|Year : 2021 | Volume
| Issue : 6 | Page : 157-158
John Hunter - Father of scientific surgery
Division of Vascular Surgery, Department of CTVS, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
|Date of Submission||24-Dec-2021|
|Date of Acceptance||24-Dec-2021|
|Date of Web Publication||20-Jan-2022|
Division of Vascular Surgery, Department of CTVS, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pitchai S. John Hunter - Father of scientific surgery. Indian J Vasc Endovasc Surg 2021;8, Suppl S2:157-8
John Hunter was born in 1728 at Scotland and he was the younger sibling of William Hunter, both of whom contributed enormously to the understanding of pathogenesis of arterial disease by various meticulous anatomical dissections, as well as scientific experiments in the 18th century. His name is famously associated with Adductor's canal also called as Hunter's canal, but his contribution to field of medicine is more than just ligating the superficial femoral artery (SFA) with in the adductor's canal. Today, John Hunter [Figure 1] is remembered as founder of “Scientific Surgery” because, in an era of bloodletting as a major modality of treatment, Hunter strived for answers by means of various extensive scientific experiments, thereby transforming surgery from manual craft to an experimental science.
|Figure 1: Portrait of John Hunter painted by John Jackson in 1813, after an original by Sir Joshua Reynolds, who exhibited his painting at the Royal Academy in 1786|
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Before going into further details, let us get familiar with the time period when John Hunter was performing these procedures. It was in the late 18th century AD, a period when there was still no proper antiseptic principles or proper anesthesia available for performing surgery. Popliteal aneurysms were mainly managed by amputation which was by itself carrying high mortality rate. Ligating the popliteal artery above and below the aneurysm followed by evacuation of its contents has been described and was practiced by few surgeons during that time albeit with less success. The ligature used was often en masse which included the surrounding structures and also the ligatures often hang outside the wound leading in the infection and secondary hemorrhage. Bradford Wilmer once remarked that “with regard to aneurysm of the popliteal artery, there is not, that I know, a single case upon record where that operation succeeded.”,
In this time period, the collateral concept of the circulation was developing wherein few surgeons were treating the aneurysm by simple ligation of the vessel above the aneurysm so that that aneurysm will not rupture and the distal perfusion will be taken care by collateral circulation. John Hunter's understanding of the collateral circulation comes from various scientific experiments. He apparently ligated the external carotid artery of a deer after which the pulsations ceased in the capillary network of one antler, but the circulation was restored within in a week owing to collateral perfusion. This story is controversial because this particular event was verbally transferred rather than transcribed.
John Hunter performed this famous surgery for Popliteal Aneurysm on December 12, 1785, on a 45-year-old coach man who presented with a large pulsatile swelling in the popliteal fossa. He exposed the artery through the incision on the anterior and inner part of the mid-thigh away from the aneurysm – now famously called as Hunter's Canal. He ligated the SFA with four ligatures since he wished to avoid the pressure on the vessel at any one point alone. He did not evacuate the aneurysm and also kept the wound open to heal by secondary intention. The patient improved well and was symptom-free. He died 15 months later due to fever. Hunter did autopsy of the patient and confirmed that there was no suppuration at the ligature site and his death was unrelated to the surgery. The specimen of this popliteal artery aneurysm is still preserved in the Hunterian Museum, London [Figure 2]a. In his life time, he treated four more patients with popliteal artery aneurysm in a similar way with three patients cured and one failure. The fourth patient died 50 years later (outlived the surgeon), and when autopsy was done, the entire SFA and popliteal artery were converted in a solid cord and this specimen is also still preserved in the Hunterian Museum [Figure 2]b.
|Figure 2: (a) Specimen of John Hunter's first case of popliteal aneurysm preserved in Hunterian Museum. (b) Specimen of the fourth patient who died 50 years after the procedure. Note the cord like femoral artery and obliterated aneurysm|
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This modality of treatment was revolutionary at that time and was followed by many surgeons for almost a century until the advent of Rudolph Matas' Endoaneurysmorrhaphy. Even though the procedure described by Hunter is outdated and seldom followed, it was a revolutionary procedure for few reasons. It was the first surgical operation done on the basis of a scientific study. He ligated the SFA away from the aneurysm in a normal healthy portion of the SFA, which was based on his experiments on canine femoral artery which concluded that pathology of aneurysmal disease was in the vessel wall itself and it was focal in nature. Further, he understood the development of collateral circulation as already mentioned, so he placed the ligatures high up so as not to disturb the valuable collaterals. These concepts, though appear to be simple now, were never thought of during that time period, and Hunter is credited with understanding the pathology of the disease on scientific basis and treating them accordingly.
John Hunter introduced a new approach to modern surgery – to start with, a proper understanding of the Anatomy and Physiology, then study the symptoms of the disease in the living person and analyze the effect of the disease on postmortem findings of those who died of it, then formulate a new modality of treatment, test it in animal experiments, and finally try the procedure on humans. These principles still remain valid in the current era, and hence, he is considered as the “Father of Scientific Surgery.”
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| References|| |
Chitwood WR Jr. John and William Hunter on aneurysms. Arch Surg 1977;112:829-36.
Perry MO. John Hunter – Triumph and tragedy. J Vasc Surg 1993;17:7-14.
Schechter DC, Bergan JJ. Popliteal aneurysm: A celebration of the bicentennial of John Hunter's operation. Ann Vasc Surg 1986;1:118-26.
Murley R. John Hunter, velvet and vascular surgery. Ann R Coll Surg Engl 1984;66:214-8.
Friedman SG. History of Vascular Surgery. Mount Kisco: Futura Publishing Co., Inc.; 1989.
[Figure 1], [Figure 2]