The Knife Man

Author: Wendy Moore

Background

This rousing history of ‘the birth of modern surgery‘ is viewed through the life of John Hunter, the phenomenal surgeon who provided the field with its earliest scientific foundations. On one hand, the book is a celebration of Hunter’s proficient ‘surgical expertise’ and ‘unrivalled knowledge of human anatomy’ which were acquired by a ‘relentless first-hand exploration of the human body’. On the other hand, the book explores his incredibly complex personality as a man with a ‘fiery temper‘ who was ‘as much feared and despised as admired in eighteenth-century London’, as well as a person whose ‘maverick views‘ made him ‘so far ahead of his contemporaries that he stood alone’. The book’s content is also characterised by the contrast it highlights between the scientific methods Hunter employed to establish his surgical breakthroughs, with the underhand tactics he exploited to acquire his anatomical specimens and his natural history collection. At its heart however, the book is a masterful depiction of how Hunter’s ‘revolutionary impact‘ transformed surgery into a specialty ‘based largely on the doctrine of observation, experimentation, and application of scientific evidence‘ (pages 3-4, 43, 157 and 275).

Synopsis

In setting Hunter’s accomplishments in context, the author painted a vivd picture of the deplorable state of medicine at the time he commenced his anatomical and surgical studies. This was a time, the author noted, when medical practice was ‘muddled, ignorant, and incompetent‘, and dominated by such ‘ineffectual‘ treatments as toxic elixirs, bloodletting, electric shocks, and hypnotism, and when surgery was confined to such limited interventions as amputations, trepanning, couching, ‘lancing boils, dressing sores,…and tending to minor injuries’. Driven by a ‘fascination with innovation and experiment‘, and committed to ‘founding surgical practice on sound scientific principles‘, the book detailed how Hunter brought the results of his meticulous anatomical studies to bear on his surgical practice. This is illustrated most cogently by his innovative approach to the treatment of femoral aneurysms which was based on experiments in which he ligated the artery at different levels to see which best maintained blood supply to the leg. The author pointed out that this technique, known as Hunter’s operation, ‘rapidly became the standard procedure for aneurysms in various arteries’ (pages 22-23, 50, 66-68 and 10-11).

In her evaluation of the factors that informed Hunter’s approach to surgical innovation, the author highlighted his conviction that ‘all surgery should be governed by scientific principles‘ as perhaps the most important. Symbolic of this scientific philosophy, that all surgical methods should be assessed by ‘rigorous observation, investigation, and experiment‘, is his approach to the treatment of urethral structures; dissatisfied with the conventional use of bougies, Hunter had carried our serial experiments until he settled on the more satisfactory escharotic technique of applying silver nitrate on a cannula. The author argued that this strategy of ‘trying a traditional method, analysing the outcome, forming a hypothesis aimed at improvement, and implementing the results’ was the bedrock of his ‘scientific revolution of surgery’. Another precept that guided Hunter’s practice was his cautious approach to surgery, the author remarking that he only operated when ‘absolutely necessary‘, and he ‘never approached an operation lightly’. This caution is perhaps best illustrated during his service in the army when he favoured a conservative approach to gunshot wounds over the painful incision that was in vogue at the time (pages 5-9, 62, 91-93 and 46-52).

Fundamental to Hunter’s success are the detailed anatomical dissections he carried out relentlessly, an undertaking that the author noted was ‘driven by tireless curiosity and a compulsion to improve the surgery he had witnessed in hospitals’. The book traced his induction to dissection at the London anatomy school established by his older brother and surgeon William – an initiation which the author said ‘would alter the course of medicine forever’. In illustrating his inspired dissecting techniques, the book described how he painstakingly prepared tissues and made life-like specimens – one of the most famous being the ‘spectacular‘ model of a full-term pregnancy. The scope of structures he dissected was also phenomenal, the author noting examples ranging from embryological specimens and cranial nerves, to the lymphatic system. Allied to his dissection work were the lectures he gave ‘free of charge’ through which he sought to ‘elevate surgery to the rank of a science’, and by which he succeeded in nurturing ‘questioning, inquisitive, skeptical young surgeons who were capable of thinking for themselves’ (pages 23, 53-60, 76-81 and 170-176).

A startling dimension to Hunter’s biography is his active involvement in the ‘underhand‘ practice of body snatching, a venture that provided him with an almost unlimited supply of anatomical study material. Whilst this was a regular practice at the time, the author emphasised that Hunter, ‘compelled by his own zeal to extend knowledge of human physiology’, went ‘further than any other anatomist of the day on his connection with the Georgian underworld‘ to obtain an inexhaustible supply of bodies to study. The book documented the unscrupulous methods Hunter adopted to accomplish his nefarious objective, from procuring bodies at the gallows to grave robbing –  his ‘stock in trade‘. The author asserted that Hunter’s obsessive un-tombing activities would transform grave-robbing ‘into an industry‘, and spawn ‘warring gangs of professional grave robbers who stalked the city’s churchyards night after night’. It is most revealing that Hunter would personally engage in the disreputable activity because, ‘with his ungainly ways, plain dress, and the vulgar paths he seemed unable or unwilling to suppress’, he ‘would have no trouble mixing in the seedy taverns of the London underworld‘ (pages 5 and 33-42).

Perhaps as remarkable as John Hunter’s anatomical and surgical works, is his extensive natural history collection – a product of his ‘single-minded mission to understand all natural life’, and to discern the rules that regulate them. Hunter started his collection whilst serving as surgeon to the army when he acquired animal specimens ranging from leeches to whales, the author remarking that ‘no animal was too large or too small, too simple or too complex, for Hunter’s knife‘. Just as he deployed devious methods to obtain anatomical specimens, so did Hunter utilise subterfuge to populate his collection, the book illustrating this with how he obtained the body of the Irish giant Charles Byrne. The uniqueness of Hunter’s collection is reflected both in the author’s assertion that ‘no other collection of its kind existed’, as well as in her observation that his ‘collecting passion’ became an ‘incessant drain on his resources‘. As a further testimony to the abiding value of the collection, the book pointed to its enduring legacy as the acclaimed Hunterian museum at the Royal College of Surgeons in London (pages 99, 104-109, 133-136, 151-155, 237-243 and 199-215).

Opinion

This book addresses an important but poorly appreciated epoch in the history of medicine. With a thrilling narrative, it succeeded in bringing to life the exceptional works of a phenomenal surgeon who stamped a scientific seal on a previously haphazard field. The imaginative and graphic descriptions, and the elevated prose, captured the essence of the period and the mood and spirit of the time. With the right mixture of heady praise and unflattering criticism, the book’s depiction of John Hunter and his achievements was ungarnished and unembellished. Apart from occasional diversions in the narrative, the themes of the book all highlight important aspects of the story, and stress the significance of Hunter’s breakthroughs and contributions to surgery.

Overall assessment

This book is thoroughly researched and well-written, and the narration is unimpeachable. Much more than just an inspiring biography of a single-minded and dedicated innovator, it is also a lesson in the sceptical approach to received wisdom that helps to overturn conventional but misguided dogmas and advance medical practice. The book is a potent reminder of how medicine’s past is pregnant with instructions for today’s practitioners, and I recommend it to all doctors.

Book details

Publisher, Place, Year: Broadway Books, New York, 2005
Number of chapters: 16
Number of pages: 341
ISBN: 978-0-7679-1653-0
Star rating: 5
Price: £4.99