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THE HUNTERIAN ORATION.
THIS biennial discourse in memory of John Hunter wasdelivered on Monday last in the theatre of the Royal Collegeof Surgeons, by Mr. Luther Holden, late President of theCollege. The large theatre was crowded with members andvisitors. The President, Mr. J. E. Erichsen, F.R.S., was inthe chair, supported by the Vice-Presidents, Messrs. ErasmusWilson and Spencer Wells, and most of the members of theCouncil.Mr. Holden commenced his oration with the well-known
words, " Let us now praise famous men and our fathers thatbegat us." He could find, he said, no better words thanthese wherewith to invite his audience to welcome thetheme which had brought them together that day to dohonour to the father of English surgeons, whose fame wasso high that we but honoured ourselves in bearing witnessbefore the world how much we honour him as loyal disciplesin self-devotion and the pursuit of truth. Some natures, itwas true, were disheartened by the contemplation of thegreat achievements of genius which mapped out the historyof our race, and here and there an indolent man might befound who has buried his own talent because it was not ten.Though this temper of mind was happily rare in the pro-fession of which his hearers were members, which dailybrought them face to face with the painful aspects andemergencies of real life, it was nevertheless very desirablethat they should always keep before them such brilliant ex-amples of successful genius. To the striving and earnestman they were full of encouragement; not only did theyurge him on the path of common duty, but they raised him,as it were, to an eminence from which he might overlookthe past, and by seeing the results of the aspirations of hispredecessors, assure himself of the reasonableness of hisown. As English sailors were proud of Nelson, Englishsoldiers of Wellington, English poets of Shakespeare,English physicians of Harvey, so were English surgeonsproud of Hunter.The orator proceeded :-" I shall claim from you some
recognition of my especial attachment to my theme if I cancontribute a new item of information towards that part ofHunter’s history which is the most obscure. We are told byJohn Hunter’s biographers, most of whom seem to havecopied from each other an unpardonable inaccuracy, thatJohn Hunter, the father, died when his son John was butten years old, and that before and after that time, up to thedate of his coming to London, he led a completely idle life,only broken into by a short and unsuccessful apprenticeshipto a cabinet-maker in Glasgow, who had married his sister,and to whom he was sent for the purpose of helping him outof some embarrassment in his trade. His father was, weknow, within two years of fourscore when he died ; and thepartiality which he must naturally have felt in his decliningyears for the high-spirited son of his old age is representedas the cause of his having dealt too leniently with him,to the neglect of his real interests. The outlines of thepicture are easily sketched : up to ten years the darlingof a decrepit father, after ten the pet of a widowed mother,spoilt, humoured, encouraged in idleness, unchecked, un-trained, uneducated; such, I say, are the outlines, leaving ablank to be filled iu according to the fancy of the biographers,who have rather dwelt upon this extraordinary contrast be-tween the boy and the man-a contrast so complete andunintelligible that, if ’the boy is father of the man,’ it re-quires a miracle to interpret it ; and in the miracle lies someof the charm of their story. Thus one orator writes, ’Heseems to have led the idle life of a wayward, petted boyuntil twenty years of age.’ Another depicts him as havingup to twenty years of age, passed a life of idleness, dissipa-tion, and amusement, with no definite object, no settled em-ployment-his highest occupation that of a cabinet-maker,and his education entirely neglected, threatening to destroy allstability of character and all capacity for sustained exertion.’And the same account is the textus receptus on the Con-tinent. Thus Fischer, in his Cbirnrgie vor 100 Jahren,’aay, ’ Hunter was destined by his father to be a ship’s car-penter, and in his twentieth year, when he came to hisbrother in London, he could gcarcely read and write.’Again, one of the latest and the most eloquent of the Hun-terJan orators has thus expressed the same story :-‘ it the
first twenty years of his life he appears to have had noinclination to science or to the arts that minister to it,or indeed to any intellectual pursuit. Had he sue.
