John Hunter and the horrors of 18th-century surgery
With the help of artefacts from a museum devoted to the anatomical collections of John Hunter, Daniel Hahn considers how the early surgeon carried out his trade…
Number 28 Leicester Square, in affluent late 18th-century London, was the home of the Scottish-born surgeon John Hunter and his wife Anne. Unremarkable on the exterior, the Hunter residence was rather unusual behind the front door. The reception rooms would have been normal enough for a wealthy family home, but the back of the house had been converted into an extraordinary museum for Hunter’s collection of anatomical samples (rows and rows of jars) and other natural oddities (such as a stuffed giraffe, and a whale skull).
The collection was designed to be seen, though strictly by invitation only. For the most part it was made up of Hunter’s own preparations – objects exciting an anatomists’ interest, in cases and jars, preparations vital to his teaching work (just as such preparations and dissections remain vital to the teaching of anatomy today). But this collection did have a dual role; it was partly a showcase for Hunter’s research and a tool for his teaching work, but it was also a cabinet of curiosities. There was the double-skull of the “two-headed boy of Bengal” for instance, a seven-year-old with a parasitic head attached to his own. He was exhibited by his parents, and seen by some official of the East India Company. When he died they shipped him to Hunter, and into the museum he went.
Now, over two centuries later, as John Hunter’s collection is brought back to life in a museum which opened at the Royal College of Surgeons in 2005, the unfortunate two-headed boy is still there.
When Hunter bought the Leicester Square house he also bought 13 Castle Street, the house that backed on to it (with the garden in-between), and built a sort of bridge between their facing back-walls. So the house seemed to extend further still – to a suite of rooms that once belonged to the back of the Castle Street property. This area beyond the museum was used to accommodate Mr Hunter’s students, with a lecture theatre where he could demonstrate experiments and dissections, and a grandly titled “conversazione room”.
From this area, a door led to the very back room – the dissection room. This is where the bodies were delivered, to be poked and sliced and generally taken apart in a good cause. One of Hunter’s students, a young man by the name of James Williams, described his Castle Street quarters: “… in point of situation it is not the most pleasant in the world,” he wrote. “The Dissecting Room with half a dozen dead bodies in it is immediately above and that in which Mr Hunter makes preparations is the next adjoining to it, so that you may conceive it to be a little perfumed…” While Hunter’s surgery was carried out at Hyde Park Corner, at St George’s Hospital, it was here, in dingy Castle Street, that the real experimental work was done.
A man of many parts
The place in society of a man like John Hunter was rich in contradictions. As a surgeon he treated some of the prominent men of his age – men like Adam Smith and David Hume (who called him “the greatest anatomist in Europe”), Gainsborough, Hickey, and the baby Byron, possibly James Boswell too. Many of these and other celebrities were personal friends of his and Anne’s – men like Joseph Banks, Joshua Reynolds and Daniel Solander – highly respected members of civilised society. And at the same time much of his work developing his skills depended on somewhat shady practices like grave-robbing, which was not only illegal but also, well, rather distasteful too.
But how else could Hunter be expected to conduct experiments that required real bodies? As a staff surgeon at St George’s Hospital he was entitled to a small quota, but that source didn’t provide nearly enough cadavers for his purposes. And though in time the Anatomy Act would increase the supply by providing access to workhouse bodies for dissection, this wouldn’t come into force for half a century yet. “The country needed skilled surgeons, especially for the wars,” explains Wendy Moore, whose Hunter biography The Knife Man is out this month; “and they knew a surgeon had to learn somewhere about the human body, and practise. It was convenient for them to practise on bodies, as long as they weren’t the bodies of the wealthy, so long as it wasn’t their relatives”.
Part of the problem, of course, was that it was hard to persuade the living to take part in experimental work; even the smallest procedure in a pre-anaesthetic world was a horror of pain and possible infection, never undertaken unless absolutely necessary. Of course, this inconvenience (the small matter of practically intolerable pain) didn’t stop Hunter from experimenting on his patients, whether they agreed to the procedure or not. As a surgical zealot, Hunter seems to have had trouble understanding why others might not want to expose themselves to a little scalpel-work.
To give him credit, Hunter was prepared to use his own body for experimentation when no other was available. One of his case studies concerns a male patient whom he infected with gonorrhoea; though there is no name on the case history, the victim may have been Hunter himself, an eager martyr to the cause of medical advancement.
For a man with such zeal it’s perhaps surprising that Hunter was such a reluctant surgeon, believing his work was not simply to cut patients up willy-nilly, but to assess their condition and ascertain when to operate and when – in preference – to leave the patient alone. “Operations should never be introduced but in cases of absolute necessity,” he wrote. And with such attendant risks, it’s a reasonable caution.
It’s no wonder those who underwent procedures under Mr Hunter’s knives and survived to see the dawn felt heroic. You can’t help admiring the man, say, who had a tumour weighing 144 ounces cut away from his neck, and think of all those brave men who agreed to undergo a lithotomy – a particularly painful operation for removing bladder-stones either with an incision-and-forceps procedure, or by inserting a nasty-looking instrument up the urethra to break the stone up.
These courageous men decided, presumably, that a few minutes of unspeakable agony were preferable to a lifetime of untreated discomfort; it’s hard to blame them when they decide that they’d rather like to keep the miserable object extracted as a souvenir, a sign of their fortitude. The museum at the Royal College of Surgeons today has quite a collection of bladder-stones, in fact (some of them extracted from quite famous bladders); one of them even has its own elegant display case (just the right size for slipping into a waistcoat pocket to be pulled out to impress people at parties), engraved “Extracted November ye 4th 1725”. Its owner must have been very proud.
