The Knife Man: the extraordinary life and times of John Hunter, father of modern surgery
Wendy Moore Bantam Press, 482pp, £18.99
ISBN 0593052099
Doctors tend to scorn hospital dramas on television, thinking that it is hard to suspend disbelief as violin prodigies with brain tumours, pregnant fashion models and epileptic airline pilots are rushed to surgery amid much flourishing of the defibrillator paddles. The opening chapters of The Knife Man, Wendy Moore's biography of the pioneering surgeon John Hunter, seem to offer the same theatrical overload. As we move through an 18th-century London that festers with grave-robbers, gangrene, scrofula, open sewers, syphilis and stolen corpses, we meet the blunt-mannered, tawny-haired Hunter "laying out his scheme for a daring and novel operation".
To abandon the book at this stage, however, would be to miss out on the extraordinary breadth of its research and its superb evocation of Hunter's genius. The writing finds its pace when Hunter goes off to be a surgeon with the British army during the Seven Years War. Moore restrains her imagination and allows Hunter to speak in his own robust voice. His description of treating the wounded during the capture of Belle-Ile off the Brittany coast and while campaigning against the Spanish in Portugal will ring true for anyone who has experience of doctoring in a war zone. Moore's own descriptions of pathology and surgical procedures are lucid and accurate, and the significance of Hunter's contributions to science is artfully set in context. This is no simple task when explaining the achievements of a man whose research transformed understanding of anatomy, dentistry, embryology, transplantation, arterial and general surgery, veterinary science, military medicine, pathology and theories of disease.
Equally well-drawn is the intellectual ferment of the 18th-century Enlight-enment in which Hunter played such a central role. His circle of scientists, writers, philosophers and artists included Tobias Smollett, James Boswell, Horace Walpole, Joseph Banks, Samuel Johnson, Adam Smith and Edward Gibbon. Hunter examined the infant Byron, and counted among his friends and patients Benjamin Franklin, the Scottish philosopher David Hume, Thomas Gainsborough and Joshua Reynolds (these last two being artists, he treated them without asking for payment, as he did medical colleagues and the poor). He offered to operate on Joseph Haydn - who fought him off and probably regretted it as his condition worsened - and attracted criticism from William Blake, who satirised him as the anatomist "Jack Tearguts". The names of many of his pupils - John Pringle, Astley Cooper, Edward Jenner, Matthew Baillie - still resonate among physicians and surgeons today.
Hunter's uniqueness lay in looking beyond the specifics of individual cases to seek out the wider principles underlying both normal and abnormal physiology. To him, this was the true practice of surgery. Operating, which he advised only as a last resort, was "a tacit acknowledgement of the insufficiency of surgery". He extended scientific observation and deduction to everything he saw. From his study of comparative anatomy and congenital deformities in different species, Hunter proposed the extraordinary idea that every part of every life form possesses an innate capacity for malformation. "Neither does this appear to be a matter of mere chance," he explained, "for it may be observed that every species has a disposition to deviate from nature in a manner peculiar to itself . . . It certainly may be laid down as one of the principles or laws of nature to deviate under certain circumstances." His identification of this principle led Darwin, some 70 years later, to his revolutionary theory of evolution.
In his house in Leicester Square, London, Hunter set out his collection of more than 13,000 anatomical, pathological, botanical and zoological specimens. The museum was nothing less than an attempt to explore the interconnectedness of all organic life. He challenged the fundamental tenets of creationism - "Does not the natural graduation of animals, from one to another, lead to the original species?" - and wrote papers on the age of the earth that were considered too heretical for publication in his lifetime, even by fellow scientists of the Royal Society.
Human life expectancy, roughly 37 years in Hunter's day, had improved little in the previous two millennia, during which time medical practice had also remained largely unchanged. Discarding tradition - "There is nothing so vague as bleeding and giving physic" - Hunter insisted that treatments be proved effective by scientific experiment. He had a sharp eye for charlatans, and would have been amused by the tosh that is peddled today by so many "alternative therapists".
More than half of Hunter's encyclopaedic collection was destroyed when the Royal College of Surgeons in London was bombed in 1941. After an extensive redesign, the Hunterian Museum is reopening this month. Every year, the college bestows a small number of Hunterian professorships upon individuals considered to have advanced scientific knowledge in a surgical field. Hunter's rigorous practice of medicine contributed a huge amount to our knowledge of disease and its treatment. As this excellent book makes clear, we are all in his debt.
Jonathan Kaplan is the author of The Dressing Station (Picador), an account of his surgical work in war zones. His next book, Contact Wounds, is due out at the end of this year
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