparatively small, never exceeding thirty; but the quality of his audience was good, as may be gathered from its having included Astley Cooper, Cline, Abernethy, Carlisle, Chevalier, and Macartney. He never became an attractive lecturer; from deficiency in extempore speaking, he was compelled to read his lectures, and seldom raised his eyes from his manuscript. His manner was frequently ungraceful, but his matter was for the most part highly intelligible and luminous to those of his hearers who came prepared by thought and attainments to be really edified, while he was often unintelligible to those who had no practice in thinking for themselves and desired to keep clear of that odious pain. In his lectures he was equally unsparing towards his own and others’ errors, and he never clung to his own past opinions. “Never ask me,” he replied to a question, “what I have said or what I have written; but if you will ask me what my present opinions are, I will tell you.”

The following extract from Ottley[13] gives an interesting view of Hunter’s after-dinner habits. “After dinner he was accustomed to sleep for about an hour, and his evenings were spent either in preparing or delivering lectures, in dictating to an amanuensis the records of particular cases, of which he kept a regular entry, or in a similar manner committing to paper the substance of any work on which he chanced to be engaged. When employed in the latter way, Mr. Bell and he used to retire to the study, the former carrying with him from the museum such preparations as related to the subject on which Hunter was engaged: these were placed on the table before him, and at the other end sat Mr. Bell, writing from Hunter’s dictation. The manuscript was then looked over, and the grammatical blunders, for Bell was an uneducated man, corrected by Hunter. At twelve the family went to bed, and the butler, before retiring to rest, used to bring in a fresh Argand lamp, by the light of which Hunter continued his labours until one or two in the morning, or even later in winter. Thus he left only about four hours for sleep, which, with the hour after dinner, was all the time that he devoted to the refreshment of his body. He had no home amusements for the relaxation of his mind, and the only indulgence of this kind he enjoyed consisted in an evening’s ramble amongst the various denizens of earth and air which he had congregated at Earl’s Court.”

In January 1776 Mr. Hunter attained a court position, being appointed surgeon-extraordinary to the king. In the same year he became interested in the efforts of the Humane Society, and at its request drew up a paper for the Royal Society on the recovery of the apparently-drowned. Herein he makes a just distinction between absolute death and suspended animation, illustrates different modes of dying, and describes many signs of life and death. This year was also the first in which he delivered the Croonian lecture to the Royal Society, on muscular motion, a subject which he continued in successive years till 1782 (omitting 1777); but the lectures were never published, being, he said, too incomplete.

In the year 1773 Mr. Hunter suffered the first open onset of the disease which occasioned him such acute pain and distress for many years, in an attack of spasm accompanied by cessation of the heart’s action apparently for three quarters of an hour. During the attack, however, sensation and voluntary actions were kept up, and he was able to continue respiring by voluntary effort. In the next few years the attacks were somewhat rare; but from 1783 onwards he was subject to severe angina pectoris whenever mentally agitated. In 1777 a constant giddiness or vertigo seized him on account of his being called upon to pay a large sum of money for a friend for whom he had become security, at a time when it was exceedingly inconvenient to do so. This illness led him to visit Bath in the autumn, leaving Mr. Bell and Mr. Home to catalogue his museum. At Bath Dr. Jenner visited him and was surprised at his altered appearance, and here first diagnosed his case as dependent upon an organic affection of the heart: but he did not tell Hunter his diagnosis, fearing an injurious effect. Returning to town, and soon recovering his usual health and vigour, Mr. Hunter published in 1778 the second part of his Treatise on the Teeth, dealing with their diseases. In 1779 a paper contributed to the Royal Society on the hermaphrodite black cattle or free martin gave him occasion to describe hermaphroditism in general. In 1780 occurred the unfortunate controversy with his brother, in regard to the discovery of the utero-placental circulation, to which we have already referred. The estrangement which followed was extreme, and protracted till the elder brother lay on his deathbed. After his brother’s death, however, which occurred just at the conclusion of John Hunter’s course of lectures, when he had finished his lecture, he still seemed to have more to say; and at length, appearing as if he had just recollected something, he began, “Ho! gentlemen, one thing more: I need not remind you of ——: you all know the loss anatomy has lately sustained.” He was obliged to pause and turn his face from his hearers. At length recovering himself, he stated that Mr. Cruickshank would occupy the place of Dr. Hunter. This, and a few words more, were not spoken without great emotion, nor with dry eyes. The scene was so pathetic, that a general sympathy pervaded the class; and though all had been preparing to leave, they stood or sat motionless for several minutes.

The eagerness with which Mr. Hunter sought and appropriated all rarities is amusingly illustrated by his own remarks to Dr. Clarke, who had a preparation illustrating extra-uterine pregnancy, which Mr. Hunter often viewed with longing eyes. “Come, Doctor,” said he, “I positively must have that preparation.” “No, John Hunter,” was the reply, “you positively shall not.” “You will not give it me, then?” “No.” “Will you sell it?” “No.” “Well, then, take care I don’t meet you with it in some dark lane at night, for if I do, I’ll murder you to get it.” It is reported that a specimen which remains one of the most valued in the Hunterian Museum cost Mr. Hunter no less than £500 in 1783, namely, the skeleton of O’Brien, the Irish giant, seven feet seven inches high. It appears that O’Brien had heard of and dreaded the scalpel of the famous dissector, and took special precautions to frustrate his ends. He made an Irish league with several compatriots that his body should be taken to sea, and securely sunk in deep water; but Mr. Hunter, more subtle than the giant, had made a big bargain with the undertaker, who arranged that during the funeral progress towards the sea the coffin should be locked up in a barn while its guardians were drinking at a tavern. The corpse was speedily extracted, and a sufficient weight of stones substituted; and Hunter soon rejoiced in the possession of his prize, which he drove to Earl’s Court in his own carriage, and quickly converted into a skeleton.

