SOME PUPILS OF JOHN HUNTER PART II SIR THOMAS HOLMES SELLORS D.M., M.Ch., F.R.C.P., F.R.C.S. Emeritus Surgeon, Middlesex Hospital; Past President, Royal College of Surgeons of England Philip Syng Physick MOVING ON, WE come to Philip Syng Physick, another brilliant Phila- delphian, who became John Hunter's pupil after the Rebellion and whose influence on North American surgery was of inestimable import- ance at the beginning of the 19th century. He was born in 1768, the son of the Keeper of the Great Seal of the Colony of Pennsylvania. He was educated in good surroundings and his father sent him to study under Adam Kuhn after he had obtained an arts degree. Kuhn was Professor of the Treatment and Practice of Medicine in the College of Philadelphia and a member of the academic staff with Shippen and Morgan. Six years after peace had been declared this young American, aged 21, came to London with his father. Introductions to John Hunter were readily obtained and the young Physick was duly installed in Leicester Fields and Castle Street. Hunter was impressed by his new pupil's ability and easy manners and encouraged his studies. In return Physick's approach to Hunter was almost that of veneration, and he kept careful notes, in one of which he records Hunter trephining a paralysed sheep and removed a hydatid cyst from the brain. His success story continued because Hunter gave him the appointment of house surgeon at St. George's. This was a unique honour for an American and Physick had, indeed, to be very watchful, for the assembled pupils were ready to try and catch out a foreigner and an ex-rebel, but Physick's dexterity with bandaging and his reduction of an acute shoul- der dislocation before the students soon gained itheir support. He overworked and became ill (as so many of them did in that age) but he completed his house surgeon's term in triumph. Hunter was so impressed with his ability and industry that he offered to take him on as a partner, but this was declined without any reflection on their firm friendship. Physick acquired the diploma of the Company of Surgeons and went on to Edinburgh to obtain the coveted M.D. This he did in 1792 with a thesis on apoplexy written and defended in Latin. He re- corded in detail a case of intussusception during his stay and was critical about the heavy-handed way specimens had been treated. The young Physick was now well trained and ready to start his Hunterian Oration delivered on 14th February 1973 (Ann. Roy. Coll. Surg. Engl. 1973, vol. 53) 205 SIR THOMAS HOLMES SELLORS own practice in Philadelphia, and though the beginning was slow he quickly became famous for the work he did during an epidemic of yellow fever. The epidemic and the accompanying panic led the author- ities to open an isolation hospital at Bush Hill, and here Physick worked indefatigably but unfortunately caught the disease, which left per- Fig. 7. Philip Syng Physick. manent traces. (Both Rush and Physick held that yellow fever was not a contagious disease.) He was next appointed as surgeon to the Pennsylvania Hospital, where he did scientific work and became the first person to do any real teaching. His practice increased rapidly as he was not only a dexterous surgeon, but a humane man. His journal records a diversity of conditions treated, from ulcers, urinary strictures, and stone to fractures and extraction of the lens for cataract. He made his own 206 SOME PUPILS OF JOHN HUNTER instruments, which were greatly admired, and his capacity for work was phenomenal. Epidemics of yellow fever were a regular hazard and Physick contracted a second attack which again affected his health, but on recovery he agreed to give formal lectures in surgery. In 1801 he was made Surgeon Extraordinary to the Philadelphia Alms House Infirmary: this was a unique appointment in recognition of his services and in 1805 he was made the first Professor of Surgery in the University. Previously the Chair had been a joint one of Sur- gery and Anatomy. He wrote a number of important papers in which he was helped by his nephew, Dr. Dorsey, who kept good notes but unhappily died young. His medical interests were many and varied- passing a seton between the ends of an ununited fracture to promote callus formation, operation for the cure of artificial anus (in which he claimed priority over Dupuytren), washing out of stomachs for poisons or overdosing, soft-wire snaring of tonsils and piles, and blis- ters for the arrest of gangrene were among his contributions. Overwork and an attack of typhus fever finally slowed down his phenomenal