The remarkable surgical collection of John Hunter CHARLOTTE GRAY Few figures loom so large in the history of surgery as John Hunter (1728-1793), but few Canadian physicians have the opportunity to pay their respects to the great pio- neer of scientific surgery. One rea- son is that the collection of speci- mens Hunter bequeathed to suc- ceeding generations of doctors is 8000 km away, in England; another is that the Hunterian Museum, housed at the Royal College of Sur- geons in London, is not widely known even among those doctors who cross the Atlantic. John Hunter revolutionized his chosen field. When he embarked on surgery as a career in 1748, by travelling to London from his native Lanarkshire in Scotland to assist his elder brother William in his anato- my school, he was entering a profes- sion with a dubious reputation. Eighteenth century physicians, well paid and with university degrees in medicine, regarded surgeons as tradesmen or rogues. Surgery was still a crude art; the majority of operations performed were either amputations, removal of stones from the bladder or skull-trepanning, to relieve pressure on the brain. Train- ing consisted of walking the wards behind an established surgeon, and attending privately owned, and often unreliable, anatomy schools. Lack of basic anatomical knowledge, anes- thetics, aseptic techniques and, most John Hunter revolutionized his chosen field. When of all, organized systems of teach- ing, meant that quacks abounded he embarked on surgery as a career in 1748, he and mortality was high. Patients who survived celebrated the anniver- was entering a profession with a dubious saries of operations with more heart- reputation. Single-handedly he raised the felt prayers of gratitude than they celebrated marriages or births. professional and social status of the John Hunter started his career by surgeon. The Hunterian Museum the usual route. He assisted his allows visitors a fascinating glimpse into the working life of a man Charlotte Gray is a CMAJ regular contributor living in Ottawa. known as "the father of modern surgery". CAN MED ASSOC J, VOL. 128, MAY 15, 1983 1225 brother's demonstrations of anatom- ical dissections, and he studied the rudiments of surgery under William Cheselden at the Royal Hospital, Chelsea, and Percival Pott at St. Bartholomew's Hospital, London. But in his anatomical investigations he was already developing the exper- imental approach to the study of physiology which would transform surgery from an art to a science. In 1760, after 12 years in the unwhole- some atmosphere of the dissecting room, his health began to deterio- rate and he was advised to find a healthier occupation. After 6 months' rest he was commissioned as an army surgeon and in 1761 posted to Belle Ile off the northwest coast of France, and later to Portugal. In his spare time the young army surgeon delved into such natural history phe- nomena as how lizard tails regener- ate and whether fish can hear. The material Hunter assembled during his army service formed the nucleus of his collection, the comple- tion of which occupied the remain- ing 30 years of his life. Unlike Henry Wellcome, the founder of London's other great collection of medical artefacts (most of which are today housed at the Science Muse- um, London: Can Med Assoc J 1982; 126: 712-720), Hunter was not motivated by joy of acquisition alone. He collected to illustrate his theories, in particular of the cons- The museum is dominated by its most infamous exhibit: the skeletons of the tant adaptation in living things of giant", along with the Sicilian dwarf and the American giant. structure to function. His collection sequently rose to eminence. In Lon- in his museum. Many of the con- was a vital adjunct to his post-army don these included Astley Cooper of temporary anatomy schools had col- career as a teacher. Guy's, Abernethy of St. Bar- lections of preserved human tissue In May 1763 Hunter left the tholomew's, Cline of St. Thomas's, for use during demonstrations and army to start his own anatomy and Edward Jenner of vaccination lectures, but Hunter's was unique school in London and build up a fame. Others were among the first because it contained so many animal practice. In 1767 he was elected a to promote medical education in and pathological items. Hunter fellow of the Royal Society and in America: John Morgan and William wanted his pupils to study compara- the following year he gained the Shippen helped found the medical tive anatomy, so they would under- diploma of the Company of Sur- faculty of the University of Pennsyl- stand the increasing complexity of geons. By 1768 his days were full; vania. The philosophy these pupils structures from the simplest organ- his mornings were devoted to his took with