The seedy side of surgery
Grave-robbing was unsavoury (not to mention illegal), and even the society-man Hunter couldn’t quite legitimise it (though of course blind eyes were turned). At least the second phase, the post mortem examination, did for the first time become fairly respectable on his watch, and its value recognised. Taking public awareness to an extreme, Samuel Johnson’s autopsy was even published in detail in the newspapers. “Hunter effectively legitimised post mortems,” says Moore, “and tried to explain the need for them. From about the middle of the 18th century it began to be realised that you could learn from a dead body; and that’s when some families were starting to be persuaded that they should allow post mortems.” Hunter even did post mortems on a number of his friends, apparently without any trace of sentiment.
And what of the collection itself? A motley assortment of cuttings from snatched bodies, famous patients, animals and human freaks. Without a doubt the most celebrated of all Hunter’s exhibits was Charles Byrne, “The Irish Giant”. Standing at just over or just under eight foot tall (depending on whom you ask), this was a body John Hunter very much wanted to get his hands on. Byrne refused all Hunter’s offers to make himself available post mortem; but when the giant died, in 1783, Hunter simply bought the body anyway (outbidding the man whom Byrne had charged to dispose of it in a more dignified way).
But it was from these bodies, and other similar acquisitions – executed criminals, and animal carcases from the royal menagerie, for instance – that Hunter was able to conduct his experiments on dentition, reproductive and digestive systems and so on; and from there, to assemble the preparations that now form the bulk of his collection.
There was always an element of spectacle to Hunter’s collection; in part it was put together to impress, and the display in Leicester Square (halfway between the front drawing-room and the back dissecting-room) was designed to its best impressive advantage. And the same goes for the collection today.
For Simon Chaplin, senior curator of the Hunterian Museum, the display-cased bladder-stone is particularly revealing for what it tells us about the way the museum itself has changed. “Before, things like that didn’t have a place, because they didn’t fit into a grand scheme of classification. I’m quite surprised no one had taken it out of the box, thrown the box away and displayed it with all the other bladder-stones.”
Remoulding Hunter’s legacy
At Hunter’s death, his collection was offered for sale to the Pitt government, who – pressed for funds as always – turned it down. It was only six years later, in 1799, that the necessary £15,000 was found and the collection – the most extensive and significant collection of physiological specimens in England, row after row after row of them – passed into public hands and the care of the College of Surgeons. The collection formed the basis for a museum constructed at a new site in Lincoln’s Inn Fields. The Museum of the Royal College of Surgeons was formally opened in 1813.
Since that time the College has displayed it more or less dustily, charmingly quirky but neither accessible nor attractive. The renovations will change that. The display area is newly laid out, newly labelled, and newly designed. The stars of the show are still the same, of course: Byrne is still there, and the shelves and shelves with jars and jars containing all manner of anatomical features – the double-skull of the two-headed boy of Bengal is here too, the nasty-looking instruments, the proudly preserved bladder-stones and all.
But now for the first time since Hunter’s Leicester Square house, both of the collection’s original roles are being fulfilled. “It used to be a rather alienating experience,” says Chaplin. “All you could do was wonder at the strangeness of it all.” Now the curators want to explain, while keeping that special element of spectacle and wonder. “If we end up with only a medical audience, or with medical visitors forming too high a proportion of our visitors, then we won’t have succeeded.” For the medically trained, it will retain that educational purpose which was so important to Hunter; but for the rest of us, yes, it’s also a cabinet of curiosities. Go and goggle at all these strange, strange things, look with awe, as unscientifically as you like. There’s no need to be embarrassed – John Hunter would certainly have understood.
From John Hunter’s casebookHunter kept a careful record of his surgical operations. This extract from his notebook details an unfortunate patient’s neck tumour:
John Burley, a Rigger, thirty-seven years of age, of a middle size, dark complexion, and healthy constitution; about sixteen years ago, fell down, & bruised his cheek on the left side, above the parotid gland. It was attended with a good deal of pain, which in four or five weeks went off, and the part began to swell gradually, and continued increasing for four or five years, attended but with little pain.
At this time it was increased to the size of a common head, attended with no other inconvenience than its size and weight. He again fell, and received a wound on its side, which gave considerable pain at first, but it got well in eight or nine weeks (This part is marked in the Drawing.) After this, the tumour increased without pain, on the lower part; as also at the basis, extending itself under the Chin to the amazing size it now appears. Lately, he had perceived that its increase is much greater than what it was some time ago: he says he can perceive it bigger every month.
The tumour is in parts the colour of the Skin, in other parts of a shining purple, where the Skin of the cheek is elongated. The beard grows upon it, and is shaved in common. When by accident it is wounded, it heals kindly, because it is only the Skin that is wounded; and has sensation in common with the Skin. It is hard to the feel some places, and in others softer, as if containing a fluid. It seems quite loose, and unconnected with the Skull or lower jaw; and may be moved easily without giving Pain.
The Operation was performed on Monday October the 24th, 1785. It lasted twenty-five minutes, and the man did not cry out during the whole of the operation.
The Tumour weighed 144 ounces.
Daniel Hahn is the author of the Tower Menagerie: The Amazing True Story of the Royal Collection of Wild Beasts (Simon and Schuster, 2003)
This article was first published in the February 2005 issue of BBC History Magazine