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John Hunter and Venereal Disease

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John Hunter and Venereal Disease Anznals of the Royal College of Surgeons of England (I98I) vol. 63 John Hunter and venereal disease D J M Wright MD Department of Medical Microbiology, Charing Cross Hospital Medical School, London Key words: HISTORY OF MEDICINE; HUNTER, JOHN; VENEREAL DISEASES; SYPHILIS; GONORRHOEA Summary both diseases did not affect the same part (4). John Hunter's contribution to the understanding He was therefore persuaded, in the interests of venereal disease is reviewed. Hunter's evidence of economy of diagnosis, that as both syphilis for the unitary nature of these diseases is and gonorrhoea could be transmitted by sexual examined and the advances he made in diagnosis, intercourse and often occurred together they pathology, and management are considered. were but one malady (4). He explained that the different clinical symptoms and appear- Introduction ances of syphilis and gonorrhoea were deter- mined by the part of the body that was affected Nowhere in the I8th century does the con- (6). When the skin was affected ulceration ventional surgeon-anatomist merge more com- resulted, while if mucous membranes such as the pletely into the experimental pathologist than vagina or urethra were involved in the disease with the career of John Hunter. He was the process, then a discharge developed. His post- inspiration for both Dr Jekyll and Mr Hyde (i) mortem dissections of the urethrae of two and according to medical folklore he inoculated corpses, retrieved from the hangman, of men himself with the 'venereal poison', becoming a who had suffered from gonorrhoea revealed 'martyr to science' (2). In the Miner Library signs of purulent inflammation and no ulcers verbatim notes of Hunter's lectures on venereal or 'absorbative reaction' (7) characteristic of disease (3) there is the statement, 'I produced in syphilis (8). myself a chancre', but it is unlikely that this is reliable as it was made at least 7 years after That gonorrhoea and syphilis were one disease Hunter's death by an unknown student and may was also suggested by an experiment undertaken be a transcription error. Whatever its historical in 1767 in which gonococcal matter produced basis, the story illustrates the fact that Hunter's a chancre (9). In this experiment urethral pus scientific beliefs arose after they had been verified was inoculated by lancet on to the surface of by personal observation and experiment. His in- the prepuce and glans. An ulcer, followed by timate experience of the subject is found in his buboes, gradually developed. These mani- observations when working between 1748 and festations were partially resolved by treatment I760 with his brother, William Hunter. These with mercury. In Hunter's detailed description observations were extended while serving as an of this experiment it was found that in 2 days army surgeon on Belle Isle and later in Portugal the patient had a 'teasing irritation' which (I76I-63), and further work was based on developed into a visible red preputial spot by patients at St George's Hospital and in his pri- the 4th day. Seven days after inoculation the vate practice. lesion began to slough and by the I I th day had progressed so far that lunar caustic and nature of and calomel dressings had to be applied. At about Unitary gonorrhoea syphilis this time a spot on the glans was noted. The John Hunter's grounds for believing that gonor- inoculation reaction resolved and at 4 months rhoea and syphilis were only one malady were broke down again and became indolent, taking various. It was his settled opinion that a patient 3 years to heal. presented with only one constitutional disease at a time (4). This was the reason, he suggested, Hunter put forward a further argument in that florid measles suppressed the cell-mediated favour of syphilis and gonorrhoea being the reactions following smallpox inoculation (5). same disease-their epidemiology (io). He He conceded that more than one disease could noted that by the time Captain Cook visited the be found in the patient but asserted that if this island of Tahiti on his last voyage both syphilitic happened the diseases would not be found in the chancre and gonorrhoea were prevalent there. same part of the body. So when smallpox In fact Cook described 'the accursed gonorrhoea occurred in a patient already suffering from lues and the little yellow jaundice (infectious Jolin IIunter and venereal disease 199 hepatitis) which was hard to account for' (iI)*. incubation periods were different and that mer- The natives of the island of Tahiti dated the cury treatment discriminated between the two onset of these diseases to the visit of Bougain- diseases, gonorrhoea being resistant and syphilis ville, whose ship had called at the island in susceptible to this treatment. Hunter even 1768, staying for 9 days (io). The crew had argued that the specificity of mercury in the developed gonorrhoea, but not