i ceeded in helping his brother-in-law, who was a bank-i rupt cabinet-maker, cabinet-making might have been
the business of his life. Happily he failed; and thenafter two years more idleness, what was to be done?’Well, we all know what John Hunter did. He came toLondon to work under his brother William at anatomy;and the true history of the man, as he was known to hiscontemporaries, begins with the famous story of the dissec.tion of the muscles of the arm, wherein he so satisfiedDr. William, at the very first outset, with his skill and pro.ficiency, that he received at once the promise of his un.limited patronage, and in the very next year was engagedby him to prepare anatomical subjects for the public lec.tures, and to give instruction to the pupils. It is notnecessary to point out to you, gentlemen, the sig-nificance of this fact, nor to remind you that it wasnot only the professional reputation of William Hunter,but even the advancement of anatomy in England, thatwas made over to John Hunter without hesitation....,."Continued searches proved that John had received the sameschooling as his brother, Dr. William Hunter, and that hehad matriculated at the University of Glasgow in Nov.1745. Mr. Holden was inclined to distinguish John Hunterthe human anatomist, from the comparative anatomist, andto say that we had in him an admirable example of themethod of the two studies, and of the manner in which theyshould both be pursued for the advancement of medicalscience. The term " comparative anatomy, strictly taken,included human anatomy, and if human anatomy had be-come a science on its own account it was due to the factthat when the anatomist investigated his own body the im.portance of the subject and the interest of his inquiriesmade this study paramount ; and were it not for the unques.tioned pre-eminence of man and the habit which henaturally had of considering himself the centre of the uni-verse, this might scientifically be called an accident. Afterpaying a tribute to the genius of Aristotle, the orator pro-ceeded to speak of the anatomy of Galen and his school, andof all anatomists who preceded the Renaissance, as wellas of many who lived to see the sciences reviving andrevived. Comparative anatomy, he pointed out, actuallystood in the way of human anatomy so as to obstructit. Human bodies were so di cult to procure for dis-section, and the study of them consequently was so rare,that the necessary observations were, as Aristotle said, sup-plemented from the dissection and investigation of the cor.responding organs of the lower animals. As illustrating therelations of human and comparative anatomy, Mr. Holdenstated that the physicians in attendance on the Margrave ofBaden-Durlach, disputed among themselves as to the positionof the heart in the thorax of the Prince, one of them con-
tending, with Galen, that it lay in the middle, the rest beingbold enough to affirm that it was on his left side. As thisunfortunate doubt assumed the aspect of a serious practicaldifficulty when it came to determining the precise spot onwhich should be applied the plaster which was destined torelieve the sufferings of the Margrave, it was decided toappeal to nature. A pig was therefore brought into theroyal chamber and opened in the presence of the sick man.The position of the heart was demonstrated to him ; it in a
pig, therefore in a prince. His highness gave way beforethis argument, and the plaster was placed accordingly; whilethe physician, who still had the temerity to defend himselfby drawing anatomical distinction between man and pig,was dismissed from the court. In remarking on theteaching of the present day, as painfully illustrated bythe large number of rejections of candidates byexamining boards, Mr. Holden was unwilling to impute thisentirely to the severity of the examiners or to the rtmissnes,of the students. After a feeling allusion to the cie,lt]lR oi
certain members of the profession since the last omtwfl watdelivered, especially those of Mr. Henry Huncock, n tornrorator and president of the College, and of Mr. G. Y<’. Cal-lender, the orator concluded by dwelling on the advantage o:a classical training for medical students, stating tLijt as anold teacher he found those pupils who had i, a pMdpublic school training could be taurnt more in two 1)Jf.ntJ’"than others in six. He urged that the youths v.’LvLi’ett t,be the future representatives of English mr;try should i’ibe looked upon as "symbols" of an inferior e<hictK)D.
In the evening the President and Council cntciiaincd r.
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large and distinguished party at dinner in the library of theCollege. Among those present were the Lord Chancellor,Earl Granville, Sir R. Cross, the Bishop of London, theDean of Westminster, and Mr. James Russell Lowell, theAmerican Minister.
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Correspondence.
THE CHLOROTIC MURMUR.To the Editor of THE LANCET.
"Audi alteram partem."
SiR,-I regret that I erroneously associated Naunyn’s nameith the chlorotic murmur. That the error is to some extent
excusable is, I think, proved by the fact that such writersas Dr. Bristowell and Dr. Fothergill2 make the same mistake.
I unfortunately was not acquainted with the article inTHE LANCET to which Dr. George Balfour refers me, or Icertainly should not have mistaken his views as I havedone. My statement of his views was based on the im-pression which I derived from the perusal of Chapter VI.of his "Diseases of the Heart." Taking that article asrepresentative of Dr. Balfour’s views, most readers would, Ithink, conclude, as I did, that he denied the arterial cha-racter of the basic murmurs in anxmia. His whole argu-ment, as I read it, and the following passages in particular,tend towards that end.
" But if we can show, as I hope to do, that the cardiacportion of these murmur is not simply hsemic or purelyfunctional in character, but is the product of an actualcardiac lesion, then we link blood disease with cardiac lesionin a very striking manner, and obtain the important patho-logical information that some cardiac lesions are certainlyand permanently curable" (page 158). "But the venousmurmurs which accompany chlorosis are for many reasonsof very much less interest and importance than those heardin the cardiac area. As already mentioned these are systolicin character, and are most frequently heard in the pulmonaryarea, less frequently so in the aortic area, and most rarely inthe mitral area" (page 159). "This so-called arterialmurmur is, therefore, not arterial at all, but strictlyauricular in its source " (page 160)...... " In all febrilediseases, whatever their character, the sequence of the phe-nomena, as observed by myself, has been precisely similarto that observed in chlorosis. That is: first, we have hadthe venous hum ; second, the auricular murmur, propagatedinto the pulmonary and aortic areas, either as an impure orprolonged first sound, or as a distinct systolic murmur ; and,lastly and more rarely, a systolic murmur in the mitralarea" " (page 168)...... " T7ae arterial nmrrnurs aretherefore not of independent origin, [the italics are my own],but are propagated from the mitral valve, which permitsslight regurgitation between its segments, which are unableto close perfectly because the ventricular lumen is somewhatdilated " (page 169).The exact mode of causation of the reduplicated second
sound in cases of mitral stenosis is confessedly somewhatobscure. The very emphatic way in which Dr. GeorgeBalfour-for whose opinion on this and all subjects relatingto the circulation I have great respect-expresses himselfagainst the theory which I have adopted, makes me thinkthat it is perhaps wrong. Still it is a view which is notwithout its weighty supporters. Thus Rosenstein, whowrites the article on Mitral Stenosis in Ziemssen’s " Cyclo-
paedia," not only concludes that the aortic valves closebefore those of the pulmonary artery, but brings actualclinical proof of the fact, when he states, that the secondportion of the reduplicated sound may be heard much moreaccentuated over the pulmonary artery than over the aorta.He says, "Geigel called attention to its frequency-(i.e.,frequency of reduplicated second sound)-of occurrence instenosis, and explains it by the unequal tension in the aortaand pulmonalis, which may prevent synchronous closure ofthe valves of the two vessels, since the aorta with its smallercontents contracts quicker, and thus closes its semilunar
1 The Theory and Practice of Medicine, p. 474.2 The Heart and its Diseases, p. 51.3 Ziemssen’s Cyclopaedia of the Practice of Medicine, p. 129.
