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February 19, 2017
18th Century John Hunter

John Hunter (1728-1793)

A treatise on the blood, inflammation, and gun-shot wounds. London, G. Nicol, 1794

A treatise on the blood, inflammation, and gun-shot wounds. London, E. Cox, 1812

John Hunter
Portrait of John Hunter
Portrait of John Hunter
Cesalpino Andrea Cesalpino Andrea

John Hunter was a British surgeon and anatomist and is regarded as one of the most distinguished physicians of the 18th century.  John Hunter had a great interest in comparative anatomy and pathology. He believed in clinico-pathological correlation and performed many autopsy examinations.

His first work entitled, "The natural history of the human teeth," was published in 1771. Hunter studied venereal diseases extensively and published his monograph, "On venereal disease,"  in 1786.

Hunter made significant amount of observations and experimentation on the physiology of cardiovascular system, wound injuries, healing and inflammation and on gunshot wounds. His writings were collected in "A treatise on the blood, inflammation, and gun-shot wounds"  which appeared in 1794, one year after his death. This authoritative work is divided into 4 sections:

1) Study of the blood and coagulation, and the structure and function of the cardiovascular system

2) Wound injuries and healing, and fundamental principles of inflammation, suppuration and granulation

3) Treatment of abscesses

4) Gunshot wounds and their treatment

In the section 1, John Hunter described the anatomy of the heart and the cardiac valves. He explained the complex nature of the atrioventricular valves, and provided the physiologic role of the subvalvular apparatus. He was also the first to report following a series of experimentation that the right-sided valves were less efficient than the left-sided ones. John Hunter pressurized the aorta and the pulmonary artery with fluid. He observed that on the left side, both the aortic and mitral valves remained competent whereas on the right side, the pulmonary and tricuspid valves became regurgitant. The entire text entitled, "Of the heart,"  is displayed here.

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He was also among the first authors to provide a functional description of the aortic valve in systole and diastole. In his text, Hunter wrote:

"...I have above observed, that the area described by the valves is the same with the artery, when that vessel is in its systole, their outer surface lining the inner surface of the artery ; but the artery being elastic, its diameter becomes larger when the blood flows into it ; and the valves being inelastic, their loose margins, or edges, are brought more into straight lines across the area of the mouth of the artery, and nearer to each other, so as to make an equilateral triangle. Thus they are fitted to catch the returning blood ; and the artery re-acting with considerable force on the blood, presses on the valves, so as to push them inwards: these having no pressure on the side next the heart become convex on this side, shutting up entirely the mouth of the artery. Here then is an effect arising naturally out of a variety of causes, viz. the oblique direction of the valves ; their want of elasticity ; the elasticity of the artery ; and the dilatation of the artery ; so that the return of the blood does not open the mouths of the valves, and in that way, shut up, the mouths of the artery."

The entire text entitled, "Valves of arteries," is displayed here. The text was illustrated with two figures.

"Figure I: shews the artery in its systole, with the three valves, nearly close to its sides. The two black dots are designed to represent the mouths of the coronary arteries, now covered by the valves.

Figure II: shews the artery in its diastole, where the three valves run nearly into straight lines, making an equilateral triangle of the area of the aorta, ddd. But as their edges are rounded, and the bodies of the valves make a curve in wards, they by these means fill up in part this triangle space, as is seen at f ; and the corpora-sesamoidea, fill up the other part at e. In this way the whole of the area of the artery is filled up."

Cesalpino Andrea Cesalpino Andrea

Regarding cardiac pathology, he reported a case of bisuspid aortic valve in 1764. His museum also contained several specimens of aortic and mitral valve diseases (mostly aortic valve). He also described cases of congential heart disease such as ventricular septal defect, pulmonary stenosis, and ductus arteriosus. Finally, similar to his other contemporaries, he observed cases of pericarditis, cardiac enlargement and aortic aneurysms.

REFERENCES

Kobler J. The reluctant surgeon. A biography of John Hunter. New York, Doubleday, 1960

Keele KD. John Hunter's contributions to cardiovascular pathology. Ann R Coll Surg Engl 1966;39(4):248-259

Proufit WL. John Hunter: On heart disease. Br Heart J 1986;56:109-114

Skandalakis M, Skandalakis JE. Profiles in cardiology: John Hunter. Clin Cardiol 1992;15:134-135


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Matthew Baillie Antonio Scarpa


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