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]
Catalogue details

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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    - ______ ' L Msdicai. JocbitaS 0X0 the application of heat and cold, and to a degree of heat generated in living tissues, Hunter made the subject of an endless number of investigations, all with the practical vmw of ascertaining how much or how little should be done to keep damaged human tissues alive.33 Here was, as we nave seen an experimental physiologist and also an experi¬ mental pharmacologist.34 He was a psycho-analyst;33 he !vnU,t036inuUkte a? ass and a bitch with the virus of ' 1 ■ 1f' ^e. Preached the doctrine of operating at the fS\T °f-a disCase> and> P]acinS b™self - the position of the patient, said, “ Nor do I go further Imn I now think I would have performed on mlself were 111 same situation.”3' He performed experiments on ie sensitive plant which are now being repeated.38 These aie only some of the points in which Hunter has anticipated modern progress. JVhhT the‘fuih’rr 1,1 “S reIati0“ t0 men. The Future. As 1 look forward I like to humour my fancy and indulge my diearns. Imagination, Keats tells us mnv i, 0 nrrof dreamrhe ‘o' tod it tenth. Th< ait of the surgeon is the pillar of science and it is beem“d to the”fnil hr ,tl,at,aImost art may non , used to the fullest advantage. We eao-erlv +1 day when disease shall not require to be checked An hSb our weapons of war shall be laid aside distant hilinaj 7 ^ tar.awaJ> hut already beyond the ir,C.h2S ^hS“ fruitf!ilWltltiailCiefnt Pre°edent’ this country of ours the riuitful mother of so many gifted sons shall ’ crownCh°Thev wi]f)Utl1S 7*° ^ g° f°rth to conquer “a lheylli best ehuipped who keep to the course leca 1 the methods, and are imbued with the ardent spirit of the two famous men whom we praise to-dav-!LP+ greatest surgeons the world has ever known ‘ “ * 0 Our youths must be prepared for self-sacrifice, for arduous discipline, perhaps for the most heart-breaking rebuffs for the stern or even bitter criticism of their fellows But eie never was a time so rich in promise, so laden with rewards for those who labour with sincerity and truth Ihey will not travel alone. The whole army of science is in league with them, moving forward with incredible Smed eage.i 1° lay at their feet the triumnhs of ’ conquests. The responsibilities which rest on them^t?8 intellectual accomplishments and the dedication of their es demanded of them, are enough to cause the stoutest heart sometimes to falter. Yet, armed with the swovd of the spirit and the breastplate of faith, they will remember that the happiness of life lies in its responsibilities that true joy is found in the search for what may aftei a weary journey prove unattainable. Ahead lies the noblest of tasks to which they may consecrate themselves: for the lives of men are in their hands, the love, the happiness the whole welfare of mankind. We need not fear They tot effort y Cha,'Se' °0d C0U,lts not result References. 1909?ik MR List^SCFirst^announcement°of °hk was made in the Lancet 1867 i s n n „ f a^lseptic metlu 4 Works of John Hunter, ’edited by Palmer 18376 i “ ®ndar> I926. P- 2 465 0 Elliot Smith: British MedicaljTurnIl'im H 816 BuU. Johns Hopkins Hosp., 1901, xii, 197 s Sir ’R ’T16’ Halstec Lister, third edition, 1924 n 600 9 r • Godlee : Lot lu Physiological Catalogue, 1840, v, 17 Work s’of 8J°ohn 19°9’ 7 43 Ibid., iv, 181. 13 aid., iV, 299. - ibid iv 187 R to 16 iv, H9. Ibid., ill, 442. 18 Ibid., iv, 20.’ r» ibid i 391 •Ib\C f%7/ ^ Observations, by John Hunter, edited'’by’ Richard O^n'lS LiZ i, i°“-- ^u‘v, 422. « collected Pap’™, 34 Collected Papers of Lister i 515 t1915’ PP’ 46> 4 Hunter, iv, 299Pafers of Lister’ i 85 38 Essays and Observations, i, 357. ’ ’ ° ' Ibld’’ lj 548> 54 EXPERIMENTAL PRODUCTION OF ACUTE AND CHRONIC ARTHRITIS AND ARTICULAR NEOPLASM BY RADIUM.* [With Special Plate.) BY A. G. TIMBRELL FISHER, M.C., M.B., Ch.B., F.R.C.S., LATE HUNTERIAN PROFESSOR, ROYAL COLLEGE OF SURGEONS. A pew years ago, in a Hunterian Lecture 011 osteo¬ arthritis, I ventured the opinion that the peculiar pro¬ liferations of bone and cartilage often occurring in the more chronic form of arthritis usually known as osteo¬ arthritis, some of which attain a very considerable size, were intermediate between a frankly inflammatory process and a genuine neoplasm. The difficulty experienced in dis¬ tinguishing between the two was so great that some of the loose bodies occurring in osteo-arthritis were designated “ synovial chondromata ” by Professor Shattock and myself. It is unnecessary to enter now into the histologicai differences between such forms of proliferation and frankly inflammatory developments. It is interesting to note, however, that the form of chronic arthritis usually known as “ rheumatoid arthritis ” or “ chronic arthritis of the synovial or mixed types ” (Fisher) is a frankly inflam¬ matory process, whereas the proliferative changes in the so-called “ osteo-arthritis ” belong to the peculiar type of proliferation akin to new growth that we are considering. It is interesting to note also that the age incidence of osteo-arthritis or chronic arthritis of the chondro-osseous type is, as a general rule, very similar to that of many forms of malignant change, particularly the carcinomatous —that is, they both occur when the resistance of the body to irritation of moderate degree of intensity is beginning to diminish because the patient has passed the meridian of life. In younger organisms the vascular response to irrita¬ tion of slight or moderate intensity is marked, and, com¬ bined with a moderate degree of cellular proliferation, probably suffices to cope with minor degrees of irritation. After the meridian of life is past the vascular reaction is not so much in evidence, and a slight but persistent form of irritation tends to bring about a proliferation of cells that are fairly well nourished but degeneration of cells whose nourishment is poor. A good example of this is seen in “ osteo-arthritis.” The physiological basis for the changes in the latter is that while the central part of the articular cartilage which is devoid of blood vessels is poorly uourislied, the extreme lateral portions receive blood vessels from the circulus articuli vasculosus. Irrita¬ tion, therefore, whether mechanical or toxic, tends to cause degeneration of the central portion of the articular area and proliferation of the lateral portions. We observe this same peculiar admixture of proliferation and degenera¬ tion in many forms of true neoplasm, both innocent and malignant. It appears that in new growths we are faced with an essential alteration. There is a breaking down of the physiological harmony between cells and the inhibiting intercellular substance. We can imagine, for example, that prolonged irritation or toxaemia might have, simul¬ taneously, a stimulating effect upon cells but an inhibiting effect upon intercellular substance. On the other hand, inhibition might be at a very low ebb from the degeneration of old age, and might, in a person with suitable dis¬ position, cause a growth to develop. If inhibition is temporarily abolished but eventually recovers, a so-called innocent new growth may result, which after a time ceases to develop actively. If inhibition is impaired a subinflammatory process such as osteo-arthritis develops (compare prostatic adenomata). If it is severely impaired and the irritation is moderate, or if it is slightly impaired and the irritation great, or if irritation is great and inhibition severely impaired, a malignant growth results. As according to this theory the condition known as “ osteo-arthritis ” is a stage intermediate between inflam¬ mation and new growth, it seemed to me that it might be of considerable interest to ascertain whether it would be * The expenses of this research were defrayed by the Medical Research Council.