capable of rapid increase in dimensions to perform the offices
of the larger.[1] It happened that, in the ensuing December,
there lay in one of the wards of St George’s Hospital a patient
admitted for popliteal aneurism. The disease must soon prove
fatal unless by some means arrested. Should the surgeon,
following the usual and commonly fatal method of treatment,
cut down upon the tumour, and, after tying the artery above
and below it, evacuate its contents? Or should he adopt the
procedure, deemed by Pott generally advisable, of amputating
the limb above it? It was Hunter’s aim in his practice, even
if he could not dispense with the necessity, at least to diminish
the severity of operations, which he considered were an acknowledgment
of the imperfection of the art of healing, and compared
to “the acts of the armed savage, who attempts to get that
by force which a civilized man would get by stratagem.” Since,
he argued, the experiment with the buck had shown that collateral
vessels are capable of continuing the circulation when passage
through a main trunk is arrested, why should he not, in the
aneurism case, leaving the absorbents to deal with the contents
of the tumour, tie the artery in the sound parts, where it is tied
in amputation, and preserve the limb? Acting upon this idea,
he ligatured his patient’s femoral artery in the lower part of its
course in the thigh, in the fibrous sheath enclosing the space
since known as “Hunter’s canal.”[2] The leg was found, some
hours after the operation, to have acquired a temperature even
above the normal.[3] At the end of January 1786, that is, in
six weeks’ time, the patient was well enough to be able to leave
the hospital. Thus it was that Hunter inaugurated an operation
which has been the means of preserving to hundreds life with
integrity of limb—an operation which, as the Italian P. Assalini,
who saw it first performed, testifies, “excited the greatest wonder,
and awakened the attention of all the surgeons in Europe.”
Early in 1786 Hunter published his Treatise on the Venereal Disease, which, like some of his previous writings, was printed in his own house. Without the aid of the booksellers, 1000 copies of it were sold within a twelvemonth. Although certain views therein expressed with regard to the relationship of syphilis have been proved erroneous, the work is a valuable compendium of observations of cases and modes of treatment (cf. John Hilton, Hunt. Orat. p. 40). Towards the end of the year appeared his Observations on certain parts of the Animal Oeconomy, which, besides the more important of his contributions to the Philosophical Transactions, contains nine papers on various subjects. In 1786 Hunter became deputy surgeon-general to the army; his appointment as surgeon-general and as inspector-general of hospitals followed in 1790. In 1787 he received the Royal Society’s Copley medal, and was also elected a member of the American Philosophical Society. On account of the increase in his practice and his impaired health, he now obtained the services of Home as his assistant at St George’s Hospital. The death of Pott in December 1788 secured to him the undisputed title of the first surgeon in England. He resigned to Home, in 1792, the delivery of his surgical lectures, in order to devote himself more fully to the completion of his Treatise on the Blood, Inflammation and Gunshot Wounds, which was published by his executors in 1794. In this, his masterpiece, the application of physiology to practice is especially noticeable. Certain experiments described in the first part, which demonstrate that arterialization of the blood in respiration takes place by a process of diffusion of “pure air” or “vital air” (i.e. oxygen) through membrane, were made so early as the summer of 1755.
Hunter in 1792 announced to his colleagues at St George’s, who, he considered, neglected the proper instruction of the students under their charge, his intention no longer to divide with them the fees which he received for his hospital pupils. Against this innovation, however, the governors of the hospital decided in March 1793. Subsequently, by a committee of their appointing, a code of rules respecting pupils was promulgated, one clause of which, probably directed against an occasional practice of Hunter’s, stipulated that no person should be admitted as a student of the hospital without certificates that he had been educated for the medical profession. In the autumn two young Scotchmen, ignorant of the new rule, came up to town and applied to Hunter for admission as his pupils at St George’s. Hunter explained to them how he was situated, but promised to advance their request at the next board meeting at the hospital on the 16th of October. On that day, having finished a difficult piece of dissection, he went down to breakfast in excellent spirits and in his usual health. After making a professional call, he attended the board meeting. There the interruption of his remarks in behalf of his applicants by a flat contradiction from a colleague brought on one of the old spasmodic heart attacks; he ceased speaking, and retired into an adjoining room only to fall lifeless into the arms of Dr Robertson, one of the hospital physicians. After an hour had been spent in vain attempts to restore animation, his body was conveyed to his house in a sedan chair.[4] His remains were interred privately on the 22nd of October 1793, in the vaults of St Martin’s in the Fields. Thence, on the 28th of March 1859, through the instrumentality of F. T. Buckland, they were removed to Abbot Islip’s chapel in Westminster Abbey, to be finally deposited in the grave in the north aisle of the nave, close to the resting-place of Ben Jonson.
