The Hunterian oration on Hunter's ideal and Lister's practice : delivered before the Royal College of Surgeons of England on February 14th, 1927 / by Sir Berkeley Moynihan.

Berkeley Moynihan

Date:: 1927]

Credit: The Hunterian oration on Hunter's ideal and Lister's practice : delivered before the Royal College of Surgeons of England on February 14th, 1927 / by Sir Berkeley Moynihan. Source: Wellcome Collection.

5/8 page 317

$same distinguished surgeon, a pupil of the Leeds school, operating upon a jaundiced girl of 18 for “ fibroid tumour of the Uterus,” discovered that the tumour was not pelvic but splenic. He removed the spleen : in a few days the lifelong jaundice was gone, and the surgical treatment of haemolytic jaundice was begun. So McGill, the pioneer in the operation of prostatectomy—precedence in which is so foolishly claimed for others—removed what he believed to be a “ tumour at the base of the bladder.” When I, acting as his house-surgeon, examined the tumour microscopically and found that it was prostatic,' I felt that I had the chance to twit my beloved chief with his error. His reply when I told him of his mistaken diagnosis was, “ Then why don’t we always take the prostate out when it projects into the bladder? ” Lister’s Discipline and Methods. When we compare Lister’s preparation for professional leadership with that of John Hunter we are impressed rather by the resemblance than by contrast. Lister, the greatest material benefactor of mankind that the world has ever known, began his medical studies at University College, London, at the age of 21, in 1848, exactly a century after John Hunter had settled down to his work in Covent Garden. In the hundred years that had passed medical education in London had undergone a revolution; voluntary schools had almost disappeared, to be replaced b}r the organized schools and colleges with which we are familiar to-day. John Hunter was Scotch, Lister English, his ancestry coming from Yorkshire and Cumberland. John Hunter owed much to his brother, Lister still more to his father, who wras not only a successful man of business, but also a Fellow' of the Royal Society. William Hunter, who impregnated the mind of bis brother, drew his own inspira¬ tion and owed his intellectual guidance to the Monro- Cullen school of Edinburgh. Lister was early influenced by William Sharpey and by Wharton Jones, both Edinburgh men steeped in the traditions of this very school. After qualifying in 1851, and taking the Fellowship of this College at the age of 25, Lister’s first research was begun: it U'as concerned with the contractile tissue of the iris.21 The injection syringe, the new instrument v'hich had served Hunter so well, had been displaced during Lister’s youth by the microscope. We rejoice, nevertheless, to notice that when Lister applied this new instrument to the tissue of the iris', it was the function rather than the form of this structure which excited his interest. In this investigation, and in another22 begun in 1852, “ Observations on the muscular tissue of the skin,” we recognize that, influenced by William Sharpey, he had become familiar with dis¬ coveries made in other countries, notably with those of Kolliker in Germany. But clinical work was not forgotten, and a liouse-surgeoncy at University College was followTed by perhaps the most critical event of Lister’s life. In tracing the motives which have directed the progress of medicine we are constantly reminded of the influence and the power of great teachers. Such men are gratefully remembered by posterity—not so much for the work which their own hands or minds have created or have modified; not for their written words which so soon seem to possess little more than an antiquarian interest; not for their spoken words, which, though at the moment of their delivery they may walk up and down in the hearts of men and stir them to new thought or to great action, yet seem so frail and cold and lifeless when the morning comes—not for any of these, but for the spiritual legacy they bequeath to those trained in their own methods and inspired by their own zeal. It is this which gives posthumous life—the true immortality. Not the least of the claims that John Hunter makes upon our reverence is that he was the first founder of a School of Surgery. He was not distinguished as teacher. “ He had not the happy talent of displaying the stores of his mind, nor of communicating to others the same perception of the importance of his facts and opinions as he himself entertained.”23 Abernethy said his language was “ in¬ elegant and often coarse ”,; “ his delivery heavy and unengaging”; “liis method confused with attempts to find words for thoughts, or else to read from little scraps of paper.” Yet despite these unattractive or even repellent qualities, men who themselves influenced surgery for genera¬ tions afterwards, whose influence still survives—Abernethy, Astley Cooper, Cline, Everard Home, Blizard—all boasted of being his pupils, and taught his method until it became, and still remains, a tradition in their schools, and from them has spreadtto every school of medicine in the world, where Hunter is recognized, unchallenged, as the founder of scientific surgery. So, too, our debt to Italy will be forever unrequited while we remember that it was the magnetism of Fabricius that drew Harvey to Padua. But for Fabricius and the magic of his work the discovery of Harvey, the great glory of British medicine, might not have been made for generations. William Sharpey, whose lectures “ inspired me with a love of physiology that has never left me,” had not only Lister’s future, but also all that this meant for mankind, in his own hands when he sent Lister to Edinburgh to the “ safest surgeon” of his day, James Syme. It was an almost incredible exodus. When the Hunters came south¬ wards they followed a national habit established fop centuries, and never permitted to fall into disuse—a habit which incited the characteristic irony of Samuel Johnson. When Lister went northward he founded a new tradition and made a novel breach in a custom which seemed to have become as firmly accepted as a law of nature. Lister’s most distinguished successor in his chair of clinical surgery, my old friend Harold Stiles, made the same adventure, to Scotland’s great advantage. London hardly notes and seems but I’ttle disturbed by the arrival and the progress in her midst of young medical men from Scotland. (Whatever would she do without them?) Edinburgh, one may suspect, raised her eyebrows when she saw a young doctor from London established as Syme’s house-surgeon'; and she must have rubbed her incredulous eyes when, within two years, she saw him become an extramural lecturer in surgery within her own stronghold. It is quite impossible to exaggerate the im¬ portance of this teaching appointment on Lister’s future. He met his students—the ultimate number in his first class was seven—on Wednesday, November 7th, 1855. Lister believed, as Hunter bad believed, that the beginning of surgery was a knowledge of the process of inflammation; and accordingly lie had resolved, before his lectures com¬ menced, to obtain a new first-hand acquaintance with inflammatory processes as watched in living tissues. Clearly he realized long before the humblest of his intel¬ lectual descendants the need to study the “ pathology of the living.” A frog was caught in Duddington Loch—» surely the greatest frog in history, honoured by being made the subject of this research. Why did not someone suggest to Lister when he was granted arms that tkis frog should be immortalized in heraldic device? The web of this frog’s foot gave all the necessary opportunities for the inquiry. Lister had many new advantages over Hunter: he kne\y that the tissue he examined was made up of living units—- cells; he had at his disposal a powerful microscope, which could mark the behaviour of these cells; and Claude Bernard in 1853 had taught him the existence of vaso¬ motor nerves. It was during the examination of the frog’s web that Lister made a biological discovery of the highest) importance—one which experimental biologists are still exploiting: that pigment-containing cells such as are seen in the frog’s web give more easily visible, and more delicate* reactions than any other kind of living cell, when subjected to a physiological or a pathological stimulus. This quality enabled him to study the effects of inflammation in terms of individual cells. He was able to prove that these pigment cells still gave vital responses fifteen days after the leg had been amputated. The list of researches carried out by Lister between the time of his arrival in Edinburgh in 1853 and his appoint¬ ment to the chair of surgery in Glasgow in 1860 would almost suggest that he was seeking to fit himself to become an experimental physiologist or pathologist rather than surgeon. I would earnestly emphasize this point, for its significance in Lister’s day was far less than it is to-day, when the full harvest of his work is ready to be gathered. In most of these researches we can clearly see the strong$