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A belated happy new year to you all. Recently I’ve been reading ‘The Knife Man’ by Wendy Moore (2005) – a biography of John Hunter, who was a surgeon and anatomist of note from the 1700s. The book starts in the 1740s, around the time that Company of Barber-Surgeons, after much aggrevated debate, finally agreed to divide into it two parts: the barbers and the surgeons – and almost a century before Lister’s discovery of antiseptic technique. Hunter stood out in his day because of his attempts to further the practice of surgery by pursuing advances in anatomical knowledge through scientific investigation. At this time the majority of physicians and surgeons still followed classical Greek teachings, believing in the influence of the four body ‘humours’: blood, phlegm, black bile and choler – and still had a tendency to dose patients up with poisonous elixirs or to bleed them half to death. Moore states that ‘although medical students usually learned some rudimentary anatomy, in private lessons, this was considered a useful but not vital adjunct to on-the-job experience.’ (p10) John Hunter, on the other hand, questioned anything and everything. Using empirical methods, he dissected cadavers and experimented on animals. An example given early in Moore’s book is Hunter’s investigations into collateral circulation that led him to perform the first treatment of a popiteal aneurysm by tying off the flow blood at the femural artery, rather than attempting amuptation of the whole limb. Hunter’s life had a more macarb side however. As the Company of Surgeons in London was only legally entitled to dissect the bodies of six hanged murderers each year, Hunter turned to bribing undertakers and gravediggers and to procuring the services of gangs of professional body-snatchers in order to gain the ‘materials’ required to further his studies. As you might know, the Georgian populus considered even the act of legal dissection to be an extremely questionable if not spiritually amoral practice. There is some suggestion even in 'The Knife Man' that Stevenson’s ‘Dr Jekyll and Mr Hyde' was based on the seemlingly contradictory behaviours and activities of John Hunter.
I think there are two possible morals to Hunter’s story. The first relates to the importance of the empirical method in the pursuit of ‘best practice’ in the health sector. Decisions regarding the selection of treatment choices should be based on sound reasoning and, wherever possible, scientific data. Continuing to provide particular interventions or particular services just because that has always been ‘the way to do it’ is liable to lead to repetition of errors. Equally problematic is the provision of interventions based on the recommendations of ‘experts’. Only time will tell whether these experts are as enlightened as we presume them to be.
The second possible moral to the story of John Hunter is this: It is never entirely easy to spot the genuises from the nutters in one’s own lifetime. Even the application of the empirical method to the study of surgery was considered a borderline practice in Hunter’s day. So maybe the real message for today’s practitioners is to keep an open mind. The non-mainstream thinking of this age may be considered visionaries in future years. Retrospect is a fine thing.
‘If we value the pursuit of knowledge, we must be free to follow wherever that search may lead us. The free mind is not a barking dog, to be tethered on a ten-foot chain.’ - Adlai E. Stevenson (1900-1965)
William Levack
