The Hunterian oration on Hunter's ideal and Lister's practice : delivered before the Royal College of Surgeons of England on February 14th, 1927 / by Sir Berkeley Moynihan.

  • Moynihan, Berkeley Moynihan, Baron, 1865-1936.
Date:
1927]
Catalogue details

Licence: Public Domain Mark

Credit: The Hunterian oration on Hunter's ideal and Lister's practice : delivered before the Royal College of Surgeons of England on February 14th, 1927 / by Sir Berkeley Moynihan. Source: Wellcome Collection.

    4/8 (page 316)
    MeDICAI. JoUBKAS -«o by a skilled use of the art of injection. And so we find him in his earlier years following arteries to their ultimate termination, tracing the course of lymphatic vessels, unravelling the structure of the testis-and kidney by means of an expert use of the injecting syringe and of tiie hand lens. He remained in his brother’s school teaching and researching until the spring of 1761, when he entered his thirty-fourth year. Here is a list of the subjects he investigated during that period. He began to note the earliest stages in the development of the chick10 and continued this study to the end of iiis life, deriving from it guidance for the interpreta¬ tion of the phenomena of repair and of disease. We find him exposing the thoracic viscera, using artificial respira¬ tion, and noting accurately what happened to heart and lungs when the air supply was withdrawn and when it was renewed.11 He studied respiration in birds, keeping cocks alive which breathed through the cannulae inserted in their air sacs instead of through their windpipes.12 He carried out a series of experiments on absorption from the bowel in various animals; the experiments were well planned and skilfully executed, but he drew from them a wrong inference—one which misled him subsequently time after time—in the interpretation of the processes of disease. He believed that these experiments proved that all the products of digestion were absorbed by the lacteal or lymphatic system, and that none entered by the veins.18 Our hero, as we have seen, was often weak when he approached the goal posts. We find him tracing out the distribution of nerves in the nose and giving, for the first time, the right explanation of why the fifth pair of cranial nerves should enter into the field of mucous fciembrane supplied by the olfactory nerves.14 The description he then gave of the descent of the testis13 and of the vital phenomena which attend that still mysterious operation has never been surpassed. He kept a tame kite to prove that a stomach accustomed to a flesh diet could be educated to deal with one which was purely vegetarian; lie noted the phenomena of digestion in the stomachs of fish, fowls, dogs; he explained post-mortem destruction of the stomach.16 He placed pieces of raw meat in suppurating wounds and observed the digestive effects which followed; he measured the digestive (or tryptic) action of pus.17 We find him deeply interested in the formation of pus upon the unbroken surfaces of serous and of mucous membranes. He began a series of observations on the uses of the vesiculae seminales,18 and was led thereby to investigate experimentally the potent and mysterious influence which testis and ovary exercise on the development and growth of the body.19 ‘ We find him seeking signs to distinguish between tissues in which life was latent and those from which life had already vanished. He believed he had discovered the organ of hearing in fishes, and sought to discover an explanation of the curious fact that the ovaries of eels were always destitute of ova. As a collector—like Pascal a ramasseur de coquillcs, who often found a pearl of great price—as an observer of incredible industry, gathering facts just for the sake of their individual value and without at the moment any care for their relative significance or for the effect of their impact upon other facts, he ranks second only to Hippocrates. But when these facts were stored in his mind and illustrated by a series of specimens he was by no means inexpert in their interpretation or in raising a general truth from a multitude of singular examples. But as we read we seem to be oppressed by the verbal difficulties he encountered. The ’words 'will not come. Even the constructive thoughts may sometimes appear to be absent, puny, or unmanageable. He cannot get his mind round them. If by chance we seem to think that he has done so, the splendour of his thought is disfigured bv his uncouth language. Abernethy is not alone in telling us of Hunter’s paucity of language and of his inaptitude in its use; but we need no other evidence than that which his own works rarely fail to give us. His letters are the same. Illiteracy is not absent from 'them, though their meaning is often clear enough, especially when express instructions are given. It is when Hunter endeavours to rise to abstract generalizations that we see this incapacity chiefly and lamentably displayed. Obscurity- of language, I believe, even in abstract matters, often means obscurity of thought. Words may come after thought, but not long after, surely. Hunter’s defects in language were due in part, no doubt, to the absence of any early education of value, but they were not lessened by his studious avoidance of the work of others. His rebuke to Jesse Foot, as brutal and irrelevant as many of Johnson’s, would have con¬ founded anybody’, but it is irrelevant nevertheless, and it was a confession of his own imperfection. After spending fully twelve years experimenting, John Hunter in the spring of 1761, and in the thirty-fourth year of his age, engaged in the practical work of his profession and was appointed surgeon to the army. In the summer of 1763 he returned to London on half-pay and commenced practice. He bought “ a piece of ground called Earl’s Court, near the village of Brompton, and two miles from Hyde Park Corner,” on which he built a small house. Earl’s Court, his week-end cottage, was soon converted into a zoological garden and experimental laboratory; many new problems engaged his mind and several avenues of investigation were opened up there; all of them were made to converge on the same subject—the behaviour of living matter under all conditions. It was not until 1768, when he was 40 y-ears of age, that his private practice began to grow, enabling him to take a lease of the house, 42, Jerinyn Street, vacated by his brother William. We may now consider him, after an apprenticeship of twenty years, fairly launched in practice. Three years later he considered that his income justified him in undertaking the responsibilities of marriage. We see, then, this leader of surgery of the eighteenth century devoting twenty years of his life to arduous obser¬ vation and experiment so as to qualify himself for the practice of his art. There has probably never been a man in our profession with so- wide an intellectual interest, so profound a knowledge of so many varied subjects wholly- derived from direct personal inquiry and observation. His industry was inexhaustible. He had no equal either as physiologist or pathologist; lie was already first among comparative anatomists, and was indeed one of the founders of this science. He was a naturalist, all subjects in animal and vegetable physiology seeming to attract him. All his unequalled attainments as biologist were brought to the service of surgery, in his hospital work and finally- in the largest private practice of his day. Before Hunter’s time surgery was a thing apart, independent of all other sciences, ostentatiously aloof from them, and governed only- by the experiences and aptitude gained in the day-to-day practice of the art. All advance was therefore slow, even when recognizable, and was largely empirical. No physiological knowledge, nor any experimental discovery, broadened the old path or opened up new ones. Hunter changed all this. Not the least of his achievements was that he made alliances* for surgery, and linked it inseparably with biology. Hardly a day- passed without some experiment. I may quote, a statement of his to show how he regarded experi¬ ment.20 “ In pursuing any subject, .most things come to light by accident; that is, many things arise out of an investigation that were not. at first conceived, and even misfortune in experiment has brought tilings to our knowledge that were not, and probably could not, have been conceived; on the other hand, I have often devised experiments by the fire-side or in my carriage, and have also conceived the result; but when I tried the experiment the result was different,, or I found that the experiment could not he attended with all the circumstances that were suggested.” This statement helps in some degree to explain the number of apparently unrelated subjects which Hunter explored in his younger years. As he opened a new subject, he still continued to investigate the old; at the time of his death he had over fifty portfolios in use, each relating to a particular line of investigation. The “ misfortune in experiment ” has its-counterpart in operative surgery. An interesting little paper might be written on “ The advantage of error in medicine.” We may recall Spencer Wells’s operation for an “ ovarian cyst,” when tuberculous ascites was found and the surgical treatment of peritoneal tuberculosis inaugurated. The