"John Hunter . . . . . the man in whose phenomenal personality may be seen all the distinctive traits of modern medicine, and the range of whose mighty intellect has had few, if any, equals since Aristotle."(1)
This statement encapsulates Williarn Osler’s opinion of John Hunter. Sir William Osler, one of Canada’s greatest physicians, was also an impassioned medical historian. The 18th century Scottish surgeon, John Hunter, was one of his heroes. In this essay I will summarize Osler’s comments on Hunter and explore some of the similarities between these two great men.
In their definitive collection of Sir William Osler’s essays, McGovern and Roland cite 24 references to John Hunter,(2) and the tenor of all of these references reflects the glowing praise that is quoted above. In his famous essay "The Master-Word in Medicine", the word, of course, being "work", Osler states:
"It is directly responsible for all advances in medicine during the past twenty-five centuries".
He then lists Hippocrates, Galen, Vesalius, Harvey, Hunter, Virchow and Pasteur as being responsible for those advances.(3) In "The Fixed Period" he includes Hunter in a similar list.
"In the science and art of medicine young or comparatively young men have made every advance of the first rank. Vesalius, Harvey, Hunter, Bichat, Laennec, Virchow, Lister, Koch - the green years were yet upon their heads when their epoch-making studies were made".(4)
Osler’s passion for medical history is legendary, and he wrote many eloquent, informed and appreciative biographical essays of varying lengths. Among them were essays on a number of those who were part of such lists of the very greatest minds in medicine, including Harvey, Laennec, Lister, Pasteur and Virchow.(5) However, it is our loss that he never had the opportunity to write such an essay on John Hunter.
John Hunter was born at Long Calderwood in the Parish of East Kilbride in 1728, the son of a farmer and the youngest of ten children. After a rather inauspicious career at a local school he went to Glasgow to assist a relative who owned a timber yard and made furniture. His life changed, however, in 1748 when he joined his brother William in London. William Hunter had already established one of London’s best schools of anatomy, and John proved to be an exceptional technical anatomist and was of great assistance to William during the eleven years that they worked together.
While working for his brother, John Hunter also had the opportunity to train with such prominent surgeons of the time as William Cheselden and Percivall Pott. In 1759, however, John Hunter developed chest symptoms, which were attributed to overwork, and he was advised to take a complete rest and then consider a change of occupation. In 1760 he was commissioned as an army surgeon. He was first stationed in Belle Isle, an island off the coast of Brittany, and then in Portugal. In addition to preparing anatomical specimens for his brother, he had also carried out experimental work with him. As a military surgeon, Hunter did not limit his activities to the care of the sick, but continued to do his own experimental work and started to collect his own specimens. He returned to England in 1763 and in 1769 he passed the examination for the Diploma of the Company of Surgeons. He joined the staff of St. George’s Hospital and built up a very large clinical and surgical practice.(6,7,8)
Although Hunter was a very busy practitioner, it is not just for that that he is remembered today. Osler summarized Hunter’s contribution thus:
"But the man who combined the qualities of Vesalius, Harvey and Morgagni in an extraordinary personality was John Hunter. He was, in the first place, a naturalist to whom pathological processes were only a small part of a stupendous whole, governed by law, which, however, could never be understood until the facts had been accumulated, tabulated and systematized. By his example, by his prodigious industry, and by his suggestive experiments he led men again into the old paths of Aristotle, Galen and Harvey. He made all thinking physicians naturalists, and he lent a dignity to the study of organic life, and re-established a close union between medicine and the natural sciences".(9)
The scope of Hunter’s interests and work can be appreciated by examining a list of the books and articles by Hunter, which Osler had in the great library, which he bequeathed to McGill University: (10)
- Observations on certain parts of the animal oeconomy.
The same. Inclusive of several papers from the Philosophical
Transactions, etc, by John Hunter. With notes, by
Richard Owen.
- The Natural History of the Human Teeth, explaining their
Structure, Use, Formation, Growth and Diseases, illustrated
with plates. With notes by Eleazar Parmly.
