Blood, Body Snatching, and the Birth of Modern Surgery: The Knife Man

CHAPTER 1 The Coach Driver’s Knee St. George’s Hospital, Hyde Park Corner, London December 1785 The patient faced an agonizing choice. Above the cries and moans of fel­low sufferers on the fetid ward, he listened as the surgeon outlined the dilemma. If the large swelling at the back of his knee was left to continue growing, it would soon burst, leading to certain and painful death. If, on the other hand, the leg was amputated above the knee, there was a slim chance he would survive the crude operation–provided he did not die of shock on the operating table, or bleed to death soon after, or succumb to infection on the filthy ward days later–but he would be permanently dis­abled. For the forty-five-year-old hackney coach driver, both options were un­thinkable. Since he had first noticed the swelling in the hollow behind his knee three years ago, the lump had grown steadily, until it was the size of an orange.(1) It throbbed continuously and was now so painful, he could barely walk. Extended on the hospital bed before him, his leg and foot were hideously swollen, while his skin had turned an unsightly mottled brown. Once the coachman had gained admittance to St. George’s, having per­suaded the governors he was a deserving recipient of their charity, the sur­geon on duty had lost no time in making a diagnosis. He had seen popliteal aneurysms at exactly the same spot on numerous occasions and knew the prognosis all too well. It was a common-enough problem in the cabdriver’s line of work. Aneurysms could happen to anyone, anywhere in the body, but they ap­peared to occur with particular frequency among coach drivers, and others in equestrian occupations in Georgian London, in the popliteal artery be­hind the knee. The condition, in which a section of artery that has been in­jured or otherwise weakened begins to bulge to form a blood-filled sac, may well have been triggered by the wearing of high leather riding boots, which rubbed the back of the knee.(2) As the aneurysm swelled, it not only became extremely painful but made walking exceedingly difficult. Whatever the cause, the outcome was often an early death–if not from the condition it­self, then from the treatment generally meted out. To lose his leg, even sup­posing the coach driver survived such a drastic procedure in an era long before anesthesia or antiseptics, would mean never being able to work again. But to carry on working, navigating his horse-drawn carriage over London’s rutted and congested roads, would be equally impossible if the lump was left to grow. Either way, the cabbie feared destitution and the workhouse. But there was a third choice, the surgeon at his bedside now confided on that early December day, for a coachman sufficiently willing or desper­ate. In his slow Scottish lilt, redolent of his humble farming origins, the surgeon laid out his scheme for a daring new operation. Surrounded by the poxed, maimed, and diseased bodies of London’ s poorest wretches, hud­dled in their beds on the drafty ward, the cabbie resolved to put his life in the hands of John Hunter. Without a doubt, John Hunter’s reputation was well known to the coach driver long before he limped through the portal of St. George’s, for he was generally acknowledged as one of the best-skilled surgeons in London, if not Europe, and was a favorite among the well-heeled and the unshod alike. As well as working for no recompense patching up the poor in St. George’s, he was in constant demand from the fee-paying patients who thronged each morning to his fashionable home in Leicester Square or called him out for consultations in the elegant drawing rooms of their West End villas. For all his blunt manners, coarse speech, and disdain for fashion–he currently sported an unkempt beard and tied his tawny-colored hair behind his head in preference to wearing the customary wig– Hunter was firmly established in Georgian high society. He visited court as surgeon extraordinary to George III, dined with the society artist Sir Joshua Reynolds, and debated science with his close friend, the well-connected naturalist Sir Joseph Banks. Now aged fifty-seven, with seventeen years’ service at St. George’s un­der his belt, Hunter was renowned for his pioneering and controversial op­erations. Only two months before the coach driver’s admission, he had skillfully cut away from the neck of a thirty-seven-year-old man a massive benign tumor weighing more than eight pounds and roughly the size of an extra head. The relieved patient had walked away with only a long, neat scar as souvenir of his ordeal.