Annals of the Royal College of Surgeons of England (I978) vol 6o HUNTERIAN ORATION,

1977

John Hunter and his relevance in

1977

R H Franklin CBE FRCS Past Vice-President, Royal College of Surgeons of England; Honorary Visiting Surgeon, Royal Postgraduate Medical School and Hammersmith Hospital, London

Introduction The life and work of John Hunter have been described and assessed from so, many different viewpoints that it becomes increasingly difficult for successive Hunterian Orators to present new facts to their audience; moreover, many of my predecessors have displayed such great knowledge of the subject that it is with some trepidation that I appear before you today. Progress in surgery often follows small, sometimes barely perceptible advances made by many different individuals, and the importance of these advances may be appreciated only in retrospect. From time to time great characters appear having the capacity of collecting together and marshalling these small advances so that a great surge of progress results. For these reasons it is often of value to review the past-to take stock of people and events which have helped or hindered progress and tol use this knowledge as a guide for the future. It would be tempting to go back to the dawn of history and try to identify some of these figures. In the time at my disposal, however, and bearing in mind the purpose of my Oration, I must reluctantly limit my retrospective study and you will be relieved to hear that I will go back in hisLtory no farther than the age of Pericles.

Hippocratic medicine and the rise of Rome Picture Greece at this time, about 400 Bc, the age of great philosophers, playwrights, and the arts. The age which produced Socrates, Plato, and Euripides also saw the birth of the famous Hippocratic School of medicine. Of the writings attributed to Hippocrates his treatise on fractures and dislocations deserves particular notice and the management which he recommended would be largely acceptable to a modern orthopaedic surgeon. His conception of the duties Delixercd on 17th February 1977

and status of the physician as being 'equally free from the mysticism of a priesthood and the vulgar pretensions of a mercenary craft' would merit attention today. Hippocratic medicine recognised that the course of disease follows natural laws and it placed great emphasis on the importance of accurate observation. In spite of the fact that human dissection was not acceptable at this time, superficial anatomy was displayed with the most remarkable accuracy, as is seen in the work of some of the great contemporary sculptors. During the next I 00 years the conquests of Alexander led to the spread of Greek medicine and the setting up of various learned centres, the most illustrious of which was the School of Alexandria, founded about 300 BC. Here there was no restriction on dissecting the human body and anatomy took a great step forward. When Greece was made a Roman province many Greek doctors emigrated to Rome and practised there, and in fact the profession was largely in their hands. Celsus, living in the first century AD, recorded the contemporary medical scene and the development of medical knowledge up to his time. He was a Roman patrician who studied medicine as a branch of general knowledge and it is said that he practised on his friends and dependants but not as a remunerative profession. I have time to make only a scant reference to Galen, who was born in AD I 70, although he was the most celebrated medical writer of his time and is said to have written nearly 500 treatises on various subjects. I must pause briefly in my flight over the years to mention Paulus of Aegina, who lived in AD 650, because he wrote a treatise of seven books, of which the sixth is devoted to operative surgery.

The barren period Progress in medicine was halted for a very long time by a series of great upheavals. Commenting on the 'influx into the Roman Empire of wave after wave of Teutonic barbarism' H A 1, Fisher writes, 'In the tragical eclipse of lay education and culture the intellectual advantages of the church became for the first time conspicuous', and from the 5th to the I oth century medical knowledge in Europe was saved from extinction by the monasteries, particularly the Benedictines. The School of Salerno had become famous by the I oth century, basing its teaching on

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that of Hippocrates, Galen, and later writers. Incidentally, one of the patients who attended Salerno was William the Conqueror. During these years medicine remained in the hands of the priests because they alone were able to read the Greek and Roman authors. They confined themselves to medicine because the practice of surgery by the clergy had been forbidden by the Council of Tours in II63. To quote Abernethy, who delivered this Oration in I8I9, 'They became intimate with the barbers, because the latter were frequently employed to shave the heads of the priests, according to the uniform of their order. The priests also frequently employed the barbers to shave the heads of patients, before they prescribed washes to cool the fever of the brain, or blisters to draw the peccant humours from the surface. Finding these fellows handy with edge tools, the priests taught them to bleed and perform such little operations as they were competent to direct, as well as to make salves and poultices and to dress wounds and sores. Such was the origin of barber surgeons'. This attitude of physician to surgeon is met with

only rarely today.

