ENGLISH LEADERS IN MEDICINE AND SURGERY DURING THE EIGHTEENTH AND EARLY NINETEENTH CENTURIES

Second Group: William and John Hunter and Sir Benjamin Brodie My information concerning the Hunter Brothers is based upon data which I found in Pettigrew’s “Medical Portrait Gallery,” Parkinson’s “Hunterian Reminiscences,” and a few other published documents.

William Hunter, the elder of the two brothers who attained such marked distinction in the world of medicine during the eighteenth century, was born in 1718 in the west of Scotland. During his early manhood he devoted his attention to the study of theology at the College of Glasgow; but, losing soon his interest in these studies, he turned his attention to medicine, a branch of science which he found much more congenial. His advance in this new field of labor was rapid, for already at the age of twenty-eight he was invited by a society of naval surgeons to deliver a course of lectures on operative surgery. Two years later (in 1748) he became connected with the Middlesex Hospital and the British Lying-in Hospital, and from that time forward his chief interest was centred in obstetrics. Rising rapidly in public favor it was not long before he acquired a large fortune. In 1764 he became Physician Extraordinary to Queen Charlotte, and in 1768 was appointed Professor of Anatomy in the Royal Academy.

His greatest work, which was begun in 1751 and published in 1783, bears the title: “An Anatomical Description of the Human Gravid Uterus and its Contents.” Pettigrew speaks of this work, which eventually comprised thirty-four plates (drawn from Hunter’s dissections and engraved by some of the best English engravers),

as one of the most splendid medical works ever published. It is not, perhaps too much to say that the engravings have never been surpassed.... A period of thirty years was necessary, to obtain sufficient instances to develop all the changes occurring in the human uterus during the progress of gestation.... The treatise upon this subject was intended to be a separate production; but Dr. Hunter did not live to publish it. It remained for his nephew, Dr. Baillie, to submit this to the profession, which he did in 1794, as an “Anatomical Description of the Gravid Uterus and its Contents.”

One of Dr. Hunter’s cherished ideas was to establish in London an anatomical school upon a most extensive scale; for, strange as it must now appear, no regular courses of anatomy were given prior to 1746, and as a consequence surgery and physiology made but slow advancement. As a first step toward the realization of his pet scheme he submitted a memorial to the Earl of Bute, the First Lord of the Treasury, setting forth the great need of such a school, and furnishing with the memorial a suitable plan for establishing a museum in which the necessary instruction might be carried on. The memorial and accompanying plan were submitted to the King, but the proposal eventually fell to the ground. In view of the lack of interest manifested by the Government, Hunter decided to devote his own fortune and the collections which he had gathered up to that time to the establishment of the contemplated school. Accordingly he purchased an extensive piece of property and built upon it a large cabinet or institute in which every facility was provided for anatomical work: laboratories, amphitheatre, etc. In his will a provision was made that this institute with all its equipment should remain in London until thirty years had elapsed from the date of his death, and then it should be transferred to Glasgow. His death occurred on March 30, 1783.

The institute which Dr. William Hunter founded was “for the improvement of anatomical knowledge, surgery and physics,” and it may therefore with justice be claimed that Dr. William Hunter was the founder of the anatomical schools of Great Britain upon a rational and extended plan. His nephew, Dr. Baillie, speaks of him as a teacher and scientific worker in the following terms:—

No one ever possessed more enthusiasm for his art, more persevering industry, more acuteness of investigation, more perspicuity of expression, or, indeed, a greater share of natural eloquence. He excelled very much any lecturer whom I have ever heard, in the clearness of his arrangement, the aptness of his illustrations, and the elegance of his diction. He was, perhaps, the best teacher of anatomy that ever lived.

