B. Herold Griffith
Chicago, Illinois, United States
Excerpted from a presentation at the meeting of the Society of Medical History of Chicago October 3, 2006
|Portrait of William Hunter. Credit: Hunterian Society loan to the Wellcome Collection. Attribution 4.0 International (CC BY 4.0)|
Of the many surgeons who have had ties to Glasgow over the past 500 years or so, the most famous were the Hunter brothers, and a century later, Sir Joseph Lister. Ironically, the Hunters, who were born near Glasgow, did their best-known work in London, and Lister, who was born in England, made his greatest discovery in Glasgow. . . .
In some ways William and John Hunter were a lot alike, but they were also very different. Their lives were so intertwined for so many years that it is impossible to discuss one without the other. They were both born on their family’s farm, Long Calderwood, seven miles from Glasgow. William was born in 1718, the seventh of ten children. John, born in 1728, was the tenth and last. Five of their siblings died in childhood, probably from tuberculosis that was rampant at that time, when the average life expectancy was thirty-seven years. A brother who was showing promise as a lawyer died in his early twenties. Their father was fifty-five when William was born, and took great interest in his son, but when John came into the world their father was sixty-five, and pretty much ignored his youngest child.
William was a good student, and at age fourteen his father sent him to the University of Glasgow to become a clergyman, but William chose medicine instead. He stayed at college for four years, but left without a degree. He then spent three years as a live-in apprentice of William Cullen, a prominent physician in nearby Halifax. Years later he said that these were the happiest years of his life. [He] next studied anatomy for two years with Professor Alexander Monro Primus in Edinburgh. He had planned to return to Halifax to practice with Dr. Cullen, but instead went down to London for further study—in 1740, at age twenty-two.
John Hunter, on the other hand, was poor student, possibly dyslexic, and unable to read until his teens, He ended his formal schooling at thirteen, and rejected books—although later in life he amassed a large library. He said he preferred “the volume of the animal body” and dissected every animal—and plant—he could find.
William quickly made a name for himself in London. The first year there he studied obstetrics with William Smellie, and then for a few months, obstetrics and anatomy with James Douglas (of Douglas’ pouch fame). Both Smellie and Douglas were fellow Scots.
In 1742, at age twenty-four, William Hunter became a “surgical pupil” at St. George’s Hospital where, in addition to surgery, he learned the “corrosion method” of preparing anatomical specimens. On a visit to Leyden, Holland, he learned from Albinus how to dissect and how to inject vessels. In Paris, he found that anatomy was being taught better there than in London and decided to change that when he got home.
|John Hunter (1728-1793), surgeon and anatomist. Oil painting after Sir Joshua Reynolds. Credit: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)|
When he returned to London, William was appointed surgeon at Middlesex Hospital and quickly developed the busiest obstetrical practice in town. In 1746 William started a school of anatomy and surgery that became the first medical school in London, a city that had lagged woefully behind other major cities that had had medical schools for centuries. The next medical school in London was not started until eighty years later!
William adjusted well to London. He was handsome, pleasant, kind-hearted, and an elegant dresser, He lost his Scottish accent and adopted the English manner of speaking. He was at home in London society and had many influential friends—among whom were Tobias Smollet, William Pitt the Younger, Horace Walpole, the artist William Hogarth, the naval surgeon James Lind of scurvy fame, and the explorer James Cook. At age twenty-eight, William Hunter had an international reputation.
Meanwhile, up in Scotland, John Hunter, aged eighteen, tired of country life and was perhaps a bit envious of his brother’s success. So he wrote William and asked if he could become his assistant. William said yes, and upon John’s arrival—after a four-hundred mile journey on horseback—William gave John a human arm to study. John did such a meticulous dissection of the arm that William recognized his exceptional talent and put him to work in his dissecting rooms. John worked tirelessly, adopting a life-long habit of sleeping only four or five hours a night. Within six months John surpassed William as a dissector. Their amicable and mutually beneficial association continued for twelve years.
John at first sight was not very impressive. He was only 5 feet, 2 inches tall, and was a very casual dresser. Unlike most men of the period, he refused to wear a wig, and his red hair was often uncombed. He made no effort to lose his Scottish accent. He was very outspoken and had a quick temper. Nevertheless, John shared many of William’s friends, and over time gained many more, among them Sir Joseph Banks and the artist Sir Joshua Reynolds.