them was a whole new isms to the most highly developed own practice; his afternoons were approach to surgery. Although a mammals, and functional anatomy, spent at St. George's Hospital where surgeon himself, Hunter regarded so they would appreciate the rela- he was surgeon; in the evenings he surgery as a mutilation of the pa- tionship of structure to function. taught. He constantly updated his tient and an admission of failure to There is no doubt that he realized teaching notes on the basis of find- cure. He told his students, "Sur- his collection's value, because on his ings from newly completed studies. geons tend to forget that they are death he made it clear he wanted it Blunt and outspoken, Hunter was not masters but only servants. They kept together. In 1799 the Company frequently at odds with colleagues can assist the natural powers within of Surgeons accepted the collection who refused to change their lecture all living flesh but cannot replace and ia 1811 a specially built new notes from year to year. His own them." museum was opened at the head- reputation as a teacher attracted When Hunter died in 1793 there quarters of the company, by now pupils of great promise. Many sub- were an estimated 13 687 specimens renamed, under a new charter, 1226 CAN MED ASSOC I, VOL. 128, MAY 15, 1983 the Royal College of Surgeons of London. During the 19th century the collection expanded rapidly, thanks to gifts from fellows and scientists, and to the efforts of eminent curators - two of whom went on to become directors of the British Museum. By the outbreak of war, in 1939, the museum held approxi- mately 63 000 specimens in five large rooms, each with two galleries. Disaster struck on the night of May 10, 1 .4 1. Several incendiary bombs hit the museum and the college and, as Elizabeth Allen, the present curator of the Hunterian Museum remarks wryly, "Old bones and alcohol burn well." The invertebrate and instrument rooms were completely demolished; the unrivalled collections of comparative osteology, physiology and pathology were badly damaged. Fortunately Hunter's fine collection of zoological and anthropological paintings, including three by Stubbs, survived, along with four tables of arteries, veins and nerves bought back from Padua by the 18th century diarist John Evelyn. The present museum opened in 1963, in the rebuilt College of Surgeons. Today the collection contains over 3590 surviving Hunterian specimens, including 1900 normal and 1545 pathological items, plus some 2500 additional specimens. Despite the loss of so much material, the museum still attracts between 6000 and 7000 visitors a year. Most come because it is a shrine to John Hunter, but others come to see the unrivalled comparative anatomy section, and the rare pathological specimens. The museum is arranged according to the scheme in Hunter's original catalogue. Normal structures are divided into two main groups: the first demonstrates how organisms adapt for everyday survival, and the second demonstrates adapta- tions geared to preservation of species. The two groups are separated by Hunter's collection of pathological specimens illustrating his opinions on the nature of diseases, and his experiments and observations on surgi- cal cases. The museum is, however, dominated by its most infamous exhibit: the skeleton of the "Irish giant", Charles Byrne. Born in Ireland in 1761, Byrne was brought to England when he was 21 years old to be exhibited as, at 8 ft 2 in (248.9 cm), "the tallest man in the world". It is unclear how Hunter got hold of Byrne's body; one account suggests that Byrne, knowing the Gelusil tablets aid patient anatomists compliance in more ways than were anxious to acquire his remains, ar- one. Convenience of Portability ranged on his death to be placed in a lead coffin and -Fresh Minty Taste. Gelusil buried at sea. However, Hunter bribed the undertakers liquid for the home and Gelusil with $1000 to deliver the body to him and then prepared tablets for patients on-the-go. the skeleton in the large boiler of his Earls Court home. Gelusil or Gelusil 400 for However, he never opened the skull, so he failed to individual patient needs. observe the hypertrophic pituitary gland that had caused Byrne's condition. Today, Byrne stands tall in a glass case in the middle of the Hunterian Museum, flanked by two abnormal skeletons dating from the 19th century the "American giant" whose skeleton mea- sures 6 ft 8.5 in (204.5 cm) and the "Sicilian dwarf', a . little lady of 19.8 in (50.3 cm). In the museum's gallery are the skeletal remains of notorious criminals. These ghoulish exhibits are the target of much interest among IccPPI the younger students who visit the museum, to the Reg TM. Parke, Davis & Company, dismay of curator Allen.