John Hunter, who was born July 14, 1728, was the youngest member of this large family of children, and, as a natural result, his early education was greatly neglected. Then, as a further misfortune, he lost his father by death before he himself had attained his eleventh year. Although he was regularly sent to school he did little else, up to the age of twenty, but waste his time. Then, bored to death by the aimless sort of life he was leading, and learning about this time what a fine reputation his brother William was building up through the work that he was doing in London, he asked him by letter whether he could not give him some regular occupation in his laboratory, stating, at the same time, that if he could not do this, he (John) would immediately enlist as a soldier. William wrote to his brother to come on to London and he would see what he could do for him. Immediately after John’s arrival in the great metropolis he was given anatomical work to do, and, to the astonishment of his brother William, he soon displayed such a remarkable degree of skill as a dissector that there could no longer be any reasonable doubt about his ability to gain eminence in this line of work; and so he was encouraged to give it a full trial. William took special pains to point out to his brother the best technical methods of procedure, and in every possible manner aided him in his efforts to advance. Thus, for example, he gained admission for him to Oxford University, and in due time obtained opportunities for him to witness the operative work of the leading surgeons in several of the London hospitals. With the lapse of time, during the following years John became more and more closely associated with his brother in his different activities,—lecturing in his place whenever he was called away by other matters of importance, making those beautiful anatomical specimens which even to-day are such a striking feature of the Hunter Museum in London, and guiding the students in their work of dissecting. But the field in which he displayed a tireless activity, and in which up to the very end he gained the greatest personal satisfaction from his labors, was that of comparative anatomy and experimental physiology and pathology. It was in this field that he performed the largest amount of original work, and almost always with a view to learning how the different classes of animals were equipped for the performance of one and the same function. About the year 1761 his health began to give way and he was obliged to spend nearly two years in efforts to regain it. With this object in view, he accepted the position of surgeon in the army, and during the period covered by the years 1761 and 1762 visited Belle-Isle, on the west coast of France, and also Portugal. On his return to England with improved health he resumed work on the anatomy of the uterus and especially on the lymphatics of that organ, and made not a few actual discoveries in this his new field. This work was conducted by him with great zest, and as a result he soon began to be the recipient of honors from different scientific societies. He was made a member of the Royal Society of London, and associate of the Society of London Surgeons and also of several German and French scientific societies, and Attending Surgeon of St. George’s Hospital, Surgeon Extraordinary to the King, Surgeon-General of the English Army, etc. In 1783 he experienced his first attack of angina pectoris, and these attacks continued to occur with increasing frequency until the final one, which ended his life on October 16, 1793.

In his biographical notice of John Hunter, Odier quotes Lavater, the famous physiognomist, as saying—after he had gazed for a few moments on Hunter’s portrait: “This man is accustomed to do his own thinking.” Lavater’s judgment, adds Dezeimeris, is amply justified by the facts. “No matter what was the subject upon which he wrote—whether surgery, medicine or physiology—he always added to it a certain measure of originality. In reading his writings one is constantly tempted to question the correctness of the opinion which one may have previously formed with regard to the particular subject under consideration, and it is in this respect—viz., by suggesting thought—that Hunter rendered very great services to his art. And yet, at the same time, it is precisely in his writings that the evidences of neglect in his early education stand out in the strongest relief; a neglect which showed itself most conspicuously in incorrectness, obscurity and slovenliness of style.” (Dezeimeris.) This critic adds that ample proof of the correctness of this judgment may be found in Hunter’s treatise “On the Blood and Inflammation,”—a book which is “full of grand and beautiful ideas that are literally choked in a chaos of conflicting conceptions, unfinished phrases, new words or words used in a sense different from that in which they are commonly employed.” I should add here, however, that the fault of which the biographer last quoted complains appears to be entirely absent in certain of Hunter’s reports of cases, as for instance in that which contains the account of a fractured thigh. At the same time it must be admitted that the physician who presumably prepared this report from notes which he took when Hunter delivered the lectures upon which the report is based, may have so edited the text as completely to eliminate the objectionable features. In our ignorance of the exact truth, it is more agreeable to assume that, in this particular instance, the lecturer revealed his ability to avoid entirely the faults to which the critic refers and to set forth the facts and his accompanying comments with perfect clearness.

Here follows the report as it is printed in the “Hunterian Reminiscences”:—

Granulation is not always confined to a breach of the solids by suppuration; for parts are capable of making new animal matter internally, in cases where it ought to have been healed by the first intention. What gave me the first idea of this was the following case, and the appearance observed on dissection, as exhibited in the preparation of the parts.

Case.—I was called to a man with a fractured thigh, and employed the usual means, but without success, for no union of the fractured parts was formed in the usual time; and at about the end of four weeks the man died with some other complaint. Upon examination of the parts I found that the upper end of the bone rode considerably over the under, and, consequently, there was a great cavity in the soft parts, the parietes of which were thickened by the adhesive inflammation, though not so much as if the parts had been better disposed for the adhesive inflammation. There was no extravasated blood, nor matter, nor coagulable lymph, to be found, except a few threads, which probably were the remains of some extravasated blood. Here the parts had lost two chances of being united, the one by the extravasated blood, the other by the coagulable lymph thrown out by the adhesive inflammation; and nature had here begun a third, which was that of forming granulations of new animal matter on the ends of the bones, and the surface of the surrounding cavity; and adhesions, you see, have taken place between the bones and soft parts, by which the bones would have been united by bony case: hence we find that granulation may take place without suppuration. This mode of union by granulation is much more extensive, I believe, than has been imagined; this third bond of union taking place when the parts have missed the first and second, as just mentioned. In the exposure of cavities of abscesses we have granulations going on hand in hand, and following suppuration. As the suppurative inflammation follows injuries with exposure, it seems that this inflammation is in general necessary to granulation in these cases. Granulation is an accretion of new animal matter, the old vessels being extended, and new ones formed, the vessels passing from one edge of the surface toward the other. Granulations are always of the same nature with the part on which they are formed: if that is diseased, as with any specific disease, so are they also. The granulating surface is convex, and covered with prominent points; the colour is of a deep florid red, but, when unhealthy, is of a livid colour, which, perhaps, may be produced by the circulation through them being exceedingly slow; this change of colour may also be an effect of difference of position.