valves an instant before those of the pulmonary artery. Thefact that the second part of the reduplicated sound may beheard much more accentuated over the ostium of the pulmo-nalis lends a great probability to the view that it is producedby the valves of this artery."
Sibson, too, in his elaborate article on Endocarditis inRussell Reynolds’ "System of Medicine," in speaking ofdoubling of the second sound in connexion with mitral mur-murs, says : " On the second day there was doubling of thesecond sound over that (i.e., the pulmonary) artery. Thesecond sound was louder than the first, and this proved thatthe later sound was the pulmonic, the earlier the aortic,sound. In this instance the doubling of the second sound,which lasted to the 60th day, disappearing on the 69th,was due, I co)tside),, to the longer time occupied by theright ventricle than the left in emptying itself, owing to theresistance to the flow of blood through the lungs." 4 4 (Theitalics are my own.)Hayden, in his work on " Diseases of the Heart
and Aorta," states: " Where the second sound is redupli-cated in connexion with mitral stenosis, the element de-ranged is most likely that produced in the pulmonary artery,the entire pulmonary system and the right chambers beingengorged by obstruction at the mitral 0 rlfic e. In e effortto 01ereowte this obstruction the systole of the right ventricleis protracted and the reaction of the pulmonary artery pro-portionately postponed. (The italics are my own.) There-action of the aorta is, on the other hand, in mitral stenosis,most probably anticipated where the left ventricle is reducedin capacity, as always is the case where mitral or aorticreflux does not co-exist. Hence it is likely that in simplemitral stenosis two causes of doubling of the second soundare in operation-namely, diminished capacity of the leftand dilatation of the right ventricle." 5To some of the general statements I have in my lecture
made, exceptions, of course, occur. Thus, for example, thetone of the same murmur may occasionally differ at twodifferent parts of the chest wall; the inorganic murmurs ofanæmia are sometimes associated with important dis-turbances in the heart and circulation, &c.In speaking of the altered character of the first sound
in mitral stenosis I say that it is due to the small amount ofblood which gets into the left ventricle, and omit to mentionas a cause the altered condition of the mitral cusps.Students who have attended my lectures, and who knowthat I am in the habit of teaching that the chief cause ofthe first sound is the tension of the auricular ventricularvalves, will readily understand that this is an unintentionalomission. Others might from the statement think that Iam one of those who advocate the purely muscular, as
opposed to the valvular, character of the first sound.With these explanations I must leave the lecture to receive
from the profession such measure of approval or disap-proval as it may deserve.
I remain, Sir, yours very truly,Edinburgh, Feb. 7th, 1881 BYROM BRAMWELL.
ANIMAL LIGATURES.To the Editor of THE LANCET.
SIR,-The interest so generally felt in this subject will,I trust, justify reference to two eminent authorities, one ofwhich is probably not generally accessible to your readers.Professor S. D. Gross,’- in his chapter on Diseases andInjuries of the Arteries, records that "animal ligatureswere first introduced to the notice of the profession byDr. Physick early in the present century, and they have eversince been occasionally employed by different practitioners,chiefly American." Luigi Porta teaches : "Amongst thesubstances applicable to the ligature of arteries, gut-cord iswithout doubt the strongest and the most homogeneous." 2He gives the results of eighty experiments to bear out thisstatement, and expresses himself confidently on the absorp-tion of the animal ligature.
I am, Sir, your obedient servant,Birmingham, Feb. 12th, 1881. SAMPSON GAMGEE.
4 Russell Reynolds’ System of Medicine, p. 488.5 The Diseases of the Heart and Aorta, p. 129.1 System of Surgery. Fifth Edition (1872), vol. i., p. 670.2 Delle Alterazioni Patologiche delle Arterie per la Legatnra e la
Torsione, esperienze ed osservazioni di Luigi Porta, Milano 1845, p. 21et seq.