Hunter was of about medium height, strongly built and high-shouldered and short-necked. He had an open countenance, and large features, eyes light-blue or grey, eyebrows prominent, and hair reddish-yellow in youth, later white, and worn curled behind; and he dressed plainly and neatly. He rose at or before six, dissected till nine (his breakfast hour), received patients from half-past nine till twelve, at least during the latter part of his life, and saw his outdoor and hospital patients till about four, when he dined, taking, according to Home, as at other meals in the twenty years preceding his death, no wine. After dinner he slept an hour; he then superintended experiments, read or prepared his lectures, and made, usually by means of an amanuensis, records of the day’s dissections. “I never could understand,” says W. Clift, “how Mr Hunter obtained rest: when I left him at midnight, it was with a lamp fresh trimmed for further study, and with the usual appointment to meet him again at six in the morning.” H. Leigh Thomas records[5] that, on his first arrival in London, having by desire called on Hunter at five o’clock in the morning, he found him already busily engaged in the dissection of insects. Rigidly economical of time, Hunter was always at work, and he had always in view some fresh enterprise. To his museum he gave a very large share of his attention, being fearful lest the ordering of it should be incomplete at his death, and knowing of none who could continue his work for him. “When I am dead,” said he one day to Dr Maxwell Garthshore, “you will not soon meet with another John Hunter.” At the time of his death he had anatomized over 500 different species of animals, some of them repeatedly, and had made numerous dissections of plants. The manuscript works by him, appropriated and destroyed by Home, among which were his eighty-six surgical lectures, all in full, are stated to have been “literally a cartload”; and many pages of his records were written by Clift under his directions “at least half a
- ↑ In his Treatise on the Blood, p. 288, Hunter observes: “We find it a common principle in the animal machine, that every part increases in some degree according to the action required. Thus we find ... vessels become larger in proportion to the necessity of supply, as for instance, in the gravid uterus; the external carotids in the stag, also, when his horns are growing, are much larger than at any other time.”
- ↑ See Sir R. Owen, “John Hunter and Vivisection,” Brit. Med. Journ. (February 22, 1879, p. 284). In the fourth of his operations for popliteal aneurism, Hunter for the first time did not include the vein in the ligature. His patient lived for fifty years afterwards. The results on the artery of this operation are to be seen in specimen 3472a (Path. Ser.) in the Hunterian Museum.
- ↑ Home, Trans. of Soc. for Impr. of Med. and Chirurg. Knowl. i. 147 (1793). Excess of heat in the injured limb was noticed also in Hunter’s second case on the day after the operation; and in his fourth case it reached 4°-5° on the first day, and continued during a fortnight.
- ↑ The record of Hunter’s death in the St James Chronicle for October 15-17, 1793, p. 4, col. 4, makes no allusion to the immediate cause of Hunter’s death, but gives the following statement: “John Hunter.—This eminent Surgeon and valuable man was suddenly taken ill, yesterday, in the Council-room of St George’s Hospital. After receiving the assistance which could be afforded by two Physicians and a Surgeon, he was removed in a close chair to his house, in Leicester Fields, where he expired about two o’clock.” Examination of the heart revealed disease involving the pericardium, endocardium and arteries, the coronary arteries in particular showing ossific change.
- ↑ Hunt. Orat., 1827, p. 5.
