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William HUNTER Observation and Experiment He Displayed a Pene- Trating Vision, Extending Far Beyond the Horizon 1718–1783 of His Own Time

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William HUNTER Observation and Experiment He Displayed a Pene- Trating Vision, Extending Far Beyond the Horizon 1718–1783 of His Own Time Who’s Who in Orthopedics has it been said that “he made his name immor- itage of the Royal College of Surgeons of England tal by the labour of his own hands outside the and it is fitting that on the anniversary of his birth- sphere of surgery.” The care of the collection, day an oration in praise of him should be deliv- which contained over 13,000 specimens, caused ered by a distinguished disciple. some anxiety to Hunter’s family, but in young Clift his assistant they found a faithful and devoted guardian. For 7 years he kept watch, pre- References venting deterioration in the soft specimens, and making copious extracts from the manuscripts. Palmer JF (ed) (1835) The Works of John Hunter, FRS, On June 13, 1799, the government bought the col- with Notes, 4 vols, with a Life by Drewry Ottley. lection for £15,000 and transferred it to the care London, Longmans of the Corporation of Surgeons. A charter was Paget S (1897) John Hunter. London, T. Fisher Unwin Butler FH (1910) John Hunter. Encyclopaedia granted to the Corporation on March 22, 1800, Britannica, 11th edn. New York whereby they were constituted the Royal College of Surgeons in London and were empowered to examine candidates for the Membership. The sur- geons gave up Surgeons’ Hall and moved to a house in Lincoln’s Inn Fields. In 1806 Parliament granted £15,000 to the College to build a museum and 3 years later another grant of £12,500. The surgeons themselves spent over £21,000 of their own money. By a charter of 1843 the title of the College was changed to the Royal College of Surgeons of England and the Fellowship of the College was instituted. John Hunter has exercised a profound influence on British surgery. This was achieved not by social gifts or personal attraction, but entirely by his scientific mind. When he started dissecting, 3 years only had passed since surgeons had ceased to be associated formally with the “art and mystery of barbers.” But through his immense labors in comparative anatomy, physiology, and pathology, he raised the status of surgery to that of a scientific profession. In his quest for truth by William HUNTER observation and experiment he displayed a pene- trating vision, extending far beyond the horizon 1718–1783 of his own time. His country experimental station long anticipated “Down House,” which is now the William Hunter, John Hunter’s older brother, was experimental farm of the Royal College of born in rural Scotland. He was well educated in Surgeons. Most of his teaching is inevitably Glasgow, Edinburgh, and London. In 1846, he bound in the corpus of surgical doctrine and has began giving a series of lectures on surgery. He lost its identity. Like Lister, he was interested in was an excellent speaker and became a very suc- the phenomena of inflammation and coagulation cessful teacher. He was an avid student of of the blood, but he was denied the use of a micro- anatomy and became the first great teacher of scope and he little dreamt of a world of micro- anatomy in England. Hunter developed an insti- organisms. But his keen intellect noted and tution for teaching and studying anatomy on stressed mysterious variation in the reaction of Great Windmill Street in London. He gradually tissues to injury according to whether the skin shifted the emphasis of his practice from surgery was broken or unbroken. If the skin was intact the to obstetrics. His most important work was the healing process proceeded smoothly; whereas book, The Anatomy of the Gravid Uterus, with a broken skin suppuration was the rule and Exhibited in Figures. repair was disturbed and delayed. And he pon- The article on the anatomy and pathology of dered why. His great museum is the proud her- the articular cartilage was published early in 155 Who’s Who in Orthopedics Hunter’s career. His description of the cartilage antibiotics and little equipment, and the operating was far in advance of his time. The article also room was heated by a wood fire. reveals the wealth of anatomic material available Nevertheless, in the two-storey wooden-frame to the author. The “subjects,” including the bodies hospital, he invented and developed the remark- of children, were procured largely through the able methods and equipment by which he became services of “resurrectionists,” that is grave known. By 1951, he was using his devices to treat robbers. The common disease of the joints in complex and infected fractures and to lengthen Hunter’s time was tuberculosis. The acuity of his bones. His theory that bone would grow if observations deserves our admiration. gradually distracted and his external fixator, of circular steel haloes connected by rods and bone-fixating wires, produced dramatic results not seen before in orthopedics. His work was the beginning of a new medical paradigm, the con- servation and exploitation of the unlimited natural plasticity of bone. Although Dr. Ilizarov’s results were astonish- ing, his theory was contrary to orthodox views on bone regeneration. His reputation remained con- fined to Siberia until 1967, when he successfully treated the Russian Olympic highjumper, Valery Brumel who, after a motorcycle accident, had chronically infected nonunited fractures of both legs, even after 14 operations by the best surgeons in Moscow. After treatment by Ilizarov, Brumel, completely healed, went on to jump again in competition. Dr Ilizarov’s years in a small wooden hospital with no research laboratory were over. It became known that he could straighten and lengthen a shattered or deformed leg and the Russian elite in Gavriil Abramovich ILIZAROV need of orthopedic care journeyed to Kurgan. His medical reputation soared into national 1921–1992 prominence and by 1984 he presided over a new 1,000-bed Scientific Center for Reconstructive Gavriil Ilizarov made a remarkable life odyssey Orthopedics and Traumatology, with over 350 from an isolated village in the Caucasus moun- surgeons, 1,500 nurses, 60 doctorate researchers, tains to become a world figure in orthopedics and and 24 operating rooms. one of the most decorated medical scientists in the By 1986, North American orthopedic surgeons Soviet Union. He was born in a small Jewish had learned the Ilizarov techniques from community and was unable to attend school until Europeans who had worked directly with him, he was 11 years old because his family had no and were performing Ilizarov limb-saving opera- money for shoes. tions. The use of his methods is widespread: the He graduated from Simferopol Medical North American Association for the Study and School, which had been moved during the war to Application of the Methods of Ilizarov (ASAMI) the Soviet Near East, and in 1944 was sent to the now includes over 200 surgeons. Siberian town of Dolgovka as the only physician Dr Ilizarov was one of the Soviet Union’s most for an area the size of a small European nation. decorated civilians, receiving the Order of Hero In 1949 he was promoted to become a staff physi- of Socialist Labor, the Order of Lenin three times, cian at the hospital in Kurgan, Western Siberia, appointments to the National Academy of where he was faced with the daunting task of Sciences and the Soviet Parliament, as well as the treating many patients with war wounds that had highest civilian honors of Italy, Yugoslavia and progressed to limb-threatening unhealed frac- Jordan. His work is now widely known through- tures, infections, and other complications. out the world and will have an enduring impact Working conditions were primitive: there were no on the relief of suffering patients. He was truly a 156.
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