The Hunters’ School of Anatomy and Surgery, situated in a large home in Covent Garden, was hugely successful. Students came from far and wide. Dissections were usually done rather quickly in the evenings in the winter since there was no refrigeration and putrefaction was a never-ending problem. William provided each student with a fresh cadaver—and hands-on experience. The Monros in Edinburgh had only two bodies per class.
But bodies were not easy to obtain. Some came from Tyburn Gallows where over fifty men, women, and occasionally children were hanged each year. Hanging was the penalty for two hundred offenses at that time. However, the families and friends of those executed often fought for possession—so body-snatching from fresh graves was an active business. Neither Hunter was ever prosecuted, although some surgeons were. John had a long-term relationship with the “resurrectionists.”
In 1749, at age twenty-one, John obtained a position as student at the Royal Hospital at Chelsea where he worked with William Cheselden, London’s leading surgeon and the author of two classics, The Anatomy of the Human Body and Atlas Osteographica. Cheselden was also renowned as a lithotomist who could extract a bladder stone in less than a minute, and with a mortality of only ten percent. Chelseden died in 1751, whereupon John Hunter went over to work with Percival Pott at St. Bartholomew’s Hospital.
John believed in operating upon a patient only when it was absolutely necessary to do so. And he was also a strong opponent of amputation of the leg for popliteal aneurysm. Instead, he ligated the femoral artery in the thigh in what came to be known as Hunter’s canal. The leg was salvaged by the collateral vessels that became enlarged and by-passed the aneurysm. This revolutionary treatment was the result of John Hunter’s life-long practice of careful anatomical study and experimentation. His response to a suggestion that a treatment might work was, “Why think it? Why not do the experiment?”
Hunter elevated the surgeon from deprecatory status of “barber-surgeon” to the same level of respect as the physician. During the years that John and William worked together teaching anatomy, they also collaborated in the management of many clinical problems, including two caesarian sections, neither of which unfortunately, had a happy outcome.
William and John were both insatiable collectors of anatomical and pathological specimens, thousands of which were preserved in jars and sealed with pigs’ bladder. Many can be seen today in Glasgow and London in their original glass containers. Over the years, William amassed over 50,000 specimens, and a library of 14,000 books and manuscripts, in English, Latin, Greek, Arabic, and Hebrew—all of which he learned to read. In addition, William spent 22,000 pounds on 30,000 ancient coins, the history of which interested him more than their intrinsic value. It was the largest private coin collection in the world. He also had a respectable collection of original paintings by Rembrandt, Ruben, Reynold, etc.
In 1750 the Univerisity of Glasgow granted William an honorary M.D. degree, and in his later years, William, who never married and thus had no direct heirs, willed all of his great collections to his alma mater where they are today. In 1770 William built a large house on Great Windmill Street, with space for his museum, dissecting rooms, lecture hall, and quarters for himself and his live-in students.
Among William’s special interests were malformations of the heart, dislocations of the shoulder, venereal disease, the forensics of bastard children, the history of anatomy (especially Vesalius), aneurysms, and—with John—arteriovenous fistulas. William was the first to describe the testicular tubules, the lacteals, and the lymphatics, which he and John injected with mercury. He was also the first to aspirate an ovarian cyst. He urged caution in purging, performing venesection, inducing vomiting, and the use of obstetrical forceps.
William Hunter was not a prolific writer, but his book The Anatomy of the Human Gravid Uterus has never been surpassed. It was published as an elephant folio and contained thirty-two magnificent engravings by the Dutch artist, Jan van Rymsdyke. In 1756, Alexander Monro Secundus who had studied with the two Hunters claimed to have discovered the seminiferous tubules, the tear ducts, and the lymphatics before they had—but his claim was discredited. In 1780 William and John got into a bitter dispute over which of them had been the first to discover that the placental circulation was separate from the mother’s. This led to an estrangement of the brothers that was never resolved.
William’s honors were many, among them Licentiate of the Royal College of Physicians (1756), Fellow of the Royal Society (1787—three months after John was elected), and the first Professor of Anatomy in the Royal Academy, of which Sir Joshua Reynolds was the first President. William was also the obstetrician who attended the births of all eleven children born to Queen Charlotte, the wife of King George III.
Among William’s students were John Hunter, Mathew Baille (their nephew), William Cruikshank, and the Americans William Shippen (first Professor of Surgery), John Morgan (first Professor of Medicine—both at the Univerisity of Pennsylvania), and John Jones, also of Philadelphia and one of the founders (in 1771) of the New York Hospital.
William Hunter died following a stroke in 1783 at age sixty-five. Although there was no reconciliation, John eased his brother’s last days by fitting him with a catheter. There was no autopsy and John did not attend the funeral. However, John later did acknowledge publicly his brother’s great contributions to anatomy and obstetrics.