The resumption of the march forward In the I6th century a great character appears in the person of Ambroise Pare (I5Io-9o). He was apprentice to a barber-surgeon in Paris and a pupil at the HOtel Dieu. Like many great surgeons he was a serious student of anatomy and attended the lectures of Sylvius in Paris and became his prosector. He published a book on anatomy in 1550. Pare was a great war surgeon and his contributions in this field included the use of ligatures to control haemorrhage and the abandonment of the use of boiling oil in the treatment of gunshot wounds, while amongst other surgical instruments which he invented was the crow's beak, the forerunner of the modern artery forceps.

John Hunter Taking his place with these surgical giants is our own John Hunter, whose birth we commemorate in this Oration. The portrait of John Hunter which hangs above the President's chair in the Council Room (Fig. i) was painted by Sir Joshua Reynolds in May 1785. Hunter was a reluctant sitter anrd consented to have the painting executed chiefly, it is said, 'to oblige William Sharp, the engraver'. Apparently Sir Joshua made little progress at first, but one day John Hunter fell into one of his deep daydreams; Sir Joshua saw the man he wished to depict and, turning the canvas upside down, he sketched out the portait. The volumes seen in the picture are part of the unpublished

FIG. I John Hunter, by Sir Joshua Reynolds. records of anatomical researches left by Hunter at his death. These, together with other manuscripts, were removed by his brother-in-law, Sir Everard Home, in I 8I2 and were eventually burnt. It has been supposed that Sir Everard carried out this monstrous act of destruction to keep secret the source of many of his own published papers. Also to be seen in this poTtrait is the lower part of the skeleton of the Irish Giant. The story of John Hunter has been told many times and there are some in this audience whose knowledge of the subject is profound. To others, however, John Hunter is little more than a famous name. I feel, therefore, that it is proper to recount this story yet again, in the hope that it will be of interest to a wide audience such as that recognised by Samuel Cooper, who delivered this Oration in I832

(see Figure 2). We celebrate the birthday of John Hunter on I4th February, and this was the date he himself gave as the anniversary of his birth. He was, however, born on the preceding night and the entry in the parish register states that he was born on I3th February 1728 at Long

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FIG. 2 Dedication of Samuel Cooper's Hunterian Oration, I832. Calderwood in the panish of East Kilbride. His father was descended from the old Ayrshire family of Hunter of Hunterstone and his mother was the daughter of Mr Paul, Treasurer of Glasgow. children. As John was the youngest of a child he was a poor attender at school and spent much of his time studying natural history in the countryside. At the age of I7 he went to Glasgow, where for a short time he assisted his brother-in-law, Mr Buchanan, who owned a timber yard assocated with which were furniture and cabinet makers. io

THE MOVE TO LONDON In I748 a great change

in his

life

took place

to London to join his brother had by then built up the most William, who celebrated school of anatomy in London. Much

and he

came

has been made of John Hunter's lack of formal education, but the impression that has so-metimes been given that he was uncouth and almost illiterate is belied by the fact that he was able to contribute very quickly to the skilled work in the anatomy school. William had become a member of the Company of Surgeons in I 747, but was concentrating more and more on obstetrics and in 1748 was appointed surgeon-accoucheur at the Middlesex Hospital. Sampson Handley, in his Oration of I939, had great prophetic foresight when he said, 'It is a tribute to the broad-mindedness of my countrymen that John Hunter, the presiding genius of this College of Surgeons of England, was not an Englshman. Nothing, unless it be the Crown itself, could better illustrate the unity of this island of Great Britain as the beneficent exchanges between its northem and southern parts which have followed the Act of Unimo of 1707, exchanges which gave the Hunters to England and Lister for a time and at a later period to Scotland'. Those who contemplate disrupting this unity should reflect on the possible loss of these beneficent exchanges. In 1745 the Barber-Surgeons separated after having been united for over 200 years. Each was reconstituted separately, but there was some delay before Surgeons Hall was completed near the Old Bailey, next to Newgate Prison. This delay caused relaxation of the regulations concerning dissections and so favoured William Hunter's private school of anatomy. In the London Evening Post of i6th September I746 an advertsement appeared: 'On Monday, the i3th October at 5 in the evening, will begin a course of anatomical lectures to which will be added the operations of surgery with the application of bandages, by William Hunter, Surgeon. Gentlemen may have the opportunity of learning the art of dissecting during the whole winter season in the same ma-nner as at Pais'. William Hunter was living with the Douglas family at that time and it is thought that Jolm joined him there, but in the autumn of the following year William took a large house in the north-west corner of the Great Piazza in Covent Garden. Here both brothers lived, the

