316
Before our Time
Feb. 13 is the 250th anniversary of the birth of John Hunter (1728-93). Hunter’s outstanding contributions to surgery, anatomy, physiology, and pathology-enshrined, with the fruits of his research in natural history, in the Hunterian Museum of the Royal College of Surgeons of England-founded surgical science and pioneered scientifically based medical education.
TOWARDS A NEW UNDERSTANDING OF JOHN HUNTER W.
J. DEMPSTER
Department of Surgery, Royal Postgraduate Medical School, London W12 OHS
antagonised their contemsympathetically handled by
MEN who in their lifetime
poraries are usually more succeeding generations. John Hunter has not been so favoured despite apparent veneration and biennial orations—on the contrary, the calumny has increased, if anything, since his death. Since 1813, when funds for the Hunterian Orations were set up by Matthew Baillie and Everard Home, information about John Hunter has been passed on mainly by senior members of the Council of the Royal College of Surgeons of England. The rules regulating the Orations stipulated that only senior Council members were eligible to deliver them and the subject of the Orations was restricted to "... the merits in comparative anatomy, physiology, and surgery ...". A reading of the Orations from 1849 will reveal that they are, with few exceptions, repetitious, malicious, and restrictive, at times betraying snobbery and irreverence towards a man who appears more an embarrassment than a figure of respected memory. It is over twenty years since F. Wood Jones1 called for a halt to the prolonged denigration of John Hunter and protested "... to proclaim biennially only his surgical triumphs is to belittle his greatness as a scientific man...". The case against John Hunter rests on three chargeshis lack of social airs and graces, his alleged self-infection with syphilis, and his lack of scholarship. In the Hunterian Society Oration for 1959, Porritt2 said: "Without Anne Home, most certainly the story of John Hunter would have been a very different one. To John Hunter she provided all the answers to the attributes he had not got, and knew by then he could not himself acquire--culture, the arts, the social graces, the ability to mix with people-and the right people ... Anne Home stimulated his hidden humanities ... she proved that there was a soft and vulnerable under-belly to the armadillo". Hunter was 43 years old when he married Anne Home and he had courted her for seven years. In a letter to Jenner dated 18th June, 1773, two years after his marriage, Hunter reveals himself as a kindly man with broad scientific and cultural interests and as an experienced and knowledgeable collector of modern paintings. There is no evidence that Anne Home
was interested in the art of the period; literature was her main interest. The malicious personal remarks about John Hunter can be traced back to the original source of the calumny-Jesse Foot’s Life of John Hunter
(1794).3 Why did the denigration of John Hunter continue for so long? Petty jealousy among his medical contemporaries, continuing into succeeding generations, is one root cause. All his colleagues at St. George’s Hospital actively conspired against him and forty years after Hunter’s death one of their successors, G. G. Babington, as editor of The Surgical Works of John Hunter (1835),4 inserted the footnote (vol. 2, p. 146) "... the author (J.H.) inoculated himself with the matter of gonorrhoea, and the consequence was the production of chancres, followed by bubo, and by secondary symptoms". Yet there appears to be no evidence to support Babington’s claim. The first edition of Hunter’s Treatise on Venereal Diseases appeared in his lifetime in 1786. The experiment later alleged to be self-inflicted is described as follows : "To ascertain several facts relative to the venereal disease, the following experiments were made. They were begun in May 1767. Two punctures were made on the penis with a lancet dipped in venereal matter from a gonorrhoea; one puncture was on the glans, the other on the prepuce ...". There is no indication in the first edition that this experiment was self-inflicted and we know from other sections of the treatise that Hunter was in the habit of performing revolting experiments on his patients which involved scarification of their backs with gonorrhoeal pus. The second edition of Hunter’s Treatise on Venereal Disease edited by his brother-in-law, Sir Everard Home, appeared in 1811 and also contained no comment that the experiment in question was selfinflicted. Babington’s footnote is the basis for the allegation that Hunter’s ill-health and death were caused by cardiac syphilis. In a modern assessment of Hunter’s death, Livesley6 drew attention to the necropsy report which rules out luetic aortitis but would support a diagnosis of hypoperfusion of the coronary arteries; William, Hunter’s brother, died at the same age also of a sudden "stroke". But Babington’s footnote created a myth of Hunter’s foolhardy experiment and his self-martyrdom for science. In 1925 D’Arcy Powerin a particularly malicious Hunterian Oration, concluded: "It never seems to have occurred to Hunter to associate any part of his ill-health with the inoculation experiment of 1767". Hunter’s symptoms, according to D’Arcy Power, were "... caused by cerebral syphilis of the interstitial variety ...". Although D’Arcy Power’s oration was pulr lished in both the Lancet and the British Medicaljour-
