The Hunterian oration on Hunter's ideal and Lister's practice : delivered before the Royal College of Surgeons of England on February 14th, 1927 / by Sir Berkeley Moynihan.

  • Moynihan, Berkeley Moynihan, Baron, 1865-1936.
Date:
1927]
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Licence: Public Domain Mark

Credit: The Hunterian oration on Hunter's ideal and Lister's practice : delivered before the Royal College of Surgeons of England on February 14th, 1927 / by Sir Berkeley Moynihan. Source: Wellcome Collection.

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    Elje Hunterian (Oration ON HUNTER’S IDEAL AND LISTER’S PRACTICE. Delivered before the Royal College of Surgeons of England on February 14th, 1927, BY Sir BERKELEY MOYNIHAN, Bt., PRESIDENT. On this day, the 199th anniversary. of. his birth, we com¬ memorate the services of John Hunter to the science and the art of surgery. In this year we celebrate the centenary of the birth of Lister. Hunter and Lister. From all who have ever served the cause of surgery these two stand apart by reason of the immeasurable gifts which they have con¬ ferred upon their fellow-men. May we to-day recall some¬ thing of Hunter’s work and of his ideals in respect of the conquest of disease, which the genius of Lister made possible! Man’s life is warfare. The individual, the whole race, is beset by foes—unresting, relentless. Against them our defence, if we are ever to subdue them, must be carefully planned, and diligently strengthened. But defence, I10 we vet stubborn, is not enough. Attacks designed after scientific study of the enemy strongholds and methods, and launched with impassioned zeal, must never for one instant falter. Not all our attacks meet with success. We are cheered when we gain some notable victory, yet when we suffer defeat, as wave after wave of our advance is checked and repulsed, we do not lose heart. Failure inspires us to fresh and still more eager endeavour. In this year, the centenary of Lister, we rejoice to acclaim the greatest victory ever won by man against his enemies. W e who are in active work to-day are perhaps unable to measure the full .extent of that victory; for during the long fight, lasting almost exactly sixty years, our standards have been so changed that we cannot truth¬ fully compare our work with that of our intellectual ancestors. Operations from time immemorial so mortal as to be prohibitive are now freely performed without anxiety. Operations formerly unimaginable are now matters of everyday occurrence. The mere tale of such work done does not adequately illustrate the change. On my last day as surgeon on the' full staff of my hospital I performed six abdominal operations. Not one of these was practised by any member of our staff during the year in which I became house-surgeon, nor had such a diagnosis as was made in three of these cases, and verified at the time of operation, ever then been attempted in the history of medicine. Above all, a statement of facts and a comparison of methods does not in adequate degree convey to our minds the difference of outlook, of the intellectual and spiritual approach of a man to his daily task, as between the surgeon in the days before Lister and since. It is barely possible for us to imagine how men felt about their daily work when an eminent surgeon could speak of his hospital as a “ house of death ” ; when hospitals “ were little short of pest-houses,” as Lister said;1 and when the oppressive mortality compelled the closure of wards or of a whole hospital for months, until the curse was lifted from them. ' 7 . • ' The change, of incalculable benefit to humanity, is due to one man—Lister.2 Before Lister’s time the surgeon dreaded the almost inevitable consequences of his operation. Lister made surgery so free from risk that we now may say that, with due care in the detailed application of the lessons learnt from him, it is no longer the fatality of the opera¬ tion itself which is feared. In these days, when a patient dies it is not because the operation leads to septic com¬ plications which he cannot withstand. We fear for him chiefly, if not only, when the extent of the operation is formidable, or when the most sensitive regions of the body, sometimes remote and almost inaccessible, are attacked by methods which half a century ago were beyond the wildest dreams of the most adventurous mind. Our main concern in these days is with the condition of the patient before and after operation. We seek to make him .as safe/or surgery as surgery has been made safe for him. Lister, in-short, has made all the methods applied by the surgeon almost devoid of risk in themselves. The risks run are dependent upon accessory factors—upon the state of the patient, the nature and extent of the disease, the intrinsic susceptibility of organs, or the anatomical con¬ ditions responsible for the difficulties which must be surmounted. Do we fully realize the implication of all these state¬ ments? We are at the end of an :epocli, indisputably the greatest in our history—the epoch in which manipulations by the surgeon have been robbed of the prohibitive dangers which formerly repelled. Now when failure comes it is the individual who fails, not the methods of which Lister laid the eternal and unshakable foundations. Lister by his genius recruited an army of surgeons which has gained astounding victories. The human body from crown to toe has for all time become our indisputable kingdom, within which we may come and go at pleasure, undismayed by the pestilences which menaced us before Lister forever sub¬ jugated our enemies. Lister is indeed Captain of the men of Life., We who inherit the glorious legacy of Lister must not be content merely to enjoy and exploit our incomparable heritage. No _ great teacher measures his success in con¬ templation of his own efforts. His greatness lies rather in the work which he inspires others to do—in the tradition not of past accomplishment but of future devotion. Tradi¬ tions are fostered and increased not by routine observance of ancient ceremony, nor by mute obedience to outworn .creed, but by active faith forever seeking new truths and exploring new paths, in conformity with the old spirit and with unchanging devotion to the great ideal of which the tradition is the shrine. There is immortality of the tomb, and immortality of the resurrection. The soul of a great teacher is born again in his pupils. What, then, are we to do with Lister’s gift To mankind? We use it already to the immense advantage of the individual sufferer; a therapeutic weapon of unapproaclred perfection, we are making it, and we must continue, in increasing, degree, to make it far more than that. After the great war the statesmen of Europe, mowed, by the highest ideals, sought, not perhaps wholly in vain, to convert the allied victory into lasting peace. The statesman’s ideal is a warless world. War is to end war. Ideals are not so much for capture as for pursuit, and though the statesman may never attain liis ideal, yet the happiness and progress of mankind surely depend upon the grim and perhaps endless struggle to reach it. So, too, for us surgery must be regarded as the most powerful weapon of research upon man and animals ever given to our hands; and the end of research is not the cure only, but, far better, the prevention, of disease, Hunter’s Ideal. •• - ; ; ; f -4- . The Oration I have now the honour to deliver was founded 114 years ago as “ a lasting mark of respect to the. late John Hunter.”,3 - Let us turn to Hunter, the greatest surgeon of all fbe ages before Lister, and see how he regarded. the art. he practised/*■ In the;opening lecture of eachsurgical, course Hunter /said’ to- his-students :4 “ The last p'art of surgery, namely operations, is a reflection on the . healing art; .it is a tacit acknowledgement of the insufficiency of surgery. It is like an armed savage;who attempts-to get that by force which, a civilized man; would get by stratagem,” In his- Treatise on 7the Venereal Disease,5 a Work more frequently quoted for its glaring errors than for its pro¬ found truths, he indicates one of the ways which lead to tluY ideal, the prevention rather than the cure of disease. He writes; “As disease in general should not only be cured but when it is possible prevented, it will not be improper to show, as far as we know, how that may be done : for in this disease we can with more certainty prevent infection, its origin being known.” Ho [34501