In the Dark

It looks set to be the proverbial wet weekend here in Cardiff and I’m waiting for a pause in the rain before going out to do my Saturday shopping. Having done the crossword already, I should be cleaning the house but instead I thought I’d post a quick comment about the fascinating book I’ve just finished reading.

The Knife Man, by Wendy Moore, is an account of “The Extraordinary Life and Times of John Hunter, Father of Modern Surgery”. It’s a measure of my ignorance about medical history that I didn’t even know who John Hunter was when I started reading this, although I had heard of the Hunterian Museum without realising who it was named after.

I won’t give a lengthy account of Hunter’s biography; that’s done very well elsewhere on the net and indeed in the book, which I thoroughly recommend. It is worth emphasizing, however, what a remarkable man he was. Born in Scotland in 1728, he didn’t go to University and received no formal medical training. He went to London in 1748 in order to become assistant to his brother William, a noted surgeon at the time. John’s primary rsponsibility was to help with the dissection of human cadavers during William’s anatomy classes. He soon became fascinated by anatomy and himself became extremely adept at dissection. He received some medical training in London, had a spell as an army surgeon and eventually set up a private medical practice in London at which he ran his own anatomy classes for paying students. He became one of the top surgeons in London and attended to the needs of many prominent Georgian figures, including King George III.

But, as impressive as it was, his medical career wasn’t the most remarkable thing about Hunter’s life. His interests extended far beyond human anatomy and from an early age he was an avid collector of all sorts of animals, alive and dead. As he became wealthier through his medical practice and lectures he spent increasing amounts of cash on acquiring rare specimens, which he usually dissected in order to understand them better. He also collected specimens of diseased human organs, bones, and fossils. There was a very dark side to this work too. The grisly business of acquiring fresh human human corpses led him to make connections with graverobbers. Worse, he also experimented on human specimens, usually members of London’s poor. He did pay them for their pains, but that’s hardly the point.

Hunter’s studies led him to conclude – years before Darwin – that species were not fixed and immutable but that animal populations altered over time, with some creatures becoming extinct. Although he doesn’t seem to have used the word “evolution”, his work in this area was certainly heading in that direction. He was made a Fellow of the Royal Society in 1767.

Above all I think what stands out about Hunter was that he pioneered the use of the scientific method in the field of medicine. His lack of formal training meant that he wasn’t steeped in the dogma or orthodox medicine which had led to many bizarre and/or dangerous practices. One wonders what chain of reasoning had led doctors to suppose that pumping tobacco smoke into a patient’s anus using specially constructed bellows could possibly have any therapeutic value!

Hunter learned primarily from experience. He knew, for example, that major surgery in Georgian times was very likely to kill the patient. There were no anaesthetics, so death by shock was a strong possibility. Loss of blood was a danger, too, unless the operation was completed extremely quickly. Moreover, doctors at the time – Hunter included – had no idea about how infections were spread and surgeons would often operate with instruments encrusted with the blood of previous victim. In the (unlikely) event of a patient surviving the agony of, say, an amputation, they would probably die of  some form of infection within a few days anyway. Hunter’s policy in the light of all this was to refuse to operate unless the situation was truly desperate.

For example, when Hunter was an army surgeon, the prevailing attitude to gunshot wounds was that the bullet had to be removed at all costs. Moreover, it was believed that gunpowder was poisonous, so entry wounds were usually “enlarged” to remove tissue that had been blackened or burnt. One day, a group of British soldiers had come under fire and several had been badly injured. They escaped the ambush and holed up in a farmhouse, where they were found a few days later. One had two bullets in his thigh, another had one in his chest. However, although seriously ill, all were still alive. Hunter knew that if men in that condition had been brought into his field hospital and operated on in the usual manner, they would all almost certainly have died. After this experience Hunter was extremely reluctant to operate at all on battlefield injuries unless they were immediately life-threatening, and often decided to let nature take its course with flesh wounds.

The Knife Man contains many more examples of Hunter’s pionering use of empirical evidence in medicine and, as such, is well worth reading by anyone interested in the scientific method. It also provides a fascinating insight into life in Georgian London. Notable characters appear in extremely unexpected ways in Hunter’s story:

• James Boswell made frequent visits to Covent Garden  in order to the employ the services of local prostitutes, which was apparently quite normal for Georgian gentry, as was the consequence – a lifelong problem with gonorrhea, which Hunter tried to treat him for.
• Hunter attended the birth of George Gordon (later Lord) Byron, who was born with a congenital deformity,  possibly a club foot. Hunter told his mother that it could probably be cured if he wore a specially constructed boot during infancy, but she didn’t take his advice.
• Joseph Haydn was a frequent visitor to the Hunter residence during his time in London; he even wrote set some poems by Anne Hunter (John’s wife) to music. There were rumours of an affair, in fact. He also suffered from a nasal polyp, about which he sought Hunter’s advice. When the nature of the required surgery was explained to him, Haydn decided not to have it operated on.

I could give more examples, but that’s 1000 words, and it’s now sunny outside, so you’ll have to go and read the book, which I  recommend heartily. However, I really should point out that it’s not for the squeamish. The primitive surgical procedures deployed in the 18th Century are described in excrutiating detail and parts of the book make for very uncomfortable reading. If you don’t think you can cope with a detailed account of an operation, without anaesthetic,  to remove stone from a patient’s bladder, then perhaps this isn’t a book for you!