nal his diagnosis went unchallenged. In 1942, Guthrie8 continued the myth "... we must accept Sir D’Arcy Power’s point of view that John Hunter suffered from cerebral syphilis as the direct result of a somewhat foolhardy experiment upon himself ". The diagnosis of cerebral syphilis does not fit the curriculum vital of John Hunter for the decade 1783-93. No other cerebral syphilitic has ever maintained such physical and mental prowess until he died. During this decade, Hunter was extremely busy as a surgeon and teacher, as an experimenter on a broad biological sper.trum, as a comparative anatomist, and in the last years as a geologist. The manuscript of Hunter’s treatise on
317 written during 1792-93 was sequestrated by Home and after his death was given to the Everard Sir Royal College of Surgeons in 1839. Its impact, when eventually published in 1859, was lost beside that of The Origin of Species, published in the same year; nevertheless the treatise anticipated by forty years the Uniformitarianism of Lyell’s Principles of Geology (1830-33).
geology9
A self-inflicted injury is often an attempt to draw attention or to avoid distasteful duties. Mutilating the penis is the work of a psychotic with a castration complex. Such. behaviour is inconsistent with what we know of Hunter. Nor are there any witnesses that he had syphilis. In February 1767 he had been elected F.R.S., he was a governor of St. George’s Hospital, and to prepare
himself for a staff appointment was studying for the Diploma of the Corporation of Surgeons. He was courting one of the beauties of London. He was on army halfpay, resident in Golden Square, and was preparing to over his brother’s house in Jermyn Street. He had bought two acres at Earl’s Court and had built a small house there. And yet it is alleged that with the world at his feet, at the age of 39 in May 1767, he inoculated himself with a poison which he knew as well as anyone produced a disease almost impossible to cure and which, according to his own theory, was liable to produce a chancre. This is incredible enough but the idea that he
take
continued-with secondary symptoms, a bubo, a tonsillar ulcer, and smelling of mercury ointment-to court a lady whose father was an army surgeon is beyond belief. HUNTER AND SCIENTIFIC METHOD
History of Civilisation in England, BucklelO concluded that John Hunter fell foul of his contemporaries in London because, being a Scot, he had applied deductive reasoning to his scientific studies at a time when his host countrymen were firmly committed to Baconian induction. The success of Scottish deductive reasoning in the 18th century, as in the works of David Hume, Adam Smith, and the physician William Cullen, was impressive. Hunter argued always from the general principle that two diseases (e.g., syphilis and gonorrhoea) could not simultaneously afflict an individual. Since bacteria had not been discovered he could not know whether the pus from a gonorrhceal patient was infect with spirochxtes or not; hence, whatever the results of his experiments, Hunter could always conclude that one disease had two manifestations. However, in so explaining Hunter’s unpopularity, .Buckle misread the real problem. To the rest of his work Hunter applied inductive logic but he interpreted his studies of fossils, geology ; embryology, and comparative anatomy in terms of the contemporary continental debate on the origin of species. He was publicly doubting holy writ--committing not only heresy but also high treason. And Hunter was not alone. The implications of Hutton’s Theory of the Earthllwere considered by Kirwan, a geologist from Dublin, to be even more dangerous than the political views which had forced Tom Paine to flee the country. The period 1790-1830 bubbled with new ideas centred upon Jacobin atheism which were to shape the future. ,
In his
.After Newton the speculative thinkers in Britain other than Erasmus and Charles Darwin were all ScotsDavid Hume, Adam Smith, and Robert Chambers. Eng-
lishmen were too impressed with the practicality of Newtonian facts and Baconian philosophy-necessary foundations for the scientific methodology of the early 18th century-to bother with speculation. But on the continent, Buffon,12 a practising scientist, in his.Histoire naturelle (1754), set out the methodology of the new science which sought to transcend the mere classification and description of primitive Baconian induction: "... to combine observations, to generalise the facts, to link them together by the force of analogy ... to grasp remote relations between things, to bring them together, and thereby to form a body of reasoned conclusions, after having duly estimated similarities and weighed probabilities". Buffon had spent some time in England absorbing Newton’s ideas and on his return to France translated Newton and studied mathematics and astronomy before concentrating on biology. Fact-finding was moving fast and a new methodology was necessary to give sense and direction to further progress.
