The Foundations of Pathology in The United Kingdom
John Hunter (1728 - 1793) {Figure 1} is regarded as being the 'founding father' of British Pathology. John's elder brother William (1718 - 1783) graduated in Medicine from Glasgow, Scotland in 1750 ; but then moved to London where he established a private medical practice and a private School of Anatomy. Perhaps William's best known medical contribution was his book "The Anatomy of the Pregnant Uterus".
Figure 1
A first edition of this book is housed in the library of the College of Surgeons and Physicians in Glasgow. It has a hard cover, and pages of thick paper. It measures approximately 4 feet x 3 feet (about 122cm x 93cm) so is easy neither to carry nor to read. The Preface in which he dedicates the book "to the King" [Figure 2] is written in the flowery, extravagant language of the time - possibly a little more exaggerated in this instance since William, by then, had become quite wealthy as a result of his being Obstetrician to the Queen, and having his patients come mainly from the nobility and the more affluent section of London society.
Figure 2 left and Figure 3 right
The book was illustrated with drawings of normal and abnormal pregnancies, taken from life-size terracotta models which William had made. [Figures 3&4] Some of these models can be seen in the Museum of the Anatomy Department of the University of Glasgow. William's School of Anatomy in Great Windmill Street in London was so successful that he needed help with the teaching ; hence he invited his young brother John to join him. John had had no previous training, but quickly acquired excellent dissection techniques. After twelve years in London, John joined the British Army as a surgeon where he spent three years, before returning to an appointment as a surgeon at St George's Hospital. He continued his teaching and research in human and comparative anatomy. One of the many topics John Hunter wrote about was inflammation. He must have been one of the earliest "experimental pathologists". The specimen of a rabbit's ears {Figure 5} consists of one which is normal (on the left), and the other which is swollen and red from fluid accumulation and capillary dilatation - ie. inflammation which he produced by freezing the ear.
Figure 4 above and Figure 5 right
The Hunterian Museum of the Royal College of Surgeons of England
During an illness which he recognised as being terminal, John Hunter realised that he had no money, and that after his death his family would face serious financial difficulty, so he instructed the executors of his will to offer to sell his collection of 14,000 specimens of anatomy, pathology, experimental pathology and comparative anatomy to the British Government. This was done, and in spite of being involved in a war with Napoleon at the time, the Government in 1799 agreed to purchase the collection for £15,000 (worth about £300,000 in 2000).
The Government, under Prime Minister William Pitt, donated the collection to an organisation that was about to be formed - The Royal College of Surgeons of England. This organisation grew out of the Company of Surgeons formed in 1745 after a split with the Barber-Surgeons. It was formally inaugurated by Act of Parliament on March 22nd, 1800. The Government stipulated that the College should build an appropriate premises to house the Hunterian Collection. The College did this, but they needed more money from the Government. A total of 57,000 pounds was ultimately given to the College. The building, erected in Lincoln's Inn Fields on the site of the wall of the old city of London, was ready for occupation in 1813. Hence, from the inception of the College, the Hunterian Museum has been the "heart" of its teaching and research activities. {Figures 6&7} On February 14th, 1792, John Hunter on his 64th birthday, the year before he died, appointed William Clift who was celebrating his 17th birthday, as an assistant. This was a most fortunate appointment. Clift (1755 - 1849) spent the rest of his working life to the age of 67 maintaining and cataloguing the collection. When the Government bought the collection in 1799, Clift was appointed first Conservator of the Hunterian Collection.
Figure 6
Figure 7
At that time there were quite a few medical people and naturalists who were making museum collections. These were purchased by the various Museums and by private collectors. Clift and the Board of Trustees enhanced their Museum by the judicious purchase of specimens. John Hunter used alcohol to preserve his specimens. (Some of his Army and Navy pupils sent him specimens preserved in Navy Rum). Some of his specimens he air dried, and then coated them with lacquer. This resulted in the specimens being black - eg. {Figures 11, 22, 23, 24}. He, like William and other anatomists of the era, injected lymphatic vessels with mercury. {Figure 8}.
Figure 8 above and Figure 9 right
His pathological specimens include bladders with hypertrophied walls and trabeculated linings resulting from the effects of benign hypertrophy and hyperplasia of the prostate. Some specimens include the presence of calculi. {Figure 9}. Some show false passages in the urethra from attempts to relieve the urinary obstruction by catheterisation. {Figure 10}. There is an example of bilateral congenital megaloureters {Figure 11}, and another of a hydrocoele. (Both of these patients died with complete urinary obstruction).
Figure 10 above and Figure 11 right
He excised a tumour from behind the angle of the jaw of a 35 year old man. {Figure 13}. This has the macroscopic appearance of a lymph node secondary of a malignant melanoma. Hunter's case history notes indicate that the tumour recurred three years later. The tumour was hit with a stick during a drunken brawl and doubled in size during the next three weeks. Hunter removed the recurrence. Its cut surface showed a similar appearance to that of the original tumour. Histological examination performed about 150 years later confirmed that it was a secondary melanoma. Figure 14 is a specimen of small intestine showing the ulceration of Peyer's patches characteristic of Typhoid Fever.
Figure 13
There is a specimen of an Osteogenic Sarcoma of the lower end of the femur. {Figure 15}. This is a dry specimen of bone prepared by digesting away all the soft tissues.
Figure 14 above and Figure 15 right