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lectures and dissections took place, and it was ARMY SERVICE possible to accommodate resident pupils. One These years of overwork in conditions which of these was John Jones of Philadelphia, who were not conducive to good health resulted was one of the founders of the New York in the development of chest symptoms, and Hospital in 177I and wrote the first textbook in I759 John was advised to have a complete of surgery to be published in America-it was rest in the first instance, followed later by a entitled Plain, Concise, Practical Remarks on change of occupation abroad. He took this the Treatment of Wounds and Fractures advice and William Hewson took over his ('775). duties at Covent Garden. After a period of When John first joined his brother he was complete rest he was commissioned on 3oth set the task of dissecting the muscles, of the October 1760 as an army surgeon by Robert arm and then an arm in which the arteries Adair, Inspector General of Hospitals. In the following March he set sail from had been injected. The results very much exceeded William's expectations and this rapid Spithead with the British expedition sent to success raises the possibility of his having al- capture Belle Isle. The next two years saw ready carried out some animal dissections in him serving first in Belle Isle and later in Scotland during the years when he was thought Portugal. Like Ambroise Pare before him he was destined to make great contributions to to be wasting his time on natural history. war surgery and his experiences fonrmed the John was destined to spend some i I years basis of his Treatise on the Blood, Inflammain association with his brother at the school tion and Gun-shot Wounds, which was not of anatomy. In those days the lack of proper published until I794, the year after his death. preservatives and refrigeration restricted dis- Not content with his duties as a military secting to the winter months. During the surgeon, he found time to make observations summer months of I 749 and 1750 John studied and carry out research and collect specimens. under William Cheselden at Chelsea Hospital. After Cheselden's retirement on account of a RETURN TO LONDON stroke John Hunter became a surgeon's pupil When he returned to England in 1763 Hunter at St Bartholomew's Hospital, where Percivail had no hospital appointment and his position Pott was one of the senior surgeons. William his brother's of anatomy had been in supervised John's surgical education assidu- filled. He had hisschool pay of io shillings half army as a him obtained place ously, and in 1754 a London At and he set as up a day surgeon's pupil at St George's Hospital. Two first his income from his practicesurgeon. small was years later he was appointed house surgeon. and he supplemented it by teaching practical He was, of course, canying out a scheme of anatomy and operative surgery. He also had rotating appointments, but this term was not the nucleus of his collection, which numbered known in those days! 200 specimens. He studied comparative anatAn attempt to make good his deficiencies omy and for this purpose obtained dead in the classics was less successful. He was per- animals frorn various sources, including the suaded to enter St Mary's Hall, Oxford, as royal menagerie at the Tower of London. In a gentleman commoner in June 1755, but he 1765 he purchased the leasehold of some land left Oxford after less than two months' at Earl's Court and in the same year took a residence. house in Golden Square. His financial position During the i i years in which John was now began to improve-so much so that in associated with his brother's school of anatomy 1768 he was able to move from Golden Square Street, he enlarged his field of investigations by to the more fashionable 42 Jermyn brother. his been had by occupied which for live animals studying function and using this purpose. Amongst many other things he Finally in 1768 he completed his house at Earl's studied the descent of the testis, the formation Court. The year I769 was a very important one of pus, the placental circulation, and the funcfor John Hunter, for on 7th July he was tion of the lymphatics.