library, which
sold at Christie’s in 1794, were 15volumes of Buffon’s Histoire naturelle and The Works of Linnaeus. Clearly he learnt from them. Richard Owen alone appreciated Hunter’s place in the mainstream of European scientific investigation. Alas, Owen and the Council of the Royal College of Surgeons quarrelled and the latter have done nothing over the years to heal the misunderstanding or reconsider Owen’s assessment of John. Hunter as a profound scholar. After 1859 Owen became too absorbed in attacking Darwinism to pay any further attention to Hunter. In Hunter’s
was
Hunter’s experiments and clear thinking brought him into conflict with the conventional contemporary ideas of geology which were based on Genesis. His views are laid out in an essay9-the rejection of the Noachian Flood as a geological agency, the firm proof that fossils were the remains of ancient animals, the clear distinction between fossils and minerals, the distinction between fossils, incrustations, and imprints, a new theory of petrification (which is remarkably similar to that later produced by his former pupil James Parkinson in 1805-1808), the contributions to the earth’s crust by volcanoes, the contribution of animal life to rock formation, the dynamic effects of sea water. The essay is an attempt to provide a total explanation of all the phenomena he had encountered and this approach, characteristic of Hunter, is the main cause of the contemporary hostility towards him. It is well known that Francis Bacon had enormous difficulties with his literary style and clarity of expression--even as a full-time writer. It is unjust that John Hunter should have been so severely criticised for his poor literary style and alleged lack of scholarship in expressing his scientific ideas. If his comprehension was troubled by the grandeur of his conception of natural history, as Buckle seemed to think, he is not alone even today. Richard Owen, the most distinguished anatomist and palaeontologist of 19th century England, had the highest regard for Hunter’s scholarship. He characterised Hunter as a thinker and observer who always strove to ascend from propositions of lesser to those of greater generality-precisely in the spirit of Buffon’s revolutionary and anti-Baconian concept of science. D’Arcy Power,on the other hand, believed that "The limi-
318 tations of
obvious. He was hampered by a defective education ...". It is curious that while many Hunterian Orators, like D’Arcy Power, have reduced Hunter to a cerebral syphilitic with a defective education, all who studied Hunter closely, from William Clift to Sir Arthur Keith and F. Wood Jones, have praised his scholarship. If he was a slow starter, intellectually, he was no different from most of the 18th century intellectual giants. Hunter arrived at a clear and entertaining style of writing on geological subjects in the last years of his life9,13 and if he learnt little Latin at school, by 177114 he could exploit the classics to formulate a classification of human teeth which survives unaltered to this day. The application of Buffon’s methodology placed John Hunter head and shoulders above his contemporaries but made him highly unpopular among his colleagues. His fate illustrates an old historical problem-it is the innovators of new ideas, not the discoverers of new scientific facts, who feel the-wrath of conservative so-
John Hunter
METHODS
are
ciety. REFERENCES 1. Wood Jones, F. Ann. R. Coll. Surg. 1952, 11, 219. 2. Porritt, A. Br. med. J. 1959, i, 582. 3. Foot, J. The Life of John Hunter. London, 1794. 4. Hunter, J. The Surgical Works of John Hunter (edited
by J. F. Palmer). London, 1835. 5. Hunter, J. A Treatise on Venereal Disease. London, 1786. 6. Livesley, B. Med. Hist. 1973, 17, 70. 7. Power, D’A. Lancet, 1925, i, 369. 8. Guthrie, D. Edin. med. J. 49, 119. 9. Hunter, J. Observations and Reflections on Geology. London, 1859. 10. Buckle, H. T. The History of Civilisation in England. New York, 1904. 11. Hutton, J. Theory of the Earth. Edinburgh, 1788. 12. Buffon, G. L. Histoire naturelle. Paris, 1754. 13. Hunter, J. Phil. Trans. R. Soc. 1794, 84, 407. 14. Hunter, J. A Treatise on Teeth. London, 1771.