Getting back to John Hunter’s life, in 1755 he was sent by William to Oxford University for some classical education, but he was uncomfortable there and left after only two months. In 1756 he started taking over some of William’s lectures. The same year The Seven Years’ War started and by 1760 John decided to get involved—as a surgeon in the army. For two years he served at the siege of Belle Isle on the French coast, rising to the position of Chief Surgeon. It was a bloody fight with many victims of hemorrhagic shock, infected wounds, and typhus. Hunter’s extensive experience with war wounds led to his book Treatise on the Blood, Inflammation and Gunshot Wounds that was not published until a year after his death.
John spoke out against the practice of cutting traumatic wounds wide open, urging instead cleansing the wound, removing any foreign material, controlling bleeding, and applying a dressing, much as Ambrose Pare had advocated in the sixteenth century. When the war ended in 1763, John was then with the army in Portugal, returned to London, only to find that his position in William’s school had been filled—so he needed a job. He was able to join the practice of a dentist, James Spencer, with whom he spent five years, part time. During this period John started his experiments with transplantation: the spur of a cockerel into its comb, a rooster’s testis into its abdomen, a human tooth into a rock’s comb, and a cow’s horn into a donkey’s forehead. He wrongly believed that transplanted teeth became viable in their new locations. He was the first to describe dental plaque and was an outspoken advocate of brushing the teeth. The names he gave to the different types of teeth—incisors, molars, etc.—are the ones we use today. Hunter’s dental work led him to write the first book on dentistry, On the Natural History of the Human Teeth, a beautifully illustrated text that went through fifteen editions. During this time Hunter also developed the science of pathology. One of the first of his more than a thousand autopsies was on the body of William Chatworth, who years earlier had been stabbed by his cousin, Lord Byron.
In 1764, John Hunter became engaged to Anne Home, a well-known poet and song-writer who was the daughter of General John Burgoyne’s surgeons, but their marriage was postponed for seven years, in part because of John’s never-ending scientific investigations. Not content with countless experiments of all sorts on all kinds of animals, John performed a number of experiments on himself. One was to inoculate himself with material from a patient with gonorrhea, a disease which he promptly contracted. Unaware that the patient also had syphilis, he developed a chancre and a succession of features of lues. Although it was thought for a time that some of Hunter’s eccentric behavior in later years might be due to advanced syphilis, no sign of it was noted at his autopsy in 1793. Hunter believed, as did others, that gonorrhea and syphilis were parts of the same disease, a belief that was not disproven until many years later. Hunter had a large VD practice that provided material for another of his books.
John Hunter, like William, was a great collector, amassing over 15,000 items. In 1765 John purchased property in Earl’s Court, on the edge of London. Here he built a house for himself and his live-in students, his museum, dissecting rooms, lecture hall, and quarters for all sorts of live animals, including leopards, bulls, dogs, and even a buffalo that used to pull him around town in a wagon. John made a great deal of money but spent most of it on specimens and salaries of the fifty or so people whom he needed to tend his collections and menagerie. He tried to prolong the life of a mouse and a fish by freezing and then thawing them. He also failed in his attempt to resuscitate a man who had just been hung at Tyburn. He studied the growth of bone in young hens and pigs by implanting pieces of metal in the shaft and measuring the change in distance between them, showing that growth occurred at the epiphyseal lines. He performed the first artificial insemination, in a woman whose husband had hypospadias.
He obtained numerous specimens from the voyages of his friend Captain James Cook, including the head of a Maori warrior, which he dissected. He was given the skin and skeleton of the first giraffe ever seen in England. He stuffed it and had it displayed in the foyer of his house—with the legs cut off, since, at 21 feet high—the animal was too tall for the ceiling. When he later built a larger house with a higher ceiling, he displayed the giraffe with its legs fastened back on. John Hunter was recognized far and wide for his many accomplishments with: Fellowships in the Royal Societies of England and Gothenburg and in what became the Royal College of Surgeons of England, Surgeons to St. George’s Hospital, Surgeon extraordinary to King George III, Surgeon General of the army, and Member of the Philosophical Society of Philadelphia, a city that he was never able to visit.