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successful in the examination for the Diploma of the Company of Surgeons, the examination taking place in the theatre of Surgeons Hall. On gth December he was appointed to the staff at St George's Hospital. One hundred and sixty-one Governors attended the Special Court for making this appointment and amongst the distinguished people present were David Garrick and Sir Joshua Reynolds. In the ballot for the post Joihn Hunter obtained 114 votes and David Bayford 42. In I77I he married Anne Home, eldest daughter of Robert Home, surgeon to Burgoyne's regiment of light horse, whom he had met during his army service and by whom he had five children. From 1772 until his death he spent weekends and long periods at his house at Earl's Court and it was here that he carried out most of his experiments and also prepared museum specimens. The Earl's Court house had by now become a research farm and here he kept fish, lizards, blackbirds, hedgehoigs, tame pheasants and partridges, at least one eagle, toads, and silkworms. He observed bees in his conservatory for over 20 years. He studied wasps and hornets. Twice he was in considerable personal danger-once when he was wrestling with his tame bull and on another occasion when two leopards broke loose among his dogs and he took them back to their den. All this seems remarkable when we think of Earl's Court today, but at that time the Earl's Court Road was a country lane running from the Cromwell Road to the Old Brompton Road. John Hunter's land adjoined this lane and his meadow is now occupied by the houses in Barkston Gardens. From now on Hunter carried on an everincreasing surgical practice and taught students with enthusiasm, and yet he found time to carry out experiments and to, add to his museum so that at the time of his death he had amassed no less than I3 6oo specimens. In I783, the lease of his Jermyn Street house having expired, he moved to Leicester Fields, as it was then. He purchased the lease of two houses, the principal one being situated in what is now Leicester Square and the second one backing on to the first in Castle Street. which later became Charing Cross

Road. In the space between the two, hc constructed a museum 52 feet loing by 28 feet wide with a gallery all around. The principal house was where he saw his private patients and was also where his wife held her famous social functions, while the Castle Street house accommodated his pupils. EXPERIMENTS AND WRITINGS

The investigations and experiments which Hunter carried out were so numerous and the field over which they extended so wide that scant justice can be done to them on this occasion. They range from investigation into the organ of hearing in fishes to the communication of smallpox to the fetus in utero and from the production of heat by animals and vegetables to the recovery of people apparently drowned. From this vast storehoiuse of Hunter's research and investigations I would like to mention a few in greater detail. His interest in the structure and development of the teeth is said by his detractors to have started when he returned from his army service in I763, when financial circumstances forced him to co-operate in a dental practice. Hunter himself says that many of his observations were made long before this, in I 754. Whatever the reasons were for his interest in this subject the result was that for the first time a really scientific approach was made to the structure and development of teeth. He resurrected the idea of transplanting teeth and discussed filling cavities with lead or gold and made observations on the origin of dental caries. In I77I the first part of A Treatise on the Natural History of the Human Teeth was published. This was Hunter's first majoir work and played a great part in arousing interest in the subject, and it is of particular interest to this College, where so much outstanding dental research has been carried out in recent years. The second part of Hunter's treatise, concerned with oral pathology, appeared in 1778. He was fascinated by the growth of bone and carried out a number of experiments to find out how and where growth takes place. By inserting lead shots into the tarsus of the domestic fowl when it was young and by killing it later on he showed that although

John Hunter and his relevance in 1977 the bone had increased in length, the distance between the shots was exactly the same as when first introduced. Further investigations were made by feeding the common hog on the root of madder. The properties of madder had been noticed in I736 by a young surgeon, John Belchier, a pupil of William Cheselden. Apparently Belchier was dining with a friend, a calico dyer. The main dish was pork and Belchier noticed that the bones were of a pinkish colour. On enquiring into the cause of this he was told that madder was used in the dying pirocess together with bran. The bran being quite wholesome, the thrifty merchant fed it to his pigs. Du Hamel used this method and showed in I739 that bone grew by layers; he considered that the source of the new layers was the periosteum. Hunter started his experiments on feeding his pigs with madder at Earl's Court in 1764. He showed that deposition and absorption of bone proceeded hand in hand. MUSEUM SPECIMENS

I will draw your attention to some of John Hunter's specimens which are highly relevant today and all of which may be seen in our Museum. The specimen of the cardia and part of the stomach of the pig shows the valve-like arrangement which would appear to prevent regurgitation into the oesophagus. The control of oesophageal reflux in the human is still a matter of discussion today. A specimen showing digestion of the stomach after death is described in great detail. I will read part of John Hunter's comments: 'The following account of the stomach being digested after death was drawn up at the desire of the late Sir John Pringle, when he was President of the Royal Society, and the circumstance which led to it was as follows. I had opened in his presence the body of a patient who had been under

his care, in which the stomach was found to be in part dissolved; a thing that appeared to him very unaccountable, there having been no previous symptoms which could have led him to suspect any disease in the stomach. . .' Hunter makes a plea for the further study of postmortem changes and goes on to write, 'Appearances which are in themselves natural may be mistaken for those of disease; we may see diseased parts, and suppose them in a natural state, we may consider a circumstance to have existed before death which was

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really a consequence of it; or we may imagine it to be a natural change after death, when it was in fact a disease of the living body. It is easy to see, therefore, how a man in this state of ignorance must blunder when he comes to connect the appearances in a dead body with the symptoms that were observed in life, and indeed, all the advantage to be derived from opening dead bodies depends upon the judgement and sagacity with which this sort of comparison is made.'

