||Tome III||Tome IV|
Anatomy and physiology in the eighteenth century
|In Abbot Islip's
chapel in Westminster Abbey, close to the resting-place of Ben Jonson,
rest the remains of John Hunter (1728-1793), famous in the annals of medicine
as among the greatest physiologists and surgeons that the world has ever
produced: a man whose discoveries and inventions are counted by scores,
and whose field of research was only limited by the outermost boundaries
of eighteenth-century science, although his efforts were directed chiefly
along the lines of his profession.
Until about twenty years of age young Hunter had shown little aptitude for study, being unusually fond of out-door sports and amusements; but about that time, realizing that some occupation must be selected, he asked permission of his brother William to attempt some dissections in his anatomical school in London. To the surprise of his brother he made this dissection unusually well; and being given a second, he acquitted himself with such skill that his brother at once predicted that he would become a great anatomist. Up to this time he had had no training of any kind to prepare him for his professional career, and knew little of Greek or Latin - languages entirely unnecessary for him, as he proved in all of his life work. Ottley tells the story that, when twitted with this lack of knowledge of the "dead languages" in after life, he said of his opponent, "I could teach him that on the dead body which he never knew in any language, dead or living."
By his second year in dissection he had become so skilful that he was given charge of some of the classes in his brother's school; in 1754 he became a surgeon's pupil in St. George's Hospital, and two years later house-surgeon. Having by overwork brought on symptoms that seemed to threaten consumption, he accepted the position of staff-surgeon to an expedition to Belleisle in 1760, and two years later was serving with the English army at Portugal. During all this time he was constantly engaged in scientific researches, many of which, such as his observations of gun-shot wounds, he put to excellent use in later life. On returning to England much improved in health in 1763, he entered at once upon his career as a London surgeon, and from that time forward his progress was a practically uninterrupted series of successes in his profession.
Hunter's work on the study of the lymphatics was of great service to the medical profession. This important net-work of minute vessels distributed throughout the body had recently been made the object of much study, and various students, including Haller, had made extensive investigations since their discovery by Asellius. But Hunter, in 1758, was the first to discover the lymphatics in the neck of birds, although it was his brother William who advanced the theory that the function of these vessels was that of absorbents. One of John Hunter's pupils, William Hewson (1739-1774), first gave an account, in 1768, of the lymphatics in reptiles and fishes, and added to his teacher's investigations of the lymphatics in birds. These studies of the lymphatics have been regarded, perhaps with justice, as Hunter's most valuable contributions to practical medicine.
In 1767 he met with an accident by which he suffered a rupture of the tendo Achillis - the large tendon that forms the attachment of the muscles of the calf to the heel. From observations of this accident, and subsequent experiments upon dogs, he laid the foundation for the now simple and effective operation for the cure of club feet and other deformities involving the tendons. In 1772 he moved into his residence at Earlscourt, Brompton, where he gathered about him a great menagerie of animals, birds, reptiles, insects, and fishes, which he used in his physiological and surgical experiments. Here he performed a countless number of experiments - more, probably, than "any man engaged in professional practice has ever conducted." These experiments varied in nature from observations of the habits of bees and wasps to major surgical operations performed upon hedgehogs, dogs, leopards, etc. It is said that for fifteen years he kept a flock of geese for the sole purpose of studying the process of development in eggs.
Hunter began his first course of lectures in 1772, being forced to do this because he had been so repeatedly misquoted, and because he felt that he could better gauge his own knowledge in this way. Lecturing was a sore trial to him, as he was extremely diffident, and without writing out his lectures in advance he was scarcely able to speak at all. In this he presented a marked contrast to his brother William, who was a fluent and brilliant speaker. Hunter's lectures were at best simple readings of the facts as he had written them, the diffident teacher seldom raising his eyes from his manuscript and rarely stopping until his complete lecture had been read through. His lectures were, therefore, instructive rather than interesting, as he used infinite care in preparing them; but appearing before his classes was so dreaded by him that he is said to have been in the habit of taking a half-drachm of laudanum before each lecture to nerve him for the ordeal. One is led to wonder by what name he shall designate that quality of mind that renders a bold and fearless surgeon like Hunter, who is undaunted in the face of hazardous and dangerous operations, a stumbling, halting, and "frightened" speaker before a little band of, at most, thirty young medical students. And yet this same thing is not unfrequently seen among the boldest surgeons.
for the Cure of Aneurisms.