Public Health RESPIRATORY-CANCER CLUSTERING ASSOCIATED WITH LOCALISED INDUSTRIAL AIR POLLUTION
The death certificates of town V for 1968-74 were reviewed for deaths attributed to primary respiratory cancer (I.C.D. 8th revision, numbers 162 and 163). Age, sex, occupation, and place of residence were noted from the death certificates. These details and the diagnosis were then checked by inspection of the hospital case-notes of the deceased and by consultation with the family doctors. Smoking histories were also ascertained from these two sources. In the examination of geographical clustering of these deaths most of town V was subdivided into six areas (fig. 1), each composed of’ three consecutive enumeration districts of the 1971 census. The mortality-rates per 1000 population for these six areas were derived as follows: numerators were the numbers of deaths from respiratory cancer during 1968-74 in each area; denominators were the populations of the areas at the 1971 census. The addresses of inhabitants of town V who died from respiratory cancer between 1961 and 1967 were also obtained from the death certificates. An air-sampling machine was installed near the town’s geographical centre, the crossroads (fig. 1). Daily and monthly concentrations of "smoke" and sulphur dioxide in the air there were recorded from May to December, 1976. The monthly values for these pollutants were compared with those from four similar communities in nearby towns (W,X,Y and Z). The contribution to the town’s air pollution of metallic dusts from a local steel foundry was investigated. Nylon-mesh bags containing Sphagnum moss’ were exposed to the ambient air in nine different sites in the town. Several bags were placed near the foundry, the town’s major factory. Most of the bags were placed horizontally, for the non-directionally determined accumulation of pollutants; for the horizontal bags, the bag at site lc on the town’s periphery acted as control. At some sites, bags were also placed vertically and facing the foundry; at site 5, a second bag (5c) was positioned vertically but with its "face" away from the foundry, as a control; as a subsidiary control, another vertical bag was exposed near the centre of an adjacent town site "n". The amounts of iron, manganese, nickel, lead, and cadmium from airborne metallic dusts adsorbed by these moss bags during 29 consecutive days early in 1977 were measured by atomic absorption spectrophotometry, the analysis being performed "blind". The values of the metals were expressed as ratios of their concentrations at the control sites-i.e., at site lc for the horizontal bags and site Sc for the vertical bags. ,
RESULTS
O. LL. LLOYD
Department of Community and Occupational Medicine, Ninewells Medical School, Dundee DD1 9SY
Between 1968 and 1974 there was a significantly large number of deaths from cancer respiratory among members of a Scottish comnear and downwind from a steel foundry. munity living The air in that area was polluted by metallic particles from the foundry.
Summary
INTRODUCTION
RESPIRATORY cancer has been associated causally with tobacco smoking and with air pollution.1,2 Occupational causes include exposure to industrial dusts, such as asbestos, nickel, chrome, and probably ferric oxide.3 Such occupational agents of respiratory cancer have been shown to reach beyond the perimeters of factories into the surrounding areas.4-6 In this study mortality from respiratory cancer in a Scottish town (town V) was investigated.
In town V between 1968 and 1974, 53 deaths were on the death certificates as being due to primary respiratory cancer. For 49 of these deaths, the
recorded
was supported by information from hospital records. Most of the deceased had resided in town V for decades--often in the same house. Of the 53 deceased, 9 (17%) were women. The equivalent percentage for the whole of Scotland in 1971 was 19%. The age-distribution of the deceased males also followed the national pattern: age 45-54 :1(2%); age 55-64 : 11 (25%); age 65-74 : 23 (52%); age 75-84 : 9 (21%); age 85 + : 0. The deceased were occupationally heterogeneous; no
diagnosis
particular occupational
exposure
claimed
a
large
number of deaths. From what was known of the smoking histories of the deceased, their deaths could not be attributed solely to tobacco: nearly a third of the men had been either nonsmokers or "occasional" smokers (i.e., light or moderate pipe-smokers, or less than 5 cigarettes daily), in almost equal numbers.