A specimen of the oesophagus and part of the stomach showing no obvious abnormality appears at first sight to be a very dull object. But listen to what John Hunter has to say concerning this specimen, taken from a man called Robertson who 'was bit of a young dog, in the lip' on Wednesday I 8th December I 7 76. 'On Sunday, the i9th of January I777, when from home, he was taken with a sickness in his stomach, and a disagreeable sensation in his throat. The un. easiness in his throat increased, and a considerable difficulty in swallowing fluids. 'This was more than simple difficulty or pain in swallowing; it produced an universal irritation, which flew up to his head, and made him almost mad at the time, and he felt the sensation of his mouth and throat being on fire. 'He could swallow any solid much better than fluids. He could not, or rather durst not swallow his own spittle. They gave him some orange, which melting into a fluid in his mouth, gave him as much pain as water. They gave him sugar-candy and it also by melting in the saliva, gave equal pain in swallowing. 'His mind was in a state of great irritability as also his body universally. 'When he saw anything which had given him those sensations in swallowing, it almost produced immediate madness. 'He accidentally looked out of the window and saw water, he immediately started back, and so quickly as to fall. If a door or window was opened and fresh cold air came in, he immediately felt it and begged they might be shut, the sensation was disagreeable: he disliked the blankets being raised, as the cold air was allowed to come in. Warmth appeared agreeable, he could hardly bear the light, at least it was disagreeable, as also noise. He complained at times of a tightness across the breast. 'He flew into passions, and more readily if anyone desired him to drink. He became very suspicious of everyone around him. 'At times, when nothing disturbed him, he was pretty calm and talked reasonably, knew his situation, but flew into a passion immediately upon the slightest occasions. He was very quick in his answer, talked freely and articulately, appearing to have no difficulty in that action similar to a sore throat.

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'All the above symptoms kept increasing from Sunday, until Thursday following, when he became at times outrageous, both from the increase of the disease, and being teased with people calling, staring, and importuning him to drink. At last an attempt was made to secure him, but they failed, and two men got bit in the hand; however, at about seven o'clock in the evening he was seized and carried to the Infirmary at Marylebone, and strapped down to the bed, and begged to be left alone, as he wished to be quiet. He then complained much of the tightness across his breasts from the straps. 'About nine, some people went to see him and he spoke to them, about seven on the Friday morning he was found dead. 'On the same day, about one o'clock, I opened his fauces, throat and oesophagus and found nothing remarkable or praeternatural. 'The salivary glands and the muscles of these parts were perfectly sound, nor was there anything remarkable in the part that been bitten. 'From all the symptoms, and from nothing appearing diseased after death, this disease would seem entirely nervous. 'It is similar in many effects to nux vomica on

dog.' This description of a case of rabies would surely justify the much derided anecdotal method of clinical presentation. It would certainly make a lasting impression on a medical student and it might even make some impression on those who try to evade our regulations controlling the import of animals -more convincing, perhaps, than the bald statement, 'Rabies is a killer'. A specimen of great historical interest is that of the remains of a popliteal aneurysm, for which Hunter first perforned his operation of proximal ligation at a distance from the sac. The artery was exposed and ligated just below the middle of the thigh in what we now know as 'Hunter's canal'. There is a very detailed account by Hunter of this case. a

'The patient returned to his usual occupation of driving a hackney-coach and being, from the nature of his employment, much exposed to cold, in March 1787 he was seized with a fever of the remittent kind, which carried him off. He had not made any complaint of the limb on which the operation had been performed from the time of his leaving the Hospital. 'He died on the Ist of April 1787, fifteen months after the operation, and leave was procured with some trouble and considerable expense, to examine the limb seven days after death, at which time it was entirely free from putrefaction.'