(3) Hunter was popular with the medical stu­dents, too. The coachman had watched the eager pupils trooping devotedly after their teacher on his ward rounds, for more students flocked to Hunter’s side than to all the other surgeons at St. George’s put together.(4) Aspiring young surgeons traveled not only from the far reaches of the British Isles but even from across the Atlantic to “walk the wards” at Hunter’s side and hear their hero expound on his radical views in the pri­vate lectures he held at his home each winter. But the cabbie would have heard darker stories, too, whispered on the wards, insinuated in newspapers, and muttered in coffeehouses and cockpits, for Hunter was as much feared and despised as admired in eighteenth-century London. Although his pupils idolized their master, and patients often had cause to thank the bluff but honest surgeon, Hunter’s fiery temper and maverick views had earned him powerful enemies within the four walls of St. George’s, and beyond. While aristocrats bowed to his medical advice, and denizens of the Royal Society–the engine room of eighteenth-century progress–hung on his every pronouncement, Hunter was isolated at St. George’s. To his fellow surgeons, he was at best a laugh­ingstock and at worst a reckless fool. And he had quarreled, too, with sev­eral of the city’s other leading practitioners, not least his own elder brother. To the students, the explanation for this was straightforward: Hunter was simply so far ahead of his contemporaries that he stood alone. But his rivals at St. George’s had other opinions. They decried Hunter’s novel approach and controversial methods, preferring to bleed, blister, and purge their patients to early graves–in strict accordance with classical teaching–than to question conventional modes of practice. They even en­couraged Hunter’s most vociferous enemy, a mediocre house surgeon named Jessé Foot, who worked in a neighboring hospital, and whom Hunter had upset by criticizing a surgical appliance the young upstart had invented. In Foot’s jaundiced view, Hunter was “a very inferior, dangerous, and irregular practical surgeon” who was embroiled in “continual war” at St. George’s.(5) But there were stranger stories still about the rebellious surgeon. Hunter was known to keep rare and exotic wild beasts–including a lion, a jackal, a dingo, and two leopards–at his country home in the tranquil vil­lage of Earls Court, a few miles west of London. In this rural retreat, the surgeon performed countless experiments on animals both dead and alive. Innumerable research papers, presented to his friends in the Royal Society, detailed his bizarre trials, such as grafting a cockerel’s testicle into the belly of a hen–an early step toward transplanting body parts in humans–as well as the freezing of fish and rabbits’ ears in a forlorn attempt to invent a scheme for human immortality. At this prototype research center, Hunter dissected great carcasses, including whales washed up on the banks of the Thames, apes sent back from explorations into unmapped territories, and elephants donated by Queen Charlotte. It was here, too, that he experi­mented on living animals, tying down squealing pigs, sheep, and dogs for lengthy dissections in order to explore how healthy organs function and to test ways to improve surgery. Although by now they had become inured to the sight of rare beasts grazing the lawns, Hunter’s curious neighbors still gaped on occasions when the surgeon set out from Earls Court driving a cart pulled by three Asian buffalo, headed for the West End. Arriving at his Leicester Square town house, a drawbridge could be swiftly lowered– and just as swiftly raised–to allow mysterious cargoes to trundle in and out.(6) The enterprising surgeon did not confine his zeal for research to the animal kingdom, however, for Hunter had built up his surgical expertise through an unrivaled knowledge of human anatomy. Since arriving in London almost four decades earlier, Hunter had dissected human bodies in unprecedented numbers. By his own admission, he had carved up “some thousands” during his lengthy career.(7) It was through this relentless first­hand exploration of the human body, rather than by reading the works of the ancient Greeks and Romans or passively watching over the shoulders of other practitioners, that Hunter had become such a skilled operator. Although other surgeons of the day had become adept at certain proce­dures through trial and error, many operations performed in London’ s char­ity hospitals were still risky gambles, due to ignorance of anatomy and physiology. Whenever Hunter cut, probed, sliced, and sawed, he knew pre­cisely what lay beneath. He possessed a better knowledge than any other surgeon in town of the exact whereabouts, functions, and habits of every organ, muscle, blood vessel, and tissue, healthy or diseased, that he was likely to encounter.