Before our Time
Feb. 13 is the 250th anniversary of the birth of John Hunter (1728-93). Hunter’s outstanding contributions to surgery, anatomy, physiology, and pathology-enshrined, with the fruits of his research in natural history, in the Hunterian Museum of the Royal College of Surgeons of England-founded surgical science and pioneered scientifically based medical education.
TOWARDS A NEW UNDERSTANDING OF JOHN HUNTER W.
J. DEMPSTER
Department of Surgery, Royal Postgraduate Medical School, London W12 OHS
antagonised their contemsympathetically handled by
MEN who in their lifetime
poraries are usually more succeeding generations. John Hunter has not been so favoured despite apparent veneration and biennial orations—on the contrary, the calumny has increased, if anything, since his death. Since 1813, when funds for the Hunterian Orations were set up by Matthew Baillie and Everard Home, information about John Hunter has been passed on mainly by senior members of the Council of the Royal College of Surgeons of England. The rules regulating the Orations stipulated that only senior Council members were eligible to deliver them and the subject of the Orations was restricted to "... the merits in comparative anatomy, physiology, and surgery ...". A reading of the Orations from 1849 will reveal that they are, with few exceptions, repetitious, malicious, and restrictive, at times betraying snobbery and irreverence towards a man who appears more an embarrassment than a figure of respected memory. It is over twenty years since F. Wood Jones1 called for a halt to the prolonged denigration of John Hunter and protested "... to proclaim biennially only his surgical triumphs is to belittle his greatness as a scientific man...". The case against John Hunter rests on three chargeshis lack of social airs and graces, his alleged self-infection with syphilis, and his lack of scholarship. In the Hunterian Society Oration for 1959, Porritt2 said: "Without Anne Home, most certainly the story of John Hunter would have been a very different one. To John Hunter she provided all the answers to the attributes he had not got, and knew by then he could not himself acquire--culture, the arts, the social graces, the ability to mix with people-and the right people ... Anne Home stimulated his hidden humanities ... she proved that there was a soft and vulnerable under-belly to the armadillo". Hunter was 43 years old when he married Anne Home and he had courted her for seven years. In a letter to Jenner dated 18th June, 1773, two years after his marriage, Hunter reveals himself as a kindly man with broad scientific and cultural interests and as an experienced and knowledgeable collector of modern paintings. There is no evidence that Anne Home
was interested in the art of the period; literature was her main interest. The malicious personal remarks about John Hunter can be traced back to the original source of the calumny-Jesse Foot’s Life of John Hunter
(1794).3 Why did the denigration of John Hunter continue for so long? Petty jealousy among his medical contemporaries, continuing into succeeding generations, is one root cause. All his colleagues at St. George’s Hospital actively conspired against him and forty years after Hunter’s death one of their successors, G. G. Babington, as editor of The Surgical Works of John Hunter (1835),4 inserted the footnote (vol. 2, p. 146) "... the author (J.H.) inoculated himself with the matter of gonorrhoea, and the consequence was the production of chancres, followed by bubo, and by secondary symptoms". Yet there appears to be no evidence to support Babington’s claim. The first edition of Hunter’s Treatise on Venereal Diseases appeared in his lifetime in 1786. The experiment later alleged to be self-inflicted is described as follows : "To ascertain several facts relative to the venereal disease, the following experiments were made. They were begun in May 1767. Two punctures were made on the penis with a lancet dipped in venereal matter from a gonorrhoea; one puncture was on the glans, the other on the prepuce ...". There is no indication in the first edition that this experiment was self-inflicted and we know from other sections of the treatise that Hunter was in the habit of performing revolting experiments on his patients which involved scarification of their backs with gonorrhoeal pus. The second edition of Hunter’s Treatise on Venereal Disease edited by his brother-in-law, Sir Everard Home, appeared in 1811 and also contained no comment that the experiment in question was selfinflicted. Babington’s footnote is the basis for the allegation that Hunter’s ill-health and death were caused by cardiac syphilis. In a modern assessment of Hunter’s death, Livesley6 drew attention to the necropsy report which rules out luetic aortitis but would support a diagnosis of hypoperfusion of the coronary arteries; William, Hunter’s brother, died at the same age also of a sudden "stroke". But Babington’s footnote created a myth of Hunter’s foolhardy experiment and his self-martyrdom for science. In 1925 D’Arcy Powerin a particularly malicious Hunterian Oration, concluded: "It never seems to have occurred to Hunter to associate any part of his ill-health with the inoculation experiment of 1767". Hunter’s symptoms, according to D’Arcy Power, were "... caused by cerebral syphilis of the interstitial variety ...". Although D’Arcy Power’s oration was pulr lished in both the Lancet and the British Medicaljour-
