Book Review
The Knife Man: The Extraordinary Life and Times of John Hunter, Father of Modern Surgery
N Engl J Med 2005; 353:2412-2413December 1, 2005
- Article
The Knife Man: The Extraordinary Life and Times of John Hunter, Father of Modern Surgery
By Wendy Moore. 341 pp. New York, Broadway Books, 2005. $26. ISBN: 0-7679-1652-2John Hunter is rightly regarded as the founder of scientific surgery, but he has long been a lightning rod for controversy, within his own lifetime and even today. In this new biography, Wendy Moore brings Hunter to life in all his flawed, combustible glory.
As a young man, Hunter left the hardscrabble Scottish Lowlands to join his doctor brother William in 18th-century London, eventually becoming the most famous physician in England. Hunter, blessed and cursed by an insatiable natural curiosity, made enormous contributions to anatomy and embryology. (These achievements were made possible by the thousands of cadavers pilfered for Hunter by the professional grave robbers known as resurrection men.) He pioneered limb-saving treatment for popliteal aneurysm, an occupational illness of coachmen caused by repetitive trauma from their high-top leather boots as their carriages bounced over the cobblestones. Hunter also experimented with artificial insemination, tooth transplantation, collateral circulation, and bone growth and remodeling. In addition, he was a naturalist who anticipated much of Darwin's theory of evolution.
Hunter was no bookman. He disdained scholarly study, particularly the prevailing orthodoxies of Galen, in favor of personal observation and investigation. As Hunter once wrote to his favorite student, Edward Jenner, “I think your solution is just, but why think? Why not try the experiment?” Hunter concluded from clinical experience, including his early placebo studies, that the contemporary cure-alls of bleeding, purging, and mercury were useless. These views were so radical at the time that 50 years after his death the editors of Hunter's collected works were still apologizing for them. Hunter was also keenly aware of the current limitations of surgery — he likened a surgeon to “an armed savage who attempts to get that by force which a civilized man would get by stratagem.”
On occasion, Hunter's zeal for experimentation misfired. In a disastrous attempt to determine whether syphilis and gonorrhea were distinct conditions, he inoculated gonorrheal pus from a patient into the genitals of an uninfected subject. Unfortunately, Hunter's source patient was infected with both gonorrhea and syphilis. When the subject developed symptoms of both, Hunter wrongly concluded that the two diseases were different aspects of the same illness. Moore agrees with the conclusions of most scholars that this was self-experimentation, citing the assertions of Hunter's editors and students' transcripts of Hunter's lectures, in which he referred to himself as the unlucky subject.
In some respects, Hunter resembled Surgeon Cuticle in Herman Melville's White Jacket, whose “long habituation to the dissecting-room and amputation-table had made him seemingly impervious to the ordinary emotions of humanity.” Hunter's obsessive collecting sometimes led him to transgress the bounds of common decency. As the Irish giant Charles Byrne was dying of tuberculosis, Hunter became obsessed with obtaining his corpse, hiring henchmen to follow the giant around London. The horrified Byrne then arranged for his body t o be sunk in the Irish Sea on his death. Hunter spent a fortune bribing the undertaker, who switched the giant's body for paving stones at a tavern on the route to the coast, while Byrne's inebriated burial party slumbered. Hunter's ruthlessness in the service of science captured the public imagination and may have influenced early literary depictions of the mad scientist. Notably, Robert Louis Stevenson used Hunter's London residence as the sinister setting for The Strange Case of Dr. Jekyll and Mr. Hyde (1886).
Hunter's iconoclasm made him beloved by his pupils and despised by his peers. Wealth and notoriety did nothing to improve his temperament, and he became more cantankerous with age. After Hunter dropped dead of angina during a particularly acrimonious staff meeting, one of the first acts of his surviving hospital colleagues was to sponsor the writing of a defamatory biography.
Moore provides a largely sympathetic assessment of Hunter's ambiguous legacy. Her complex portrayal nicely balances the rigor of the historian with the art of the storyteller. The Knife Man makes for fascinating, often macabre reading, and it will be enjoyed by anyone with an interest in the history of medicine.
John J. Ross, M.D., C.M.
Caritas St. Elizabeth's Medical Center, Boston, MA 02135
jrossmd@cchcs.org