Hunter’s biographer in the “New International Encyclopaedia” speaks of him as a man of great industry, the boldest and best operating surgeon of his day as well as the greatest anatomist known and a marvelous zoÖlogist.

Some idea of the intensity of Hunter’s devotion to the cause of science may be obtained from a perusal of the following incident, which is related in A. M. W. Stirling’s “Coke of Norfolk and His Friends”:^[17]

Epping Place may be said to have been the centre of his [Coke’s] operations; and there was in these days a celebrated Irish giant O’Brien or O’Bryne who came to live there solely for the sake of joining Mr. Coke’s hounds whenever he allowed himself any recreation. O’Brien was eight feet high in 1780 and apparently went on growing, for in 1782 he measured two inches more and after his death in 1783 he was found to measure eight feet four inches, yet no other member of his family was unusually tall. He was crazy about hunting and became so attached to Jones, Mr. Coke’s huntsman, that he paid the latter a visit at Holkam and was there solemnly introduced by Jones to Mr. Coke and his guests. O’Brien’s end was curious. With extreme simplicity he invested all his property in a single banknote of seven hundred pounds which, needless to say, he lost; and grief at his loss combined with excessive drinking brought about his death. John Hunter, the celebrated surgeon, was extremely anxious to secure his skeleton; and learning that the giant was dying he set his men to watch the house in order to be sure of getting the body. O’Brien hearing of this, and having a horror of being dissected, left orders that his corpse should be watched night and day until a lead coffin could be made, in which it was to be conveyed to the Downs and sunk in twenty fathoms of water. O’Brien died, and his body started for the Nee, escorted by a walking wake of thirty Irishmen who drank deeply en route. Howison, Hunter’s man, who watched closely, informed the surgeon when he might catch the bodyguard off duty at the public house, and Hunter went thither to bribe them. He offered fifty guineas to one of the men to allow the body to be kidnapped, and the man consented on his own account, but said that he must first consult with his companions, who, perceiving Hunter’s eagerness, raised their price, first to one hundred pounds and finally to five hundred before they would agree. Hunter borrowed the money to pay them, and the coffin consequently went on its way filled with stones, while the body of the dead giant journeyed back to London in a spring cart, until John Hunter’s own carriage met it, after dark, and drove it to his house in Earl’s Court. There, for fear of detection, he did not dare to dissect it; but, separating the flesh from the bones by boiling and cutting, he quickly skeletonized it. Hence in the Museum of the Royal College of Surgeons may be seen, to-day, the skeleton—brown from boiling—of the giant whose greatest joy when living was a gallop with Mr. Coke’s hounds and the friendship of Mr. Coke’s huntsman.

At the time of Hunter’s death, his museum contained 10,563 specimens and preparations illustrative of human and comparative anatomy, physiology, pathology and natural history. He died, however, in comparative poverty, and his collection was purchased, two years after his death, by the Government for £15,000 and was presented to the Royal College of Surgeons.

John Hunter, says Pettigrew, had some very good ideas regarding the educational training of the pupils who placed themselves under his guidance. One of these is revealed in his practice of receiving certain pupils into his house. In this way several of England’s most distinguished physicians came to be, for varying periods of time, inmates of his home, and among this number—to mention only a single instance—was Dr. Jenner, the inventor of vaccination. One or more physicians from the United States—if I am rightly informed—also enjoyed this privilege. Valuable as this practice must have been to those who were thus given the opportunity of frequent informal intercourse with a most inspiring master, it certainly could not have been an easy matter, even in those more primitive days, to fit these pupils into the rÉgime of the teacher’s home life; and, under the conditions of modern life, the arrangement would certainly prove impracticable.