nal his diagnosis went unchallenged. In 1942, Guthrie8 continued the myth "... we must accept Sir D’Arcy Power’s point of view that John Hunter suffered from cerebral syphilis as the direct result of a somewhat foolhardy experiment upon himself ". The diagnosis of cerebral syphilis does not fit the curriculum vital of John Hunter for the decade 1783-93. No other cerebral syphilitic has ever maintained such physical and mental prowess until he died. During this decade, Hunter was extremely busy as a surgeon and teacher, as an experimenter on a broad biological sper.trum, as a comparative anatomist, and in the last years as a geologist. The manuscript of Hunter’s treatise on
317 written during 1792-93 was sequestrated by Home and after his death was given to the Everard Sir Royal College of Surgeons in 1839. Its impact, when eventually published in 1859, was lost beside that of The Origin of Species, published in the same year; nevertheless the treatise anticipated by forty years the Uniformitarianism of Lyell’s Principles of Geology (1830-33).
geology9
A self-inflicted injury is often an attempt to draw attention or to avoid distasteful duties. Mutilating the penis is the work of a psychotic with a castration complex. Such. behaviour is inconsistent with what we know of Hunter. Nor are there any witnesses that he had syphilis. In February 1767 he had been elected F.R.S., he was a governor of St. George’s Hospital, and to prepare
himself for a staff appointment was studying for the Diploma of the Corporation of Surgeons. He was courting one of the beauties of London. He was on army halfpay, resident in Golden Square, and was preparing to over his brother’s house in Jermyn Street. He had bought two acres at Earl’s Court and had built a small house there. And yet it is alleged that with the world at his feet, at the age of 39 in May 1767, he inoculated himself with a poison which he knew as well as anyone produced a disease almost impossible to cure and which, according to his own theory, was liable to produce a chancre. This is incredible enough but the idea that he
take
continued-with secondary symptoms, a bubo, a tonsillar ulcer, and smelling of mercury ointment-to court a lady whose father was an army surgeon is beyond belief. HUNTER AND SCIENTIFIC METHOD
History of Civilisation in England, BucklelO concluded that John Hunter fell foul of his contemporaries in London because, being a Scot, he had applied deductive reasoning to his scientific studies at a time when his host countrymen were firmly committed to Baconian induction. The success of Scottish deductive reasoning in the 18th century, as in the works of David Hume, Adam Smith, and the physician William Cullen, was impressive. Hunter argued always from the general principle that two diseases (e.g., syphilis and gonorrhoea) could not simultaneously afflict an individual. Since bacteria had not been discovered he could not know whether the pus from a gonorrhceal patient was infect with spirochxtes or not; hence, whatever the results of his experiments, Hunter could always conclude that one disease had two manifestations. However, in so explaining Hunter’s unpopularity, .Buckle misread the real problem. To the rest of his work Hunter applied inductive logic but he interpreted his studies of fossils, geology ; embryology, and comparative anatomy in terms of the contemporary continental debate on the origin of species. He was publicly doubting holy writ--committing not only heresy but also high treason. And Hunter was not alone. The implications of Hutton’s Theory of the Earthllwere considered by Kirwan, a geologist from Dublin, to be even more dangerous than the political views which had forced Tom Paine to flee the country. The period 1790-1830 bubbled with new ideas centred upon Jacobin atheism which were to shape the future. ,
In his
.After Newton the speculative thinkers in Britain other than Erasmus and Charles Darwin were all ScotsDavid Hume, Adam Smith, and Robert Chambers. Eng-
lishmen were too impressed with the practicality of Newtonian facts and Baconian philosophy-necessary foundations for the scientific methodology of the early 18th century-to bother with speculation. But on the continent, Buffon,12 a practising scientist, in his.Histoire naturelle (1754), set out the methodology of the new science which sought to transcend the mere classification and description of primitive Baconian induction: "... to combine observations, to generalise the facts, to link them together by the force of analogy ... to grasp remote relations between things, to bring them together, and thereby to form a body of reasoned conclusions, after having duly estimated similarities and weighed probabilities". Buffon had spent some time in England absorbing Newton’s ideas and on his return to France translated Newton and studied mathematics and astronomy before concentrating on biology. Fact-finding was moving fast and a new methodology was necessary to give sense and direction to further progress.