- Practical Treatise on the Diseases of the Teeth; intended as
a Supplement to the Natural History of those Parts.
- Treatise on the Venereal Disease.
- Observations Tending to Shew that the Wolf, Jackal and Dog,
are all of the same Species.
- Observations on Bees. From the Philosophical Transactions. A Treatise on the Blood, Inflammation, and Gun-Shot
Wounds. To which is prefixed, A short account of the Author’s Life by his brother-in-law, Everard Home
- The Works of John Hunter. F.R.S., with notes. Ed. by F. James Palmer in 4 vols., illustr. by a vol, of plates.
- Memoranda on vegetation.
- Essays and observations on Natural History, Anatomy,
Physiology Psychology and Geology.
Being his post-humous papers revised, with notes: to which
are added. The introductory Lectures on the Hunterian
Collection of fossil remains by Richard Owen 2 vols.(11)
John Hunter is known primarily now as a surgeon and an anatomist, but his inquiring mind pursued anatomy far beyond the human. He was, in fact, a pioneering comparative anatomist.(12) His interest in human and comparative anatomy led to the creation of his great museum, which by the time of his death contained 14,000 specimens.(13) This museum was eventually acquired by the Royal College of Surgeons of England, where it is still preserved. He did not limit his studies to normal anatomy, and he developed an extensive pathological collection as well.(14,15)
Although a meticulous observer of the normal and abnormal, he was not satisfied with mere observation. He was the founder of experimental surgery6,7 and he carried out pioneering work in experimental dentistry.(16) His interests even extended beyond the animate to the study of geology and paleontology.(17)
Osler was always more than ready to appreciate and praise the accomplishments of others, but he may have had a special appreciation for the work and accomplishments of John Hunter, because there were many parallels in their lives, personalities and achievements.
Neither Hunter nor Osler were particularly good students in school, but both were very interested in nature as schoolboys, and each prepared themselves well for their future careers in medicine by their activities in this area.(18,19) Osler’s interest in nature was particularly stimulated by "Father" Johnson, the Warden of Trinity College School, which he attended from 1866 to 1867, and by Johnson’s friend Dr. James Bovell, a medical practitioner who taught at the medical school in Toronto.(19) Both Osler and Hunter finally blossomed as students when they found their calling in medicine, Hunter when he joined his brother William in London,(6,7) and Osler when he transferred from Trinity College Toronto to the Toronto Medical School in 1868.(20)
Osler, from the beginning of his medical training in Toronto, performed his own detailed studies in anatomy and pathology, a natural continuation of his previous studies in the natural sciences.(20) This interest continued through his career as a teacher at McGill, where he performed over 1,000 autopsies.(5) He was thus well able to appreciate Hunter’s life-long dedication to detailed anatomical and pathological studies.
