John Hunter, Harvey Cushing, and acromegaly

Kevin R. Loughlin
Boston, Massachusetts, United States

 

Illustration featuring Charles Byrne who had acromegaly
Figure 1. Charles Byrne, a giant, George Cranstoun, a dwarf, and three other normal sized men. Etching by J. Kay, 1794. Credit: Wellcome Collection. (CC BY 4.0)

Introduction

John Hunter and Harvey Cushing were two of the most preeminent surgeons of their eras. John Hunter is considered to be “The Father of British Surgery” and Harvey Cushing the “Father of American Neurosurgery.” They both became interested in acromegaly and in the process went to extreme lengths to secure acromegalic cadavers for museum display or scientific dissection.

 

John Hunter and the Irish Giant

John Hunter was born in Scotland and was educated at St. Bartholomew’s Hospital in London. He learned anatomy by assisting his older brother, William, and also spent time as an army surgeon. He started a museum composed of anatomical specimens and gained wide notoriety. Hunter became a Fellow of the Royal Society in 1767 and his museum continues to the present day as the Hunterian Museum of the Royal College of Surgeons.1

Hunter was always interested in obtaining specimens for his museum and became aware of Charles Byrne, known as the Irish Giant. Byrne was born in County Tyrone in Northern Ireland in 1761. He grew to be almost eight feet tall and decided by his late teens to travel to London where he settled. Because of his enormous height, he became a curiosity and celebrity of sorts.2 (Figure 1)

Through his notoriety, he had become known to John Hunter and other notable surgeons of the era. Byrne was an alcoholic and had tuberculosis, and realized he would be short-lived. He told his friends he did not want his body snatched and directed them to weigh down his coffin and bury him at sea.3 Nonetheless, Hunter intervened to circumvent Byrne’s wishes. He hired a man named Howison to stay with Byrne and alert him of the giant’s death the moment it occurred.4 However, after he died on June 1, 1783, a local paper recorded that, “the whole tribe of surgeons put in a claim for the poor departed Irish Giant and surrounded his house just as Greenland harpooners would an enormous whale.”3,5 After Byrne’s death, his friends attempted to carry out his wishes as best they could. Hunter, however, bribed a member of the burial party with 500 pounds and procured the body. He stripped the skin and boiled the body to isolate the skeleton and placed it in his museum, where it has remained for over two centuries. (Figure 2)

Controversy has continued to surround Byrne after his death. A confirmation of Byrne’s underlying acromegaly continued to interest the medical community. In the modern era, a research team led by Doctor Marta Korbonits of London identified that the mutations of a gene, encoding the aryl hydrocarbon-interacting protein (AIP), predisposes the carrier to pituitary adenoma formation.6 They identified a cohort of four families in Northern Ireland near where Byrne was born.7 Knowing the story of the Irish Giant led Dr. Korbonits and her colleagues to contact the Hunterian Museum and, with their permission, were able to remove two of Byrne’s molars. With DNA analysis of his molars, they confirmed the AIP mutation as the cause of his acromegaly.8

Photo of the Skeleton of the Irish Giant, who had acromegaly, in the Hunterian Museum
Figure 2. The Skeleton of the Irish Giant in the Hunterian Museum. Photo by Paul Dean (StoneColdCrazy at Wikipedia). September 2007. CC BY-SA 3.0.

