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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    influence of John Hunter. It is not accident, surely, that the men who have done most for surgery trained themselves rather as research workers than as practitioners, that they revelled in and set out to master one problem after another in biology. Lister’s acknowledgement of the immense influence of Hunter upon him is not in the least overstrained. If the spirit of Hunter watches over his Museum and this College, as we hope it may, how infinite must be its pride in the thought that the one man greater in service than Hunter himself was his direct intellectual offspring! Let me recall the names of a few of Lister’s early papers: that “On the flow of the lacteal fluid in the mesentery of the mouse,”24 begun in 1853 and published in 1857, is a direct extension of Hunter’s experiments on absorption;25 the communication on “ The persistent vitality of the tissues ”26 is founded upon observation made *>y Hunter himself on the same subject. The studies on “ Coagulation of the blood ” began by observing what happened in the veins of “ sheep’s trotters ” taken from the shambles. By devising new and critical experiments he was able to carry the knowledge concerning coagulation to a point far beyond that which Hunter had reached a century before him. Yet his methods were clearly modifica¬ tions of Hunter’s. Lister’s vocabulary, indeed, was still that of Hunter: for he spoke of the “ solids ” of the body, of “ preternatural stimuli,” of the “ disposition of the tissues,” of “ inherent tendencies,” and of “ sympathetic irritation.” The Antiseptic System: Preventive and Curative. The events which followed Lister’s arrival in Glasgow are too well known to all the world to need more than the briefest recapitulation. Lister was then 33 years of age, almost the same age as Hunter when he joined the army as a surgeon. As a result of seven years of a pre¬ paratory experimental investigation, conjoined with a wide clinical observation which was closely related to it, he had become immersed in all the problems relating to inflammation and suppuration. He had already formu¬ lated a hypothesis that suppuration was due to putre¬ faction, and in 1865 was ready to put his supposition to a practical test. Pasteur’s epochal, discovery that putrefaction was due to “germs” set matters going. Lister wrote:27 To prevent the occurrence of suppuration, with all its attendant risks, was an object manifestly desirable; but till lately apparently unattainable, since it seemed hopeless to attempt to exclude the oxygen, which was universally regarded as the agent by which putrefaction was effected. But when it had been shown by the researches of Pasteur that the septic property of the atmosphere depended, not on the oxygen or any gaseous con¬ stituent, but on minute organisms suspended in it, which owed their energy to their vitality, it occurred to me that decomposition in the injured part might be avoided without excluding the air, by applying aS a dressing some material capable of destroying the life of the floating particles.” Lister was first of all concerned with the destruction of organisms after they had obtained access to wounds. He knew of the experiments with the Carlisle sewage, and of the bactericidal properties of carbolic acid. He observed carefully the effects produced upon living tissues by anti¬ septics, and concluded that the reparative processes in a wound were not thereby weakened. We are apt, however, to forget the gradual change that came over Lister’s views’ and the effect this had upon his practice: how he came to a full realization of the essential powers of defence possessed by the living tissues, and of our obligation to protect and if possible to increase them. Sir Rickman Godlee, who knew more of Lister than any man has written that Lister before 1881, when he first told the world of his changed opinions, “ had long recognized and taught that healthy living tissues exercised an inhibiting influence on the growth of micro-organisms. ... He there! fore began to wonder, whether if only slightly damaged for example, by the incision made by a very sharp knife’ the living tissues of any wound might not be able to deal with a certain number of germs by their own efforts ” This we gleefully observe is a return to Hunter’s work in Medical Journal which he recognized the “ powers,” “ disposition,” and “ action ” of living tissues. It may not be inappropriate to quote Lister’s own words. He writes : 28 29 “ The original idea of the antiseptic system was the exclusion of all microbes from wounds.” Again, “ During the operation, to avoid the introduction into the wound of material capable of inducing septic changes in it, and secondly to dress the wound in such manner as to prevent the subsequent entrance of septic mischief.” Again, “ In wounds already septic attempts are made with more or less success to restore the aseptic state.” Again, “ In speaking of the antiseptic system of treatment I refer to the systematic employment of some antiseptic substance so as entirely to prevent the occurrence of putrefaction in the part concerned, as distinguished from the mere use of such an agent as a dressing”; and further, “I always endeavour to avoid the direct action of the antiseptic substance upon all tissues.” The distinction between the preventive and the curative use of antiseptics is in many respects that existing between, on the one hand, the power of a germicide as determined by experiments in vitro, and, on the other hand, its capacity to destroy organisms when it is introduced among the living and the dead tissues of a wound. I11 the former there is a direct conflict, a clean fight between the microbe and the chemical agent. Few or none of the many inter¬ vening conditions are present which have to be considered when a bactericide Is introduced into a wound cavity wherein there are multitudes of actions and reactions which even now seem very obscure and are so often conflicting. We may therefore regard Hunter and Lister as bridge- builders ; it is out of a multitude of scientific observations, of apposite inferences, and of wide generalizations that such bridges are built, stone by stone, arch by arch. Posterity will perhaps remember only the one bridge— permanent, indestructible, all-sufficing—of Lister. Across that bridge we have swarmed, a triumphant host, and a vast new territory has met our almost incredulous eyes. Hunter was forever building bridges, ambitious in design, firm in their foundations, but always left unfinished. Some day new architects will come and give them the full span which Hunter surely meant them to have. It is remarkable to note how often he anticipated the lines along which we see that modern surgery is making its advance. Crdtures of both benign and malignant tissues are now being kept alive by methods which, devised by Dr. Ross G. Harrison while studying the growth of fibres from the nerve cells of a tadpole, have been rapidly developed by Alexis Carrel. John Hunter, too, tried his hand at experimental embryo¬ logy. He “ exposed the little animal [the chick embryo] by putting it into water heated to about 104° F. just covering the egg ” and “ hoped to keep it alive by these means and observe in the same chick the whole progress of growth* but it soon died therefore, he says “ I was obliged to have recourse to a succession.”30 He was an experimental surgeon, as may be shown from the following quotation31 from one of his lectures: “ Here is the testicle of a cock, separated from that animal and put through a wound, made for that purpose, into the belly of a hen, which mode of turning hens into cocks is much such an improvement for its utility as that of Dean Swift when he proposed to obtain a breed of sheep without wool. The lien was afterwards killed and the testicle was found adhering to the intestines, as may be seen in this preparation where the parts are preserved.” He devised and carried out experiments to asoertain whether the growth in a cock’s spur is due to a “ disposi¬ tion ” inherent in the spur or derived from the constitu¬ tion of the cock. He excised spurs from the legs of cocks and implanted them in their combs to note the rate of growth under such unfamiliar surroundings. The first vital stain ever used was madder; it was introduced to the notice of biologists in 1764 by John Belchier, surgeon to Guy’s Hospital; by its experimental application John Hunter revolutionized our knowledge of bone growth and bone decay.32 In the hands of Professor A. V. Hill the measurement of heat in living tissue has become the most delicate and certain indication of the nature of their vital reactions. The manner in which living matter reacted to