library, which
sold at Christie’s in 1794, were 15volumes of Buffon’s Histoire naturelle and The Works of Linnaeus. Clearly he learnt from them. Richard Owen alone appreciated Hunter’s place in the mainstream of European scientific investigation. Alas, Owen and the Council of the Royal College of Surgeons quarrelled and the latter have done nothing over the years to heal the misunderstanding or reconsider Owen’s assessment of John. Hunter as a profound scholar. After 1859 Owen became too absorbed in attacking Darwinism to pay any further attention to Hunter. In Hunter’s
was
Hunter’s experiments and clear thinking brought him into conflict with the conventional contemporary ideas of geology which were based on Genesis. His views are laid out in an essay9-the rejection of the Noachian Flood as a geological agency, the firm proof that fossils were the remains of ancient animals, the clear distinction between fossils and minerals, the distinction between fossils, incrustations, and imprints, a new theory of petrification (which is remarkably similar to that later produced by his former pupil James Parkinson in 1805-1808), the contributions to the earth’s crust by volcanoes, the contribution of animal life to rock formation, the dynamic effects of sea water. The essay is an attempt to provide a total explanation of all the phenomena he had encountered and this approach, characteristic of Hunter, is the main cause of the contemporary hostility towards him. It is well known that Francis Bacon had enormous difficulties with his literary style and clarity of expression--even as a full-time writer. It is unjust that John Hunter should have been so severely criticised for his poor literary style and alleged lack of scholarship in expressing his scientific ideas. If his comprehension was troubled by the grandeur of his conception of natural history, as Buckle seemed to think, he is not alone even today. Richard Owen, the most distinguished anatomist and palaeontologist of 19th century England, had the highest regard for Hunter’s scholarship. He characterised Hunter as a thinker and observer who always strove to ascend from propositions of lesser to those of greater generality-precisely in the spirit of Buffon’s revolutionary and anti-Baconian concept of science. D’Arcy Power,on the other hand, believed that "The limi-
318 tations of
obvious. He was hampered by a defective education ...". It is curious that while many Hunterian Orators, like D’Arcy Power, have reduced Hunter to a cerebral syphilitic with a defective education, all who studied Hunter closely, from William Clift to Sir Arthur Keith and F. Wood Jones, have praised his scholarship. If he was a slow starter, intellectually, he was no different from most of the 18th century intellectual giants. Hunter arrived at a clear and entertaining style of writing on geological subjects in the last years of his life9,13 and if he learnt little Latin at school, by 177114 he could exploit the classics to formulate a classification of human teeth which survives unaltered to this day. The application of Buffon’s methodology placed John Hunter head and shoulders above his contemporaries but made him highly unpopular among his colleagues. His fate illustrates an old historical problem-it is the innovators of new ideas, not the discoverers of new scientific facts, who feel the-wrath of conservative so-
John Hunter
METHODS
are
ciety. REFERENCES 1. Wood Jones, F. Ann. R. Coll. Surg. 1952, 11, 219. 2. Porritt, A. Br. med. J. 1959, i, 582. 3. Foot, J. The Life of John Hunter. London, 1794. 4. Hunter, J. The Surgical Works of John Hunter (edited
by J. F. Palmer). London, 1835. 5. Hunter, J. A Treatise on Venereal Disease. London, 1786. 6. Livesley, B. Med. Hist. 1973, 17, 70. 7. Power, D’A. Lancet, 1925, i, 369. 8. Guthrie, D. Edin. med. J. 49, 119. 9. Hunter, J. Observations and Reflections on Geology. London, 1859. 10. Buckle, H. T. The History of Civilisation in England. New York, 1904. 11. Hutton, J. Theory of the Earth. Edinburgh, 1788. 12. Buffon, G. L. Histoire naturelle. Paris, 1754. 13. Hunter, J. Phil. Trans. R. Soc. 1794, 84, 407. 14. Hunter, J. A Treatise on Teeth. London, 1771.