In 1781 Mr. Hunter was called by the defence as a witness in the trial of Captain Donellan at Warwick Assizes for the murder of his brother-in-law, Sir Theodosius Boughton. In his evidence Mr. Hunter gave all that could justly be deduced from the facts known to him, but refused to speak positively as to the cause of death. Under cross-examination he became confused and hesitating, as was certain to be the case. This rather aroused the wrath of Mr. Justice Buller, who in his charge said, “I can hardly say what his opinion is, for he does not seem to have formed any opinion at all of the matter.” But Hunter’s caution was undoubtedly justifiable.

In 1783 the lease of the Jermyn Street house expired, and finding it difficult to accommodate his museum in any premises he could obtain, Mr. Hunter purchased the remainder of the lease, extending to twenty-four years only, of a house on the east side of Leicester Square, with ground extending on the rear to Castle Street, where there was a second smaller house. On the vacant ground Mr. Hunter determined to build a museum for his collection, including a large upper room fifty-two feet by twenty-eight, lighted from above, and having a gallery running round it. A lecture-room and other rooms were beneath. By the spring of 1785 this considerable undertaking was complete, absorbing all Hunter’s spare cash and costing him more than £3,000. But the museum, which was removed to it in April 1785, had by 1782 cost him £10,000 in addition to valuable presents, so that it cannot be said that the casket cost more than the jewels although being on so short a lease it was doubtless expensive. The museum in its new home became continually more celebrated, and was visited by many foreign anatomists of distinction, including Blumenbach, Camper, Scarpa, and Poli. At this period Hunter was at the height of his career; his mind and body were in full vigour; “his hands,” says Home, “were capable of performing whatever was suggested by his mind; and his judgment was matured by former experience.” There were diverse opinions about his skill as an operator, however; Astley Cooper did not consider him especially dexterous or elegant. Nevertheless his anatomical knowledge and great experience stood him in good stead, and he was almost always successful in completing his operations. It must be recollected, however, that special importance was, in pre-chloroform days, attached to speed, and in this Hunter did not excel. Indeed, to him, operating was a distasteful element in a surgeon’s curative efforts. “To perform an operation,” he would say, “is to mutilate a patient we cannot cure; it should therefore be considered as an acknowledgment of the imperfection of our art.”

The year of greatest success, however, was marked by a period of grave illness, with attacks of violent spasms of the heart, followed by syncope. These recurred on occasions of extra exertion, anxiety of mind, fits of temper, or even the fear lest an animal which he wished to secure might escape before a gun could be brought to shoot it. To this year (1785) we are indebted for the celebrated portrait of Hunter by Sir Joshua Reynolds, in the possession of the Royal College of Surgeons. He was a bad sitter, but Reynolds, dissatisfied with his progress, one day was gratified by seeing Hunter in deep reverie, with his head supported by his left hand. He at once turned his canvas upside down, and began to record that life-like face, which shows Hunter the philosopher in the true profundity of his nature. Sharp engraved this portrait, and it was one of his greatest successes.

The year 1785 was that in which Hunter first tied the femoral artery in a case of popliteal aneurism, and thus initiated one of the greatest modern improvements in surgery, relying upon the enlargement of the smaller communicating or collateral vessels to make up for the cessation of circulation through the principal vessel. This appears to have been suggested to him by an experiment on the mode of growth of deer’s antlers. Having been granted by the king the privilege of experimenting with the deer in Richmond Park, he tied one of the external carotid arteries supplying (inter alia) one of the half-grown antlers. The antler became cold, but after a week or two Hunter, to his astonishment, found that it had again become warm and was growing again. On a post mortem examination he discovered that this continued growth was due to the enlargement of small branches of the carotid above and below the wound, to an extent sufficient to restore the blood-supply in the antler. And by a stroke of genius Hunter saw that a similar process might be expected to occur in cases of aneurism, and supersede the then generally fatal methods of operating by means of amputation, or by directly evacuating the sac of the aneurism. The fourth patient Hunter performed the new operation upon lived for fifty years; a specimen illustrating the case is preserved in the Hunterian Museum.

In 1786, on the death of Middleton, Hunter received the appointment of deputy surgeon-general to the army; becoming in 1790, on the death of Mr. Adair, surgeon-general and inspector of hospitals. In 1786 he published his long-deferred work on the Venereal Disease, which, though printed and sold in his own house, met with a rapid sale, and proved a very valuable work. In the same year he collected a large number of his papers contributed to the Royal Society, together with others not previously published, into a quarto volume entitled, “Observations on certain Parts of the Animal Œconomy,” and thus placed his researches in imposing bulk before the general public. The Copley Medal of the Royal Society was awarded to Hunter in 1787 for his discoveries in natural history.