CONCLUSION

John Hunter's death in I 793, at a. board meeting at St George's Hospital, was dramatic. For some years he had suffered from anginal attacks and he is reputed to have said that 'his life was in the hands of any rascal who choose to annoy him'. On this occasion he was supporting the applications of two young men who wished to be admitted as pupils. Their credentials did not satisfy a committee requirement and it is said that the argument which followed precipitated his fatal heart attack. How did John Hunter manage to carry olut such a vast amount of work in one lifetime? We learn that he rose at or before 6, dissected till 9 (his breakfast hour), received patients from half-past 9 till I2, at least during the latter part of his life, and saw his outdoor and hospital patients till about 4, when he dined, taking, according to Home, as at other meals in the 20 years preceding his death, no wine. After dinner he slept an hour; he then superintended experiments, read or prepared his lectures, and made, usually by means of an amanuensis, records of the day's dissections. William Clift, who entered John Hunter's service only in the last two years of Hunter's life, proved to be a most devoted admirer and was the custodlian of the collection during the seven years which elapsed between Hunter's death and the acceptance of his museum by the Company of Surgeons. He became the first curator. Clift writes, 'I never could understand how Mr Hunter obtained rest, when I left him at midnight, it was with a lamp fresh trimmed for further study, and with the usual appointment to meet him again at six in the morning'. At the peak of his career John Hunter was earning a large income, but it was all swallowed up in the expense of his museum and research establishment. According to Clift, who left careful records of domestic matters, there were never less than 50 people employed by Hunter. John Hunter brought science into surgery and he sought out the truth by experiment and by observation. To this day we exhort our newly admitted Fellows 'to practise the science as well as the art of surgery'. To Jenner, of smallpox fame, who was his first pupil at St

John Hunter and his relevance in 1977 George's Hospital, he gave the often quoted advice 'I think your solution is just; but why think? Why not try the experiment?' Perha,ps of even greater relevance today is another of his axiomns, which is not so well known-'Experiments should not be often repeated, which tend merely to establish a principle already known and admitted, but the next step! should be the application of that principle to useful purpOseS. What has become of the activities which were so dear to the heart of John Hunter? The answer lies all around us. His resident pupils have been remembered and their successors are now housed in the Nuffield College next door. His scientific approach to surgery and his enquiring mind have established a tradition which has flourished in this Royal College; and the evidence for this is for all to see in the research laboratories both here and at Downe. His enthusiasm for teaching has been perpetuated in the lectures and symposia which are held within the College and extended by the network of surgical tutors which embraces the whole country. These activities are backed up by what is probably the finest surgical library in the world. The tools for investigation and the methods of research are now so numerous and so ingenious that they have become bewildering, and it is more important than ever that the student or research worker should have a sound basic knowledge. With this knowledge he can select the machine or method which will lead him forward; without it the machine may take charge and carry him off on futile and expensive excursions. John Hunter would not have scorned the new machines or the opportunities which they

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bring-think how delighted he would have been with the operating microscope, which has made it possible to anastomose minute vessels and to work on such small structures as the ossicles of the ear or the delicate parts of the eye. Microsurgery has indeed given a new dimension to surgery and should be a stimulus to the study of anatomy. Use the new opportunities-not to supplant the work of John Hunter but rather to enhance and continue it. Our Museum is unique in its arrangement; you will find in it not only a treasure trove of pathological specimens but also a collection illustrating the processes directed to the survival of the individual and another illustrating the processes of reproduction aimed at the continuation of the species. In conclusion, Mr President, I would like to say one final word to all students and research workers, young and old. Make use of all the modem machines and methods available to you-but before you rush out to buy your new computer just have a look upstairs in John Hunter's Museum. You will certainly get some very good ideas and you may even find the answer to your particular problem. The preparation of this Oration was made possible and pleasurable by the facilities afforded by the Library and the Museum and I am most grateful

for the help which I received from Mr E H Cornelius, our Librarian, and from Miss Elizabeth Allen, Curator of the Hunterian Collection.

Bibliography Fisher, H A L, A History of Europe. London, Edward Arnold, 1976. Encyclopaedia Britannica, i ith edn. Cambridge, University Press, I9IO. Dobson, Jessie, John Hunter. Edinburgh, Livingstone, I969.

John Hunter and his relevance in 1977.

Annals of the Royal College of Surgeons of England (I978) vol 6o HUNTERIAN ORATION, 1977 John Hunter and his relevance in 1977 R H Franklin CBE FR...
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