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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    studying of functional anatomy in man and in animals. Physiology, with its offspring biochemistry, has intro¬ duced physical and physico-chemical methods—methods of quantitative observation which have supplemented where they have not supplanted the merely qualitative methods. The brilliant work of Sherrington, Lucas, and others upon the nervous system gave us fresh conceptions of it; further advances along their lines were becoming difficult until the application of thermionic valves made it possible, by recording the transmission of impulses in the afferent nerves, to investigate the effects of stimuli upon the sensory end-organs. And in the interpretation of sym¬ ptoms, a study to which my old friend James Mackenzie bent the strength of a most eager and original mind, physiology alone can read the occult significance. In acute pancreatitis there is, as Halsted,7 a great benefactor of mankind, first told us, a lividitv of the face. Why? Is it due to some disordered action of the respiratory system imposed by the closeness of the affected organ to the diaphragm and the structures which lie above it, or is there circulatory stasis, or alteration in the blood pigment? Physiology is the master of all the methods by which these three possible causes may be quantitatively investigated. Estimations of the oxygen saturation of the arterial blood give information of disturbance of respiratory function— information which we may compare to that derived from a measurement of the amount of blood urea when the renal functions are deficient. Estimations of the carbon dioxide combining power of the blood are essential if we are to recognize the presence and the degree of acidosis. Circu¬ latory stasis may be gauged by the ethyl iodide method of measuring the circulation rate. Alterations of the blood pigment are detected bv the spectroscope, and quantitative estimations of abnormal pigments are readily made after the method of Hartridge. Like the physiologist, the bacteriologist is engaged in work which is ranged alongside our own. The more he discovers of the offensive powers of bacteria and of the defensive mechanism of living flesh under their attack the nearer are we brought to our surgical ideal. The alliance between bacteriologist and surgeon has been necessary for the proof that the true estimate of an antiseptic is not measured only by its bactericidal value tested in the labora¬ tory, but also by its power to encourage the blood serum or ; the tissues themselves to ward off and to break up an attack. Hunter, with the crude methods which were all he had at his disposal, demonstrated the tryptic power of wound discharges, and anticipated a part of the admirable work of Almroth Wright during the war. Who could have imagined, when Lister’s work began, that to-day we should be able to keep tissues alive in our laboratories, breeding them and growing them in captivity, separating the one kind from the other, noting the influence which one type of cell is able to produce on its neighbours, and thus coming by the kind of knowledge which John Hunter so earnestly sought—a knowledge of the intrinsic processes of growth and repair? The problem of malignancy is now installed 1 in our laboratories, and the cancer cell is being compelled to yield most reluctantly some of the complex secrets of its Bolshevist behaviour. The old art of vital staining, which Hunter learnt from Belchier of Guy’s, has taken on new improvements: bv means of suitable dyes we can now select special elements in the living body, trace their movements, and note their conduct. The experimental embryologist, too, can help us if we seek to know in what manner the various tissues of the body come into existence. . Hunter : Pasteur : Lister. These, then, are the allies of surgery in the great war: Biology in ali its branches, Chemistry, Physics, Radiology. Never before has the master surgeon had such bountiful resources at his disposal. He cannot afford to neglect a single one of them. The urgent problem of our time, there¬ fore, is a dual one: We must seek to determine the line of advance which surgery will trace in the years ahead, increasing and strengthening our alliances; and we must earnestly discover how the leaders of our army of advance are to be trained. Are the old methods, which in their day served so well, still enough; or is the form of warfare already so changed, and now so rapidly changing, that a new discipline and a wider knowledge are needed? To answer these questions we must look backwards, and, calling upon our past experience, seek in the records of our great masters not so much what their knowledge was, but what methods they pursued as they qualified themselves for great leadership. We shall find at once that Hunter and Lister, incomparable among surgeons, each put himself through a long and arduous training, never resting in his inquiries as to the activities of living matter, as to its behaviour in health, and its reactions in disease. At the threshold of our survey we recognize that the activities of our two leaders are not unrelated. Hunter’s professional life covered the latter half of the eighteenth century, Lister’s the corresponding half of the nineteenth century; between them there intervened two generations of surgeons. My distinguished predecessor, the late Sir Rickman Godlee, who gave this oration in 1913, tells us in the Life of his uncle, Lord Lister,8 that “ Hunter was Lister’s greatest hero”; that “his copy of Palmer’s Life of Hunter was marked in many places by pencil notes which show that he was studying it at least as early as 1855 ”; that “ a proof of Sharp’s engraving of the portrait of Hunter by Reynolds, which had belonged to Syme, hung in his study ” ; that “ he always spoke of Hunter with reverence.” Further, if we turn to' the paper9 which Lister read to the Medico-Chirurgical Society of Edinburgh in March, 1858, on the “ Causes of the coagulation of the blood,” we find evidence of his early admiration of Hunter. “ The nearest approach,” he wrote, “ which I have been able to find to such an observation [that blood which is retained in the smaller veins of the body remains uncoagulated] is contained in that inexhaustible treasury of original observations and profound reflection, the works of John Hunter.” If I may borrow a simile from the football field to express the relation of these two great men, I would say that it was Pasteur who made the final pass to Lister possible; it was Hunter’s captaincy in the scrum that placed Lister in the scoring position. Indeed, we have to admit that while Hunter’s resource in midfield has never been excelled, or even approached, and though the ingenuity with which he worked the surgical ball towards the goal remains unsurpassed, yet when he was in a scoring position and we were counting so confidently upon a “ try,” the ball ivas fumbled, and our hopes were foiled. The young surgeon of to-day can learn almost as much from Hunter’s mistakes as from his triumphs. Hunter’s Discipline and Methods. Let us now examine the discipline to which John Hunter submitted himself to attain his leadership. He is the “ Dick Whittington ” of British surgery. In September, 1748, at the age of 20, he left his home, an upland farm in the parish of Kilbride, eight miles to the south of Glasgow, and, travelling on horseback, he entered London in a little under a fortnight, alighting in Covent Garden, where his brother William kept a school of anatomy. William Hunter was beyond doubt the foremost medical teacher of his time; his best pupils caught from him the spirit of research: among his inspired disciples were John Hunter, William Hewson, William Cruickshank, Charles White of Manchester, and William Hey of Leeds, the founder of the Leeds Infirmary, the first stone of which was laid in 1767 by Edwin Lascelles, the first Lord Harewood. In 1751, after three years of study, John Hunter counted himself a qualified surgeon; he remained in his brother’s school to teach and to research, at what salary we cannot now tell, but assuredly it was a small one. John Hunter thus entered the critical years of his life, for the career of a young surgeon was determined then, just as it is to-day, not so much by his conduct during the years of pupilage, as by the Use made of the period after qualification. The problems which a young surgeon first attacks, and the methods he employs to solve them, are suggested to him by the age in which he lives and by the school in which he has been trained. In John Hunter’s youth a knowledge of the human body was being extended