The Knife Man

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!

5 Responses to “The Knife Man”

  1. Anton Garrett Says:

    And I had thought that the Hunterian was named after Ian Hunter of Mott the Hoople…

    I learned form the book God’s Philosophers by James Hannam, about the prehistory of Galileo’s work, that the “scientific revolution” of the 17th century was a misnomer, as there was no revolution in biological sciences to match that in physical sciences. (Harvey’s discovery of blood circulation was magnificent but did not trigger much else in the way Galileo and Newton did.) The revolution in biology came two centuries later.

    Interesting about speciation/macroevolution being inferred in the 18th century.

    Anton

    • telescoper Says:

      Yes, it’s very striking that the life sciences were so far behind the physical sciences in the 18th Century. Hunter’s careful study of human and animal physiology was a magnificent achievement, but it didn’t require sophisticated equipment and could in principle have been done centuries earlier. For some reason, the questions weren’t asked.

  2. It is a great book about a great man who with no preconceived ideas revolutionised a field. It’s still incredible that so many easily discredited ideas still existed in medicine long after the beginning of the Enlightenment. I still wonder if this is true in astronomy (following on from earlier discussions). Our current `concordance’ cosmology really only encapsulates the magnitude of things we don’t yet understand. Not that there is anything wrong with scientists admitting how much we don’t know, indeed it should be this way, but there is a massive breakthrough to come at some point. I suspect it may come from someone looking at the data we have at that point in a new way which we will say is obvious in retrospect. I just wonder if that breakthrough will come in 5 or 50 years.

    • telescoper Says:

      One factor must have been that the medical establishment at the time had a vested interest in the status quo and also determined who got jobs in the major institutions, so it was extremely difficult for a brilliant maverick to break into the system. Hunter was constantly rebuffed when he applied for positions in major hospitals, and he achieved what he did by spending all the money he earned from private fees on his collection.

      A field dominated by received orthodoxy, with elder statesmen taking all the strategic decisions, making it difficult for people with unconventional ideas to get support. You might think there’s a parallel with modern cosmology, but I couldn’t possibly comment.

  3. “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!”

    Don’t some people do this for fun?

    More seriously, Darwin embarked on the course which eventually led him to evolution after his broke off his medical training after having to watch an amputation.

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