capacity for work. He became dyspeptic, ate little, had renal calculi with recurrent attacks of colic, and finally felt that his Chair was too much for him. The authorities, with marked lack of con- sideration and against his wish, removed him from the Chair of Surgery and made him Professor of Anatomy as a consolation. Honours from abroad were showered on him-he was the first American to be made an honorary member of the French Royal Academy of Med- icine and in 1836 an honorary Fellow of the Royal Medical and Chirurgical Society of London-but he was slowly declining. In spite of deteriorating health he was able to operate on the Chief Justice (Marshall) and removed 1,000 bladder stones, but his last aotual operation in 1837 was for a cataract. He died not very comfortably at the end of that year. Physick was a remarkable figure in the surgery of his time. His contributions were numerous and many were valuable. He did not become an active formal teacher until fairly late on in his career, but in this, following Hunter's example of careful preparation, he was highly successful. He was a somewhat austere man, but most kindly, and his letters were pithy and very much to the point. He was a religious man, until during his last months he was disturbed in his faith by some of the new scientific doctrines that were gaining sway. Possibly the best impression that one could gain of Hunter's in- fluence on him and American surgery in general appears in the dedication to him, by Dr. Randolph, of Physick's biography, published two years after his death. Hunter had been dead exactly 50 years and yet across the Atlantic came these words: 'To the shade of John Hunter this im- 207 SIR THOMAS HOLMES SELLORS perfect sketch of the Life and Labour of a favourite and attached pupil is respectfully consecrated.' Everard Home and William Clift Next we come to a very contrasting pair-the brother-in-law, Everard Home, who probably never really understood what John was aiming at, and the poor lad, William Clift, who though he only knew Hunter for a short period of months became his most valuable disciple. Both these men were intimately concerned with the fate of the Hunterian Collection. The one, William Clift, the true and devoted conservator of anything connected with Hunter. The other, Everard Home, the brother-in-law who destroyed a mass of Hunter's manuscripts for motives that are still uncertain. Everard Home (not Hume) was the son of an army surgeon, and his elder sister, Anne, was to become Mrs. John Hunter. He was pre- sumably intelligent as he was a King's Scholar at Westminster and was due to go to Trinity College, Cambridge. While at school he frequently saw John, who courted Anne for seven years, and when offered the opportunity of becoming one of John's pupils accepted read- ily. He became immersed in dissections, preparations, and papers, bu,t though apparently industrious, he was not as dexterous as John would have liked: 'Those fingers of yours are all thumbs'-'He will never have sense enough to tie down a bottle'. In spite of these early strictures Everard became a good practical surgeon, if a little rough, and delivered Hunter's lectures for him when he was unwell or away. After five years (1773-78) he was admitted to the Company of Surgeons and took up a post in Plymouth treating the injured after Keppel's engagement with the French. He then went to Jamaica as a staff surgeon and stayed there until 1784, and on re- turn was accepted back into the Hunter household, taking on increasing responsibilities in John's practice. That he was competent is shown by the fact that (possibly through John's influence) he was made an F.R.S. in 1785. When there was a vacancy at St. George's Hospital in 1788 Everard failed to be appointed, in spite of Hunter's influence, losing the post to Gunning's prot6g6, Keate. He did not get appointed until after Hunter had died in 1793-the same year as Marie Antoinette. Home and Matthew Baillie, Hunter's nephew, were Hunter's ex- ecutors, and after his death they saw to it that John's magnificent work On the Blood, Inflammation and Gunshot Wounds was published. But the fate of the whole Collection was still at stake. Pitt declined to purchase it for the Government, saying he had not enough money for gunpowder. Two years later the influential men of science and med- icine re-presented the case and suggested that £20,000 would be its proper value. Finally in 1799, six years later, it was bought for £15,000 208 SOME PUPILS OF JOHN HUNTER and given to the Company of Surgeons, which became a College in 1800.