John’s marriage to Anne Home in 1771 was attended by Captain Cook and Sir Joseph Banks, but not by William Hunter. The Hunters had four children, two of whom died in infancy. Their house was always busy with children, students, dinners, concerts, and guests, including composer Joseph Haydn, one of Anne’s friends. Eventually John sold the Earl’s Court property and built a house on Leicester Square—large enough for all of his activities. In 1758 he opened his museum to the public, but only twice a year. In 1783 Hunter got the just deceased “Irish Giant,” 7 foot, 8 inches tall Charles Byrne, aged twenty-two. Hunter, anticipating Byrne’s early demise, had the poor chap tailed constantly in order to obtain his skeleton for his museum. Byrne, terrified by the prospect, arranged that upon his death his body would be put into a lead coffin and dropped into the English Channel. But when death came, Hunter bribed Byrne’s friends with 500 pounds to replace the body with stones. Byrne’s skeleton may be seen today in the Royal College of Surgeons in a glass case, next to the skeleton of a normal-sized man for comparison. Early in the last century Harvey Cushing persuaded his friend, Sir Arthur Keith, Curator of the Museum, to remove Byrne’s calvarium. Examination of the skull revealed, as Cushing expected, a greatly enlarged sella turcica, indicating that Byrne had a pituitary tumor.
Among John Hunter’s many patients were the infant Lord Byron (whose club foot he treated with a special boot), Benjamin Franklin (who decided, at age 77, to keep his bladder stone rather than have Hunter remove it), the economist Adam Smith, Prime Minister William Pitt (from whom Hunter removed a large sebaceous cyst of the cheek—in six and a half minutes), the artist Thomas Gainsborough (who had inoperable cancer), and Joseph Haydn (who refused to let Hunter remove a large obstructive nasal polyp). John Hunter’s more than 1,000 students included Mathew Baillie, Everard Home (his brother-in-law), Sir Astley Cooper, Henry Cline, William Shippen, John Morgan, Philip Syngh Physick, John Abernathy, and his most devoted pupil, Edward Jenner.
Hunter advises his students not to take notes at his lectures since “knowledge is always changing.” But he himself kept voluminous case records and wrote over 100 papers and eight books. His phenomenally wide range of interests included, in addition to those already mentioned, geology, botany, animal cross-breeding, lizards, insects, kangaroos, tendon injuries, lymphatics, digestions, whales, and evolution—sixty years ahead of Darwin. In 1791 he helped found the Royal Veterinary College.
John’s quick temper finally proved to be his undoing. He suffered from angina for the last twenty years of his life and early on he recognized that he was “at the mercy of any rascal who provoked [him] to anger.” In 1793 he got into a heated argument with a colleague at St. George’s Hospital and suddenly collapsed and died. He was just sixty-five years old, the same age at which his brother had died ten years earlier. Having spent most of his money on his collections and salaries, he left his family in dire financial straits. His possessions had to be sold and his animals were given to various menageries. Anne Hunter became a lady’s companion, but continued to publish some of her poems. Their son had to leave Cambridge and joined the army where he had an undistinguished career. Their daughter, Agnes, had an unhappy first marriage, but fortunately fared better with a second.
Hunter’s great museum, containing 13,687 items and valued at 70,000 pounds was purchased by the government for 17,000 pounds after being carefully tended by William Cliff for several years. Eventually it was given to the Royal Company of Surgeons, which in 1800 became the Royal College of Surgeons. Since 1835 it has been on exhibit in the College’s building in Lincoln’s Inn Fields. Sadly, a large portion of the collection was destroyed by a German bomb during “the Blitz” in World War II.
Anne Hunter’s brother, Everard Home, who had been Hunter’s student, was given John’s voluminous papers, some of which had never been published. A few years later Home burned most of them, allegedly to conceal the fact that he had taken credit for many of Hunter’s discoveries. Home, who had become Sir Everard, thanks to his friend, the future King George IV, died “a sot” in 1832.
Incredibly, neither William nor John was ever knighted.
John Hunter was buried first in St. Martin in the fields facing what is now Trafalgar Square. But in 1859 he was re-interred in Westminster Abbey where a plaque placed by the Royal College of Surgeons reads simply “John Hunter, the Father of Scientific Surgery.”
What is the legacy of these two Renaissance men who lived in the age of enlightenment? We have only to look around us. Their curiosity was insatiable and their accomplishments in anatomy, pathology, surgery, obstetrics, and education have had an immeasurable influence on the science and practice of medicine.
B. HEROLD GRIFFITH, M.D., F.A.C.S., presented this paper at the meeting of the Society of Medical History of Chicago on October 3, 2006. He was a plastic surgeon, launched the plastic surgery residency program at Northwestern University, and was chief of the division for more than twenty years. He died on October 30, 2016, at age 91.