syphilis, 3 weeks treatment of syphilis was evidence for the syph- after leaving the island. After Bougainville left ilitic nature of rheumatism (M8), which may have the island it is recorded that the Tahitians re- been bone gummata or periostitis, as the con- tired to the interior of the island where gonor- dition was subdued by treatment with mercury. rhoea, unlike the 'pox', could be cured (io). An Hunter recognised that immunity to reinocula- earlier explorer, Wallis, who discovered the tion was a feature of syphilis (1g), while re- island in I767, made no mention of gonorrhoea, peated episodes of gonorrhoea were frequent despite spending 5 months on the island (io). occurrences, implying that immunity to the gono- This lends support to the suggestion that coccal component of the disease did not develop. Bougainville did introduce the disease to the When Hunter's inoculation experiment men- island. It was also known that Wallis was con- tioned above was considered it was suggested cerned about the health of his sailors and had by d'Arcy Power (2) that, as the lesion follow- his crew inspected by the ship's surgeon before ing inoculation of syphilitic material developed going ashore to ensure that they were free from so quickly, the initial lesion might be chancroid. the disease (12). Hunter deduced that Wallis, It is possible that the infection might have who had been at sea for i i months before resulted from lack of aseptic precautions and the arriving at Tahiti (io), was unlikely to have disease may have been rendered chronic by the brought gonorrhoea with him as the time spent application of topical medication. Furthermore, at sea was longer than the incubation period there is no evidence that the person inoculated for this disease, whereas Bougainville, who had refrained from sexual intercourse in the 3 years left Rio de la Plata 5 months previously (io), of observation and might well have contracted would have noticed if his sailors had developed syphilis at a later date. It is unlikely that penile chancre en route but might have over- Hunter missed the diagnosis of an intraurethral looked mild gonorrhoea. Hunter was convinced chancre in the patient who was the source of that syphilis must have been transmitted in the gonococcal material for the inoculation experi- form of gonorrhoea and then developed as ment. He advocated the diagnosis of cowperitis syphilis on the island of Tahiti (io). Hunter by the clinical technique of palpation of the base did not know that when Wallis landed on the of the penis (20). If he had followed his own island a Spanish merchant ship landed, un- directions before beginning the experiment he known to Wallis, on the other side of Tahiti would have detected the diagnostic intraurethral (io) and it has been suggested that it was these mass in the donor's urethra (20). Lastly, it sailors who spread gonorrhoea throughout the seems unlikely that Huniter experimented on him- island if the disease was not already present self since if he had inoculated himself with (I4). Gonorrhoea has been endemic there ever syphilis he surely would have treated himself since (I5). with mercurials, which might have caused skin discoloration, and it is difficult to imagine that Inconsistencies in the theory that syphilis even if this treatment was taken in secret it would not have come to light. The postmortem and gonorrhea were a common disease reports on him indicate no pathological changes The separate identities of syphilis and gonorrhoea attributable to syphilis (22). In addition, all his were not settled until Ricord's experiments in other inoculation experiments were on patients 1837, when he inoculated 2500 'human volun- on whom he attended (23). He was not, how- teers' with gonorrhoea, none of whom developed ever, averse to self-experimentation and was syphilis (i6). Even today, nearly 200 years later, known to have given himself madder root to Koch's postulates for syphilis and gonorrhoea discover whether his urine changed colour, which have not been fulfilled. Jesse Foot, a contem- it did (24). porary of Hunter's who criticised much of his work, accepted the theory of the single nature of the diseases without question (I7). Apart from Immunological observations the clinical differences between syphilis and Hunter made a number of interesting obser- gonorrhoea, Hunter also chose to ignore that their vations on the immunology of syphilis. He was unable to produce lesions by inoculating the *Gook voyaged to Tahiti to observe the transit of disease in patients with secondary syphilis, but Venus, not the transmission of her diseases. he could do so during the primary stage (ig). 200 D J M Wright He attempted a variety of challenge experiments: Observations on transmission of disease he was unable to produce syphilitic ulcers if Hunter had no doubt that the mode of transmis- material for autoinoculation was derived from sion common to both syphilis and gonorrhoea patients with late secondary lesions but could was venereal.
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