However, the debate over the rightful legal ownership of Byrne’s skeleton continues to the present day. Although he had no direct living descendants, he clearly expressed his desire to be buried at sea. The Hunterian Museum is presently closed for renovations until 2021, but the board of trustees has said they will consider the matter of the disposition of Byrne’s remains before reopening.9 Thomas Muizer of the Department of Law, Queen’s University, Belfast, Northern Ireland, has been one of the legal champions regarding the possession of Byrne’s skeleton by the Hunterian. He continues to advocate that Byrne’s wishes should be fulfilled, that his remains are the cultural property of the Northern Irish, and that the Hunterian Museum should divest itself of the skeleton.10

 

Harvey Cushing and acromegaly

Cushing was also interested in acromegaly. In 1909, while visiting the Hunterian Museum, he prevailed on its curators to remove the top of Byrne’s skull to confirm the presence of an enlarged sella.3 That same year, Cushing proposed that acromegaly and gigantism resulted from hypersecretion of growth hormone11 and later, in 1912, emphasized the dominant role of the pituitary in the endocrine system.12

In 1910, while at Johns Hopkins, Cushing cared for the thirty-six-year-old John Turner, with apparent gigantism. Like Byrne, Turner’s health was not robust, and Cushing was eager to have access to the body when death occurred on June 18, 1910. However, when approached, the family refused post-mortem examination. Cushing was frantic and after bribing the undertaker, sent Doctor Crowe, one of his residents, to perform the autopsy which occurred while the funeral service was going on and without the family’s consent or knowledge.13 Cushing would later comment that the autopsy was conducted under “inauspicious circumstances.”13

Doctor Crowe later confided to Cushing’s biographer, John Fulton, that Cushing “would stop at nothing to gain his ends.”13 The same could be said of John Hunter.

 

References:

  1. John Hunter. www.wikipedia.com accessed 5/31/2020
  2. The Irish Giant vs. The Eager Anatomist. Weird Historian. http://www. Wierdhistorian.com/the-Irish-giant-vs-the anatomist. Accessed 6/1/2020
  3. Bergland RM. New information concerning the Irish Giant.1965 J. Neurosurg. 23(3): 265-269
  4. Dr. Pembroke’s Clinic-John Hunter and the Irish Giant. https://the pandorasociety.com/dr.-pembrokes-clinic-john-hunter-and-the-irish-giant/ accessed 7/22/2020
  5. The Tallest Man in England. St. George’s University Hospitals. www.stgeorges.nhs.uk-history-st.georges-hospital. Accessed 9/6/2020
  6. Leontiou CA, Gueorguier M, van derSpuy J et al. The role of the arylhydrocarbon receptor-interacting protein gene in familial and sporadic pituitary adenomas. 2008 J. Clin. Endocrin. Metab. 93:2390-2401
  7. Kolata G. In a Giant’s Story, a New Chapter Writ by His DNA. The New York Times. 1/5/2011
  8. Chahal HS, Stals K, Unterlander M et al. AIP mutation in pituitary adenomas in the 18th century and today.2011 N. Engl. J. Med. 364: 43-50
  9. Devlin H. ‘Irish Giant’ may finally get respectful burial after 200 years on display. The Guardian 6/22/2018
  10. Muinzer TL. A Grave Situation: An Examination of the Legal Issues Raised by the Life and Death of Charles Byrne, the “Irish Giant.”2013 Int. J. Cultural Property 20: 23-48
  11. Cushing H. The hypophysis cerebri. Clinical aspects of hyperpituitarism and of hypopituitarism. JAMA 1909; 53: 249-255
  12. Cushing H. The pituitary body and its disorders, clinical states. produced by disorders of the hypophysis cerebri. J.B. Lippincott Company, Philadelphia. 341 pp
  13. Pendleton C, Ward G, Quinones-Hinojosa A. The autopsy was conducted “Under most inauspicious circumstances:” John Turner, Harvey Cushing case XXXII, and his unwitting contributions to the early understanding of acromegaly. Pituitary, 2010;13: 324-328

 

 


 

KEVIN R. LOUGHLIN, MD, MBA, received his A.B. from Princeton University, M.D. from New York Medical College, M.B.A. from Boston University, and M.A. (Hon.) from Harvard University. He has been a practicing urologist for almost forty years and is currently the Vice President of the American Board of Urology and a member of the board of directors of the American Urological Association. He has had a lifelong interest in medical history.

 

Fall 2020  |  Sections  |  Anatomy