Public Health RESPIRATORY-CANCER CLUSTERING ASSOCIATED WITH LOCALISED INDUSTRIAL AIR POLLUTION
The death certificates of town V for 1968-74 were reviewed for deaths attributed to primary respiratory cancer (I.C.D. 8th revision, numbers 162 and 163). Age, sex, occupation, and place of residence were noted from the death certificates. These details and the diagnosis were then checked by inspection of the hospital case-notes of the deceased and by consultation with the family doctors. Smoking histories were also ascertained from these two sources. In the examination of geographical clustering of these deaths most of town V was subdivided into six areas (fig. 1), each composed of’ three consecutive enumeration districts of the 1971 census. The mortality-rates per 1000 population for these six areas were derived as follows: numerators were the numbers of deaths from respiratory cancer during 1968-74 in each area; denominators were the populations of the areas at the 1971 census. The addresses of inhabitants of town V who died from respiratory cancer between 1961 and 1967 were also obtained from the death certificates. An air-sampling machine was installed near the town’s geographical centre, the crossroads (fig. 1). Daily and monthly concentrations of "smoke" and sulphur dioxide in the air there were recorded from May to December, 1976. The monthly values for these pollutants were compared with those from four similar communities in nearby towns (W,X,Y and Z). The contribution to the town’s air pollution of metallic dusts from a local steel foundry was investigated. Nylon-mesh bags containing Sphagnum moss’ were exposed to the ambient air in nine different sites in the town. Several bags were placed near the foundry, the town’s major factory. Most of the bags were placed horizontally, for the non-directionally determined accumulation of pollutants; for the horizontal bags, the bag at site lc on the town’s periphery acted as control. At some sites, bags were also placed vertically and facing the foundry; at site 5, a second bag (5c) was positioned vertically but with its "face" away from the foundry, as a control; as a subsidiary control, another vertical bag was exposed near the centre of an adjacent town site "n". The amounts of iron, manganese, nickel, lead, and cadmium from airborne metallic dusts adsorbed by these moss bags during 29 consecutive days early in 1977 were measured by atomic absorption spectrophotometry, the analysis being performed "blind". The values of the metals were expressed as ratios of their concentrations at the control sites-i.e., at site lc for the horizontal bags and site Sc for the vertical bags. ,
RESULTS
O. LL. LLOYD
Department of Community and Occupational Medicine, Ninewells Medical School, Dundee DD1 9SY
Between 1968 and 1974 there was a significantly large number of deaths from cancer respiratory among members of a Scottish comnear and downwind from a steel foundry. munity living The air in that area was polluted by metallic particles from the foundry.
Summary
INTRODUCTION
RESPIRATORY cancer has been associated causally with tobacco smoking and with air pollution.1,2 Occupational causes include exposure to industrial dusts, such as asbestos, nickel, chrome, and probably ferric oxide.3 Such occupational agents of respiratory cancer have been shown to reach beyond the perimeters of factories into the surrounding areas.4-6 In this study mortality from respiratory cancer in a Scottish town (town V) was investigated.
In town V between 1968 and 1974, 53 deaths were on the death certificates as being due to primary respiratory cancer. For 49 of these deaths, the
recorded
was supported by information from hospital records. Most of the deceased had resided in town V for decades--often in the same house. Of the 53 deceased, 9 (17%) were women. The equivalent percentage for the whole of Scotland in 1971 was 19%. The age-distribution of the deceased males also followed the national pattern: age 45-54 :1(2%); age 55-64 : 11 (25%); age 65-74 : 23 (52%); age 75-84 : 9 (21%); age 85 + : 0. The deceased were occupationally heterogeneous; no
diagnosis
particular occupational
exposure
claimed
a
large
number of deaths. From what was known of the smoking histories of the deceased, their deaths could not be attributed solely to tobacco: nearly a third of the men had been either nonsmokers or "occasional" smokers (i.e., light or moderate pipe-smokers, or less than 5 cigarettes daily), in almost equal numbers.