Simply stated, every organ or muscle of the body is supplied by one large artery, whose main trunk distributes the blood into its lesser branches, and thence through the capillaries. Cutting off this main artery, it would seem, should cut off entirely the blood-supply to the particular organ which is supplied by this vessel; and until the time of Hunter's demonstration this belief was held by most physiologists. But nature has made a provision for this possible stoppage of blood-supply from a single source, and has so arranged that some of the small arterial branches coming from the main supply-trunk are connected with other arterial branches coming from some other supply-trunk. Under normal conditions the main arterial trunks supply their respective organs, the little connecting arterioles playing an insignificant part. But let the main supply-trunk be cut off or stopped for whatever reason, and a remarkable thing takes place. The little connecting branches begin at once to enlarge and draw blood from the neighboring uninjured supply-trunk, This enlargement continues until at last a new route for the circulation has been established, the organ no longer depending on the now defunct original arterial trunk, but getting on as well as before by this "collateral" circulation that has been established.
The thorough understanding of this collateral circulation is one of the most important steps in surgery, for until it was discovered amputations were thought necessary in such cases as those involving the artery supplying a leg or arm, since it was supposed that, the artery being stopped, death of the limb and the subsequent necessity for amputation were sure to follow. Hunter solved this problem by a single operation upon a deer, and his practicality as a surgeon led him soon after to apply this knowledge to a certain class of surgical cases in a most revolutionary and satisfactory manner.
What led to Hunter's far-reaching discovery
was his investigation as to the cause of the growth of the antlers of the
deer. Wishing to ascertain just what part the blood-supply on the opposite
sides of the neck played in the process of development, or, perhaps more
correctly, to see what effect cutting off the main blood-supply would have,
Hunter had one of the deer of Richmond Park caught and tied, while he placed
a ligature around one of the carotid arteries - one of the two principal
arteries that supply the head with blood. He observed that shortly after
this the antler (which was only half grown and consequently very vascular)
on the side of the obliterated artery became cold to the touch - from the
lack of warmth-giving blood. There was nothing unexpected in this, and
Hunter thought nothing of it until a few days later, when he found, to
his surprise, that the antler had become as warm as its fellow, and was
apparently increasing in size. Puzzled as to how this could be, and suspecting
that in some way his ligature around the artery had not been effective,
he ordered the deer killed, and on examination was astonished to find that
while his ligature had completely shut off the blood-supply from the source
of that carotid artery, the smaller arteries had become enlarged so as
to supply the antler with blood as well as ever, only by a different route.
In pondering over what he had learned about collateral circulation and the time required for it to become fully established, Hunter conceived the idea that if the blood-supply was cut off from above the aneurism, thus temporarily preventing the ceaseless pulsations from the heart, this blood would coagulate and form a clot before the collateral circulation could become established or could affect it. The patient upon whom he performed his now celebrated operation was afflicted with a popliteal aneurism - that is, the aneurism was located on the large popliteal artery just behind the knee-joint. Hunter, therefore, tied off the femoral, or main supplying artery in the thigh, a little distance above the aneurism. The operation was entirely successful, and in six weeks' time the patient was able to leave the hospital, and with two sound limbs. Naturally the simplicity and success of this operation aroused the attention of Europe, and, alone, would have made the name of Hunter immortal in the annals of surgery. The operation has ever since been called the "Hunterian" operation for aneurism, but there is reason to believe that Dominique Anel (born about 1679) performed a somewhat similar operation several years earlier. It is probable, however, that Hunter had never heard of this work of Anel, and that his operation was the outcome of his own independent reasoning from the facts he had learned about collateral circulation. Furthermore, Hunter's mode of operation was a much better one than Anel's, and, while Anel's must claim priority, the credit of making it widely known will always be Hunter's.
The great services of Hunter were recognized both at home and abroad, and honors and positions of honor and responsibility were given him. In 1776 he was appointed surgeon-extraordinary to the king; in 1783 he was elected a member of the Royal Society of Medicine and of the Royal Academy of Surgery at Paris; in 1786 he became deputy surgeon-general of the army; and in 1790 he was appointed surgeon-general and inspector-general of hospitals. All these positions he filled with credit, and he was actively engaged in his tireless pursuit of knowledge and in discharging his many duties when in October, 1793, he was stricken while addressing some colleagues, and fell dead in the arms of a fellow-physician.