After a very busy day of clinical practice, Hunter would continue to work far into the evening. Clift, his assistant reported: " . . . then I go to write for Mr Hunter at 8 till 11".(21) On weekends, Hunter would go to his country house at Earl’s Court to continue his scientific work.(7)
Osler was also known to work long hours. Often after tea or dinner he would remain only for five or ten minutes for social conversation and then discretely depart, leaving his wife, Grace, to entertain the guests.(22)
Both men were internationally known as teachers. Osler moved successively from McGill, to Philadelphia, to John’s Hopkins University in Baltimore and finally to the position of Regius Professor of Medicine at Oxford.5 After his return from his tour of duty as a military surgeon, Hunter remained for the rest of his life in London, but he attracted an international reputation as a teacher, particularly in America, as Osler described:
"Neither Boerhaave, Cullen nor Fothergill stamped colonial medicine as did the great Scotsman, John Hunter . . . Hunter’s influence on the profession of this continent, so deep and enduring, was exerted in three ways. In the first place, his career as an army surgeon, and his writings on subjects of special interest to military men, carried his work and ways into innumerable campaigns in the long French wars and in the War of Independence. Hunter’s works were reprinted in America as early as 1791 and 1793. In the second place, Hunter had a number of most distinguished students from the colonies, among whom were two who became teachers of wide reputation. William Schippen, the first Professor of Anatomy in the University of Pennsylvania, lived with Hunter on terms of greatest intimacy. He brought back his methods of teaching and some measure of his spirit. With the exception of Hewson and Home, Hunter had no more distinguished pupil than Philip Syng Physick, who was his house surgeon at St. George’s Hospital, and his devoted friend. For more than a generation Physick had no surgical compeer in America, and enjoyed a reputation equalled by no one save Rush. He taught Hunterian methods in the largest medical school in the country, and the work of his nephew (Dorsey) on Surgery is very largely Hunter modified by Physick.. But in a third and much more potent way the greater master influenced the profession of this continent. Hunter was a naturalist. He made all thinking physicians naturalists both in Britain and Greater Britain he laid the foundation of the great collections and museums, particularly those connected with the medical schools. . . He was, moreover, the intellectual father of that interesting group of men on this side of the Atlantic who, while practising as physicians, devoted much time and labor to the study of Natural History."(23)
There are, of course, some differences in the personalities of the two men, but these differences may be more apparent than real. Osler’s passion for books is immortalized in his library at McGill University, and in the wideranging erudition that informs ail his writings. Hunter is often considered to have been poorly educated and uninterested in books. Osler tells an anecdote, which illustrates this:
"Descartes, one of the most brilliant thinkers and observers, had no library. At Egmond, asked by a friend the books he most read and valued, he took him into his dissecting room and showed him a calf " "there is my library". An identical anecdote is told of John Hunter. But these were exceptional men; and few will be found to doubt the importance of books as a means to what the same author called the end of all study " the capacity to make a good judgment." (24)
However, Hunter’s lack of interest in books has probably been exaggerated. Qvist records that the catalogue of Hunter’s library, which was auctioned after his death, listed more than 100 books. There were books on anatomy, medicine, surgery and the sciences, which might be expected, but there were also dictionaries, Johnson’s Dictionary among them, histories by Smollett, Hume and MacAuley, Bacon’s works, and other books on philosophy, political economy, travel and geography.(18)
Osler was known for his warmth and friendship. Cushing quotes Dr. Garrison as follows:
"What made him, in a very real sense, the ideal physician, the essential humanist of modern medicine, was his wonderful genius for friendship toward all and sundry; and, consequent upon this trait, his large, cosmopolitan spirit, his power of composing disputes and differences, of making peace upon the high places, of bringing about ‘Unity, Peace and Concord’ among his professional colleagues. "Wherever Osler went . . . ", says one of his best pupils, "the charm of his personality brought men together; for the good in all men he saw, and as friends of Osler, all men met in peace". (25)
However, Charles Roland has pointed out that Osler had his rougher edge, and that there are recorded instances of his speaking his mind very plainly in public to the consternation of some of his colleagues.(26) Hunter on the other hand had a reputation of being irascible. It is known from his autopsy that he had atheroscierosis, and he recognized during his lifetime that his angina could be brought on by emotional exertion, as he is quoted as saying, "My life is at the mercy of any rogue who chooses to provoke me". In fact, his death in 1793 may well have been brought on by an argument at a board meeting at St. George’s Hospital.(27) However, the rougher side of Hunter’s character has probably been exaggerated. Murley refers to his ‘innate kindness and humanity’(28) and Qvist points out that Hunter had many friends in the artistic and aristocratic circles of the London of his time, including Adarn Smith, Sir Joshua Reynolds, and Thomas Gainsborough, and that he was elected to the staff of St. George’s Hospital with an overwhelming majority of the 161 governors who attended.(18) Separated by a generation, Osler and Hunter are two of the giants in the history of medicine. Osler clearly appreciated the genius of his predecessor, and the many traits they have in common explain their manifold contributions to our profession.