Benjamin Collins Brodie was born at Milford, near Salisbury, England, on June 9, 1783. In 1803, when he was twenty years of age, he became Sir Everard Home’s pupil at St. George’s Hospital, London. Two years later he began to assist Mr. Wilson in teaching anatomy, and during the following four years he filled the position of Demonstrator of Anatomy. In 1808, a year and a half before he began private practice, he was appointed assistant to Sir Everard Home at St. George’s Hospital, and retained the position up to the time (1822) when he was appointed full surgeon at that institution. About six months after Mr. Brodie received his appointment as Assistant Surgeon, he began lecturing on surgery and continued giving instruction on this subject up to 1830. In addition, he gave clinical lectures regularly to large classes, and this most important part of his work, which he began in 1813, was kept up by him through a long period of years. In 1819 he was appointed Professor of Anatomy and Surgery to the Royal College of Surgeons, a position which he held until 1823. In that year, upon the death of Sir Everard Home, he was appointed one of the Serjeant-Surgeons to the King. Two years later a baronetcy was conferred upon him, an honor which gave him the right to be addressed as Sir Benjamin Brodie.

In the history of medicine one can find only a few instances of men who were very clever surgeons and at the same time highly gifted physiologists. A study of the life and writings of Sir Benjamin Brodie reveals clearly that he is a conspicuous instance of this kind. The very limited space at my command does not permit me to furnish more than a few incomplete proofs of the truth of what I have just stated. Such are, for example, the following:—

In 1810 Sir Benjamin Brodie delivered the Croonian lecture before the Royal Society, the subject chosen being “On some Physiological Researches respecting the Influence of the Brain on the Action of the Heart, and on the Generation of Animal Heat.” His experiments, according to the account given by his biographer, “go to show that if respiration can be maintained, even artificially, the heart will continue to contract with strength and frequency, even though the spinal cord be divided from the brain.” Sir Brodie contrived an apparatus to effect this, and at the same time carefully noted the circumstances connected with the secretion of the urine, which in these experiments was found to be suppressed. The conclusions he has drawn from this inquiry, conducted with great precision and detailed with equal perspicuity, are the following:—

1. The influence of the brain is not directly necessary to the action of the heart.

2. When the brain is injured or removed, the action of the heart ceases, only because respiration is under its influence; and if under these circumstances respiration is artificially produced, the circulation will still continue.

3. When the influence of the brain is cut off, the secretion of urine appears to cease, and no heat is generated; notwithstanding the functions of respiration and the circulation of the blood continue to be performed, and the usual changes in the appearance of the blood are produced in the lungs.

4. When the air respired is colder than the natural temperature of the animal, the effect of respiration is not to generate, but to diminish animal heat.

In 1811 Sir Benjamin Brodie reported to the Royal Society the results of various experiments which he made on the different modes in which death is produced by certain vegetable poisons (for example, alcohol; the essential oil of bitter almonds; the juice of the leaves of aconite; the infusion of tobacco; the empyreumatic oil of tobacco; the curare; etc.). During the following year he reported to the same society the results of a similar series of experiments which he made upon the effects produced by certain mineral poisons (for example, arsenic, muriate of barytes, tartar emetic, and corrosive sublimate).

The preceding brief references to the experimental work carried on by Sir Benjamin Brodie must suffice to show how thoroughly he deserved to be ranked as one of the leading English experimental physiologists of his day.

Among Sir Benjamin Brodie’s contributions to the science of surgery are many that may be classed as of the first importance. Such, for example, are his researches respecting the diseases of the joints; his remarks on a case of ununited fracture of the femur, in the course of which he praises the method of treatment first proposed by Dr. Physick of Philadelphia; his observations on the treatment of varicose veins of the legs; pathological and surgical observations relating to injuries of the brain—a contribution of very great value; and pathological and surgical observations on the diseases of the joints. The latter treatise, which already, in 1836, had reached its fourth edition, is mentioned by his biographer as “a book which must ever form an essential part of the library of every surgeon.”

Like all his predecessors who have given instruction in the art of surgery, from John Hunter to Desault, Sir Benjamin Brodie laid great stress upon the importance of an intimate knowledge of anatomy and physiology—of the inseparable connection of these branches of science, and of the interest derivable from a contemplation of the organization and functions of animal bodies, the laws which regulate the phenomena of life and the changes which matter undergoes, and the form which it assumes when associated with this mysterious and active principle.... “He believes them to be incapable of explanation, except on the hypothesis of there being in living bodies something superadded to organization, without which, he says, ‘they would be as incapable of executing their functions as the pendulum of a clock would be of vibrating, or its wheels of revolving, if they were deprived of the spring or weight, in which the cause of their motion resides.’” (Pettigrew.)

The matters referred to above are only a few of those which Sir Benjamin Brodie has discussed in so instructive a manner in the numerous short essays and larger treatises which he published between the years 1809 and 1837. His death occurred in 1862.